Oral Manifestations

Question 1

What is oral ulceration?

Answer 1

Discontinuity in the oral mucosa

can present as a solitary ulcer or multiple ulcers

Question 2

What is the first thing to exclude upon presentation of a solitary ulcer?

Answer 2

physical or chemical trauma

Question 3

What are possible causes of ulcers?

Answer 3

they can be caused by a huge range of conditions as well as infection and as a side effect of drugs

Question 4

Causes of solitary ulcers

Answer 4

trauma
malignancy - oral squamous cell carcinoma
infective - TB - primary or secondary infection of mycobacterium
tuberculosis also tertiary syphilis

Question 5

Causes of multiple mouth ulcers

Answer 5

RAU - Recurrent aphthous ulceration (potentially stress related) 3 types major, minor and herpetiform
Bechets
Anaemia
Mucocutaneous disorders

Question 6

What needs to be ruled out when there are multiple ulcers

Answer 6

haematinic deficiency and GI disease

Question 7

What is Bechets

Answer 7

a multisystem condition
hereditary systemic vasculitis
oral ulcers almost identical to RAU, genital ulceration, uveitis, erythema nodosum

Question 8

What is the oral presentation of anaemia?

Answer 8

Mucosal pallor
Oral ulceration
Glossitis (tongue inflammation)
Angular chelitis (red, swollen patches at the corners of your mouth)
Predisposition to candida (fungal infection)
Disturbed taste

Question 9

Mucocutaneous disorders resulting in mouth ulcers

Answer 9

Lichen Planus
Vesiculobullous disease - Pemphigus and Pemphigoid
Lupus Erythematosus

Question 10

Presentation of lichen planus

Answer 10

bilateral mouth ulcers
asymtomatic
can affect the skin
potentially malignant

Question 11

Presentation of lupus erythematosus

Answer 11

Oral manifestation 
ulceration
White patches
Red and white patches
Similar in appearance to lichen planus
(can be discoid or systemic)

Question 12

Presentation of VB - pephigus vulgaris

Answer 12

• oral lesions often first manifestation

- painful extensive oral ulceration

Question 13

Presentation of VB- pemphigoid

Answer 13

• benign mucous membrane pemphigoid
• painful oral ulceration
• blisters more likely
• affects mucous membranes of other organs

Question 14

What GI diseases cause malabsoption and consequent haematinic deficiency leading to oral manifestation

Answer 14

Crohns
Ulcerative Colitis
Peutz Jegher
Gardeners Syndrome

Question 15

Oral Manifestation of Crohns

Answer 15

- may present before abdominal symptoms 
Cobble-stoning of mucosa
Localised mucogingivitis
Linear ulceration
Tissue tags/polyps
Diffuse swelling – commonly of the lips ( OFG)
Pyostomatitis vegetans

Question 16

Oral manifestations of Ulcerative Colitis

Answer 16

Oral ulceration
Pyostomatitis vegetans
Angular stomatitis
the oral symptoms reflect the severity of the intestinal disease

Question 17

What can white patches indicate

Answer 17

if wipe off - usually pseudomembranous candidasis/ thrush 
if don't wipe off - 
trauma 
epithelial dysplasia 
neoplasia 
chronic mucocutaneous candidasis

Question 18

What are the causes of oral pigmentation?

Answer 18

Racial pigmentation 
Melanotic macules 
malignancy 
smoking 
Addison's Disease - excess ACTH/MSH released from the pituitary in response to reduced corisol levels

Question 19

What can reults in xerostomia?

Answer 19

dry mouth can be a result of
drugs
sjogren’s
radiation therapy

Question 20

What are the oral manifestations of Sjogren syndrome?

Answer 20

Enlarged salivary glands
As a result of dry mouth:
Increased caries
Depapillated tongue, fissured
Red dry wrinkled mucosa
Increased predisposition to candida

Question 21

What is Sjogren’s syndrome?

Answer 21

Dry eyes and dry mouth, commonly affects females - primary or secondary
secondary - associated with autoimmune disease

Question 22

Oral manifestations of leukaemia?

Answer 22

Gingival enlargement (enlarged gums)
Petechiae (purple, red or brown spots)
Mucosal bleeding
Ulceration
Infiltration by malignant cells
Boggy gingiva (gum ulcers)
Presentation due to underlying immuno-compromise:
Candida
Herpes infection
Opportunistic infection

Question 23

What are the oral manifestations of lymphoma?

Answer 23

Palpable lymphnodes
Extra/intraoral diffuse swellings
Ulceration
Tooth migration/mobility

Question 24

What are the oral manifestations of HIV?

Answer 24

Ulceration
Kaposi’s sarcoma
HPV lesions
Salivary gland swelling
As a result of immunosuppression
Increased risk of malignancy