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Oral Med Flashcards

1
Q

Describe atypical odontalgia

A

Dental pain without detected pathology
Distinct pattern of pain - pain free or mild between episodes, intense unbearable pain for 2-3 weeks which settles spontaneously, typical acute pulpitis symptoms with irrational attention behaviour

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2
Q

What is the treatment for atypical odontalgia?

A

Refer from primary care to oral medicine
Chronic strategy:
- reduce chronic pain experience
- reduce frequency of acute episodes
Acute strategy:
- opioid analgesics high intensity/short duration to control pain
- extraction of tooth if needed

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3
Q

Describe persistent idiopathic facial pain

A

Pain which poorly fits into standard chronic pain syndrome which often has a high disability level (autonomic component)

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4
Q

How is persistent idiopathic facial pain managed?

A

Refer to OM
Believe the pt and do not increase damage
Adopt holistic strategy for pain control and quality of life issues

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5
Q

What is the link between alcohol and oral cancer?

A

Alcohol abuse (more than 21 units/week) 2nd largest risk factor for development of oral cancer
Alcohol dehydrates the cell walls enhancing the ability of other toxins such as tobacco carcinogens to penetrate mouth tissues
Heavy drinking lowers bodies ability to use antioxidants to prevent formation of cancers
Alcohol damages cells which try to repair leading to DNA changes that can be a step towards oral cancer

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6
Q

What effects does alcohol have on health?

A

Drinking in excess puts you at risk of many cancers in clouding oral, stomach, liver, colon and rectal
Causes decay and tooth wear due to high acidity and sugar levels
Puts the person at risk of facial and denture injuries if under the influence

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7
Q

What are the alcohol limits?

A

No more than 14 units per week
Spread drinking over 3 days or more if you regularly drink as much as 14 units
Try to have at least 2 alcohol free days per week
14 units = 6 pints of beer, 10 small glasses of low strength wine, 14 single 25ml spirits

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8
Q

How do you approach alcohol intervention?

A

Raise the issue about if they drink
Screen and give feedback on risks - drinking more than 14 units puts you at greater risk of several health Robles m which not only affect the oral cavity but also the rest of your body
Listen to readiness for change - ask if they would like help in cutting down or stopping alcohol
Suitable referral information

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9
Q

What is a dental abscess and what are the causes?

A

Pus enclosed in the tissues of the mandible at the apex of an infected tooth/roots
Usually originates from a bacterial infection accumulated in the pulp of the tooth
Causes - caries, trauma, NCTSL, periodontal disease

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10
Q

What are the symptoms of a dental abscess?

A

Swelling, trismus, dysphonia, dysphagia, drooling, poor neck flexion, inability to stick out tongue, pain, pyrexia, tachycardia, tachypnoea

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11
Q

What specifics should you ask a pt about for dental abscesses?

A

Think SIRS
Ask about temperature, pulse rate, respiratory rate, colour and temperature

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12
Q

What are the criteria for SIRS (National early warning score NEWS)

A

Temperature <36 or >38
WCC <4000 or >12000 cells/mm3
Heart rate >90/min (tachycardia)
Respiratory rate >20/min (tachypnoea)

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13
Q

In SIRS, when should you urgently refer to OMFS or A&E?

A

2 out of 4 positive SIRS - sepsis syndrome
Spread of infection to pharyngeal or submandibular space
Systemic manifestations and pt is immunocompromised
Trouble swallowing or breathing
Rapidly progressing infection

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14
Q

What is the antibiotic info for dental abscesses if systemic manifestation or immunocomromised?

A

Always try local measures first: incision and drainage, extraction and drainage, drainage through retraction of socket or instrumentation
Amoxicillin 500mg 3x daily for 5 days
Metronidazole 400mg 3x daily for 5 days

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15
Q

What is Candida leukoplakia

A

Fungal infection of the cheek side of mouth
Potential malignant, can progress to oral cancer

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16
Q

What are the risk factors of candidal leukoplakia

A

Poor OH
Steroid inhaler
Diet
Diabetes
Deficiencies
Dry mouth
Antibiotic use
Immunosuppression

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17
Q

How should candidal leukoplakia be managed?

A

Incisional biopsy - referral to OM
OHI, reduce carbohydrate intake, rinse mouth after inhaler
Correct deficiency, control diabetes, stop smoking, correct denture fault
Systemic antifungal - review after 7 days:
- fluconazole 50mg, send 7 tablets, label 1 tablet to be taken once per day for 7 days

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18
Q

How is candida treated in immunocompromised patients?

A

Systemic antifungal + topical antifungal/chlorhexidine rinse

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19
Q

How is candida treated in pts with poor oral hygiene?

A

Improve oral hygiene +/- chlorhexidine rinse

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20
Q

How is candida treated in pts with good oral hygiene and no dry mouth?

A

Any topical or systemic antifungal

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21
Q

How is candida treated in pts with dry mouth?

A

Topical antifungal, avoid systemic antifungals

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22
Q

How is candida treated in pts with large erosive lesions?

A

Systemic antifungal + topical antifungal/chlorhexidine rinse

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23
Q

How can you take a facial pain history with no dental issues?

A

Pain history:
- site, onset, character, radiation, associations - no local signs of inflammation, timing, worsening or relieving factors, severity
Special investigations - radiograph for caries, sensibility tests, mobility, perio disease, tooth slueth

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24
Q

How are the first 7 cranial nerves tested?

