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Module 6 > Oral Med > Flashcards

Oral Med Flashcards

1
Q

What can orofacial pain be classified into?

A
  1. Pain attributed to a lesion or disease of the trigeminal nerve
  2. Pain attributed to a lesion or disease of the glossopharyngeal nerve
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2
Q

What is the aetiology behind trigeminal neuralgia?

A

Neurovascular compression
Underlying disease
No apparent cause - idiopathic

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3
Q

What are the features of trigeminal neuralgia?

A

Unilateral electric shock like pains
Abrupt onset and termination
Limited to distribution of one or more divisions of the trigeminal nerve - unlikely to be the ophthalmic division
Can arise spontaneously but likely to be triggered by innocuous stimuli - ie. touch, air etc.
Additionally, may be continuous background pain of moderate intensity within the distributions of the affected nerve divisions

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4
Q

What is the investigatory method of choice for trigeminal neuralgia?

A

MRI scan

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5
Q

What is the drug of choice for trigeminal neuralgia?

A

Carbemazepine

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6
Q

What are the red flags for trigeminal neuralgia?

A

28 sensory or motor deficits
Deafness or other ear problems
Optic neuritis
History of malignancy
Bilateral TN pain
Systemic symptoms (e.g. fever, weight loss)
Presentation in pts under 30

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7
Q

What are the main clinical features of idiopathic orofacial pain?

A

Unilateral or bilateral intraoral or facial pain in the distribution(s) of one or more branches of the trigeminal nerve(s)
Usually persistent pain of moderate intensity
Poorly localised - radiates more than trigeminal neuralgia
Dull, pressing or of burning character
Daily pain >2hr/day for >3months - at 3 months becomes chronic
Conventional analgesics are usually ineffective

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8
Q

What are the 3 types of idiopathic orofacial pain?

A

Persistent Idiopathic Facial Pain
Persistent Idiopathic Dentoalveolar Pain
Burning Mouth Syndrome

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9
Q

What is burning mouth syndrome also known as?

A

Oral dysaesthesia
Glossodynia - when only the tongue is affected

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10
Q

What is white sponge naevus?

A

An inherited autosomal dominant condition. May also be sporadic.

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11
Q

List some clinical features of White Sponge Naevus

A

White/greyish patches
Can merge with surrounding mucosa
Firmly adherent - cannot be removed by scraping
No associated erythema or ulceration
Fold, soft and spongy surface
Location - any area

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12
Q

List some clinical features of Leukoedema

A

Buccal and labial mucosa filmy/milky white/grey appearance
Soft on palpation

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13
Q

What is the cause of leukoedema and is it harmful?

A

Secondary to low grade mucosal irritation
It is not harmful - not potentially malignant

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14
Q

What is epitheliolysis?

A

Oral mucosal peeling secondary to mucosal irritation by toothpaste, mouthwashes (SLS)

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15
Q

What are the clinical features of epitheliolysis?

A

Strands of gelatinous milky white material removable by wiping
No significant abnormality of underlying tissue

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16
Q

Is epitheliolysis harmful?

A

No it isn’t harmful

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17
Q

What is the aetiology of traumatic frictional keratosis?

A

Secondary to physical (frictional), chemical, thermal irritation - low grade chronic trauma

18
Q

What are the clinical features of traumatic frictional keratosis?

A

White plaque not removed by rubbing/scraping
May have a shaggy surface, appear macerated or be associated with ridging
Clinical appearance should match cause

19
Q

What are the clinical features of stomatitis nictotina?

A

Generalised white/greyish white appearance of the hard palate extending onto the soft palate
Small red dots <1mm represent inflamed openings of minor salivary glands

20
Q

Is stomatitis nicotina a potentially malignant disorder?

A

No

21
Q

What can lichenoid reactions be caused by?

A

Reactions to medications (iatrogenic)

  • Antihypertensive drugs:
    - ACE inhibitors (-pril)
    - Beta-blockers (-lol)
    - Calcium channel blockers
    - Methyldopa
    - Thiazide diuretics
    - Loop diuretics
  • Oral hypoglycaemics
    - Tolbutamide
    - Chlorpropamide (sulphonylureas)
  • NSAIDS

Reactions to dental materials (allergic)

22
Q

Which conditions can mimic oral lichen planus?

A

Lupus erythematosus
Graft vs Host Disease

23
Q

What are the 7 different forms of lichen planus?

A

Reticular
Papular
Gingival
Plaque
Atrophic
Bullous
Erosive

24
Q

What are the clinical features of reticular lichen planus?

A

Lace-like

25
Q

What are the clinical features of papular lichen planus?

A

Papules - small slightly raised white patches

26
Q

What are the clinical features of gingival lichen planus?

A

Desquamative gingivitis - although not painful and wont lead to gingival recession or periodontitis

27
Q

What are the clinical features of atrophic lichen planus?

A

Normal/red areas on tongue
Diffuse erythema with scattered white areas
Papilla disappeared

28
Q

What are the clinical features of bullous lichen planus?

A

Blisters/vesicles - can burst leaving areas of ulceration

29
Q

What are the clinical features of erosive lichen planus?

A

Ulcers

30
Q

What symptoms might a pt with lichen planus experience?

A

Asymptomatic

The affected area may feel rough

Soreness only on eating e.g. spicy, salty, acidic, rough, hot foods and tooth brushing (often related to toothpaste)

Soreness present at all times exacerbated by the above factors.

Symptoms tend to wax and wane in severity.

Stress may be an exacerbating factor

Other site involvement - skin, scalp, nails, genital

31
Q

Is oral lichen planus a potentially malignant disorder?

A

Yes

32
Q

What is graft vs. host disease?

A

An iatrogenic, immunological disorder
Can be mistaken for lichen planus

33
Q

What is lupus erythematosus?

A

An autoimmune/connective tissue disorder
Can be mistaken for Lichen Planus

34
Q

What is hairy leukoplakia?

A

An infective condition that affects the lateral borders of the tongue, candida frequently present

35
Q

What virus is associated with Hairy leukoplakia?

A

Epstein Barr Virus (Human Herpes virus 4)

36
Q

What might hairy leukoplakia further indicate?

A

HIV
or general immunosuppression in pts using topical corticosteroids

37
Q

What should be offered to patients with hairy leukoplakia?

A

Biopsy
HIV testing

38
Q

What are the 4 types of canidiosis

A

Acute pseudomembranous (thrush)
Acute erythematosus
Chronic erythematosus
Chronic hyperplastic

39
Q

What medications might predispose a pt to hyperplasia?

A

Nifedipine, Ciclosporin, Phenytoin

40
Q

Which bacteria are commonly associated with angular chelitis?

A

Candida
Staph aureus - causes yellowing
Beta-haemolytic streptococci

41
Q

What drugs might cause oral ulceration?

A

Methotrexate
Nicorandil
Bisphosphonates
NSAIDS

Module 6 (7 decks)

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