Oral Manifestations

Question 1

Causes of ulcers (7)

Answer 1

Haematological disease
Gastrointestinal disease
Autoimmune conditions
Neoplastic conditions
Infective conditions
Metabolic disease
Drugs side effects

Question 2

Presentation types of ulcers (2)

Answer 2

Solitary

Multiple

Question 3

Solitary ulcer causes (2)

Answer 3

Physical or chemical

Exclude trauma

Question 4

Solitary ulcer malignancy description

Answer 4

Oral squamous cell carcinoma

Question 5

Infective solitary ulcer causes (3)

Answer 5

TB
Tertiary syphilis - Gumma
Premalignant lesion

Question 6

Recurrent aphthous ulceration - Multiple ulcers properties (4)

Answer 6

3 types - Major, minor, herpetiform
Patient usually well
Could be stress related
Exclude haematinic deficiency and GI disease

Question 7

Bechet’s - Multiple ulcers

Answer 7

Multisystem condition
hereditary systemic vasculitis
Presents with genital ulceration, uveitis, erythema nodosum

Question 8

Anaemia characteristics (6)

Answer 8

Mucosal pallor
Oral ulceration
Glossitis - Tongue inflammation
Angular stomatitis  - Red swollen patches at mouth corners
Predisposition to candida
Disturbed taste

Question 9

Infective multiple ulcer example and properties

Answer 9

Primary herpetiform gingivo-stomatitis - Inflammation of oral mucosa and gingiva
Initial presentation of herpes simplex infection
Most common viral infection of mouth

Question 10

Mucocutaneous disorders examples (3)

Answer 10

Lupus Erythematosus
Lichen Planus - Itchy, non infectious rash on limbs
Vesiculobullous disease - Pemphigus and Pemphigoid

Question 11

Lichen Planus features (4)

Answer 11

Bilateral
Asymptomatic
Can affect skin
Potentially malignant

Question 12

Lupus Erythematosus presentations (3)

Answer 12

Can be discoid (disc shaped) or systemic
Ulcerations
White with/without red patches

Question 13

Vesiculobullous disease - Pemphigus Vulgaris properties (2)

Answer 13

Oral lesions are first manifestation and precede skin lesion by a year or more
Painful ulcers preceded by blisters

Question 14

Vesiculobullous disease - Pemphigoid presentations (3)

Answer 14

Benign mucous membrane
Blisters and painful ulcers observed
Affects mucous membrane of other organs like eyes

Question 15

GI diseases causing oral manifestations (2)

Answer 15

Crohn’s

Ulcerative Colitis

Question 16

Crohn’s disease oral presentation (6)

Answer 16

Cobble-stoning of mucosa
Localised mucogingivitis
Linear ulceration
Tissue tags/polyps
Diffuse swelling of lips
Pyostomatitis vegetans - Small, superficial yellow pustules

Question 17

Ulcerative Colitis oral presentation (3)

Answer 17

Pyostomatitis vegetans
Angular stomatitis
Exacerbation and remission indicates severity of disease

Question 18

White patches that wipe off are

Answer 18

Pseudomembranous candidiasis/thrush

Question 19

White patches that don’t wipe off are caused by (4)

Answer 19

Trauma
Epithelial dysplasia
Neoplasia
Chronic mucocutaneous candidiasis

Question 20

White patches that don’t wipe off indication

Answer 20

Consider haematinic deficiency or immunosuppression

Question 21

Oral pigmentation causes (5)

Answer 21

Race
Malignancy
Smoking
Melanotic macules - Well-defined, oval, brown to black, flat patch on central third of lower lip
Addison’s disease - Excess ACTH/MSH release and reduced cortisol levels

Question 22

Xerostomia (Dry mouth) causes (3)

Answer 22

Drugs
Sjogren’s syndrome
Radiation therapy

Question 23

Sjogren’s syndrome properties (4)

Answer 23

Dry eyes and mouth
More common in women
Can be primary or secondary
When secondary it is associated with other autoimmune disease

Question 24

Sjogren’s syndrome presentations (5)

Answer 24

Enlarged salivary glands
Increased cavities
Depapillated fissured tongue
Red dry wrinkled mucosa
Increased predisposition to candida

Question 25

Dental erosion indication and causes

Answer 25

Erosion on palatal surfaces of upper anterior teeth | Causes are gastro-oesophageal reflux disease or bulimia

Question 26

Leukaemia oral presentations (7)

Answer 26

``` Petechiae - Tiny purple, red or brown spots on skin Gingival enlargement Mucosal bleeding Ulceration Malignant cell infiltration Boggy gingivae Immuno-compromised presentation - Candida, herpes, opportunistic infection ```

Question 27

Lymphoma presentations (4)

Answer 27

Palpable lymph nodes Extra/intra oral diffuse swellings Ulceration Tooth migration/mobility

Question 28

HIV oral presentations (4)

Answer 28

Ulceration Kaposi’s sarcoma - Purple masses in skin or lymph nodes HPV lesions Salivary gland swelling