Oral Med Flashcards
What can orofacial pain be classified into?
- Pain attributed to a lesion or disease of the trigeminal nerve
- Pain attributed to a lesion or disease of the glossopharyngeal nerve
What is the aetiology behind trigeminal neuralgia?
Neurovascular compression
Underlying disease
No apparent cause - idiopathic
What are the features of trigeminal neuralgia?
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
What is the investigatory method of choice for trigeminal neuralgia?
MRI scan
What is the drug of choice for trigeminal neuralgia?
Carbemazepine
What are the red flags for trigeminal neuralgia?
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
What are the main clinical features of idiopathic orofacial pain?
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
What are the 3 types of idiopathic orofacial pain?
Persistent Idiopathic Facial Pain
Persistent Idiopathic Dentoalveolar Pain
Burning Mouth Syndrome
What is burning mouth syndrome also known as?
Oral dysaesthesia
Glossodynia - when only the tongue is affected
What is white sponge naevus?
An inherited autosomal dominant condition. May also be sporadic.
List some clinical features of White Sponge Naevus
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
List some clinical features of Leukoedema
Buccal and labial mucosa filmy/milky white/grey appearance
Soft on palpation
What is the cause of leukoedema and is it harmful?
Secondary to low grade mucosal irritation
It is not harmful - not potentially malignant
What is epitheliolysis?
Oral mucosal peeling secondary to mucosal irritation by toothpaste, mouthwashes (SLS)
What are the clinical features of epitheliolysis?
Strands of gelatinous milky white material removable by wiping
No significant abnormality of underlying tissue
Is epitheliolysis harmful?
No it isn’t harmful
What is the aetiology of traumatic frictional keratosis?
Secondary to physical (frictional), chemical, thermal irritation - low grade chronic trauma
What are the clinical features of traumatic frictional keratosis?
White plaque not removed by rubbing/scraping
May have a shaggy surface, appear macerated or be associated with ridging
Clinical appearance should match cause
What are the clinical features of stomatitis nictotina?
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
Is stomatitis nicotina a potentially malignant disorder?
No
What can lichenoid reactions be caused by?
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)
Which conditions can mimic oral lichen planus?
Lupus erythematosus
Graft vs Host Disease
What are the 7 different forms of lichen planus?
Reticular
Papular
Gingival
Plaque
Atrophic
Bullous
Erosive
What are the clinical features of reticular lichen planus?
Lace-like
What are the clinical features of papular lichen planus?
Papules - small slightly raised white patches
What are the clinical features of gingival lichen planus?
Desquamative gingivitis - although not painful and wont lead to gingival recession or periodontitis
What are the clinical features of atrophic lichen planus?
Normal/red areas on tongue
Diffuse erythema with scattered white areas
Papilla disappeared
What are the clinical features of bullous lichen planus?
Blisters/vesicles - can burst leaving areas of ulceration
What are the clinical features of erosive lichen planus?
Ulcers
What symptoms might a pt with lichen planus experience?
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
Is oral lichen planus a potentially malignant disorder?
Yes
What is graft vs. host disease?
An iatrogenic, immunological disorder
Can be mistaken for lichen planus
What is lupus erythematosus?
An autoimmune/connective tissue disorder
Can be mistaken for Lichen Planus
What is hairy leukoplakia?
An infective condition that affects the lateral borders of the tongue, candida frequently present
What virus is associated with Hairy leukoplakia?
Epstein Barr Virus (Human Herpes virus 4)
What might hairy leukoplakia further indicate?
HIV
or general immunosuppression in pts using topical corticosteroids
What should be offered to patients with hairy leukoplakia?
Biopsy
HIV testing
What are the 4 types of canidiosis
Acute pseudomembranous (thrush)
Acute erythematosus
Chronic erythematosus
Chronic hyperplastic
What medications might predispose a pt to hyperplasia?
Nifedipine, Ciclosporin, Phenytoin
Which bacteria are commonly associated with angular chelitis?
Candida
Staph aureus - causes yellowing
Beta-haemolytic streptococci
What drugs might cause oral ulceration?
Methotrexate
Nicorandil
Bisphosphonates
NSAIDS