A

CN1 (olfactory) - can pt smell as normal
CN2, 3, 4, 6 (optical, oculomotor, trochlear, abducens) - test visual acuity and eye movement
CN5 (trigeminal) - any abnormal sensation at each branch, can pt clench jaw, corneal reflexes
CN7 (facial) facial muscles tests (puff out cheeks, pout, wrinkle forehead, raise eyebrows)

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25
How are cranial nerves 8 - 12 tested?
CN8 (vestibulocochlear) - can pt hear normally, block one ear and check for differences CN9, 10 (glossopharyngeal, vagus) - deviation of uvula on saying ah, gag reflex CN11 (accessory) - can pt shrug their shoulders CN12 (hypoglossal) can pt protrude tongues is there deviation on protrusion or asymmetry
26
How can you explain lichen planus to a pt?
Whiteness comes from keratin deposition, a protein present in skin and body Kind of allergic reaction, most cases we don’t know what from, likely medications or metal fillings Small chance to develop into something sinister - 1% of cases over 10 years Spectrum disease can range from asymptomatic white patches to more sinister ulcerated areas Not something we can treat other than if possible remove the causing factor if we know it but can manage the symtoms
27
How can lichen planus be treated?
Avoiding SLS containing tooth pastes Avoid other allergens such as benzoates Chlorhexidine mouthwash Pain managed with difflam spray Later stages can use corticosteroids - local then systemic If sinister looking refer to OM, if not handle by GDP
28
How can you take a history for dry mouth?
How dry mouth is affecting pt - need water to swallow/affect speech/uncomfortable What medication is pt taking - amitiptyline?, alcohol?, smoking? MH - diabetes, epilepsy, anxiety, stroke, sjogrens, CF, HIV
29
What are the symptoms of dry mouth?
Usual features/symptoms - swallowing difficulty, clicking speech, discomfort, altered taste, cervical caries, halitosis, candidiasis
30
How is dry mouth managed?
Treat cause - hydration, chew gum, modify drugs, control diabetes, reduce caffeine, stop smoking/alcohol Prevent diseases - high F toothpaste, CHX Saliva substitutes - spray/lozenges, stimulants - pilocarpine Contact G to query if medication change is possible
31
How is a facial palsy given and tested
Injection of LA in parotid gland Test CN7 - puff out cheeks, wrinkle forehead, raise eyebrows
32
What are the symptoms of facial palsy?
Generalised weakness of the ipsilateral side of the face Inability to close eyelids Obliteration of the nasolabial fold Drooping of corner of mouth Deviation of mouth to unaffected side
33
How can you confirm facial palsy?
Temporal branch is affected - is stroke pt can still wrinkle forehead
34
What is OFG?
Oral granulomatous inflammation causing problems - blocks lymphatic channels causing swelling Autoimmune - type IV hypersensitivity to additives (benzoates, sorbic acid, chocolate)
35
What are the symptoms of OFG?
Lip swelling/cracked, angular cheilitis, buccal cobblestoning, ulceration, lymphoedema, gingivitis
36
How can you take a history and diagnose OFG?
Take full systems history including info like weight loss and bowel problems Diagnosis - patch testing for 20 minutes
37
How is OFG managed?
Dietary avoidance Antibiotics (macrolides) Tacrolimus ointment to lip Steroids Azathioprine
38
What is the link to OFG and Crohn’s?
Crohn’s is inflammatory disease that can affect any part of the GI tract If GI involved and mouth then termed oral Crohn’s Refer pt to GP to investigate
39
How can you give biopsy results for epithelial dysplasia?
Establish what pt knows about biopsy and implications Break news - epithelial dysplasia has a potential to be cancerous - not cancerous yet but evidence of change in the tissues Ensure pt understands this Good news - risk can be reduced by removing factors that cause cancer Alcohol advice
40
What LNs should be palpated in an exam?
Preauricular Post auricular Submandibular Submental Occipital Jugulo-digastric Jugulo-omohyoid Deep cervical Supraclavicular
41
How can you take a history for a lesion on the FoM?
When did you notice lesion How long for Is it painful Is it painful to eat or swallow Hoarseness of voice? Relevant MH Smoker? Alcohol? Regular dental attender? Daily mouthwash use, does it contain alcohol?
42
How would you discuss a lesion on the FoM to a pt?
Lesion has multiple possible causes Some are harmless and benign Some could be more serious and possible cancerous Site is a high risk for oral cancer and you have other risk factors I’m going to refer you on to have this looked at Explain the referral will be urgent and OM/OMFS will take a biopsy so lab can tell us what it is
43
What can you tell a pt to expect at OM for a biopsy of the FoM?
Biopsy: - LA injection around site - taking a small amount of tissue to send to lab for analysis - sutures will be placed to close up wound Lymph node biopsy - fine needle aspirate Post-op advice - It will be sore for a week after, similar to having an ulcer - Sutures will dissolve and come out on their own 2-4 weeks - Advice will be provided - salt water mouth rinse, soft diet, limit smoking, reduce alcohol - Review appts will be made to discuss findings
44
What are the urgent cancer referral guidelines?
Persistent unexplained head and neck lumps for >3 weeks Ulceration or unexplained swelling of oral mucosa >3 weeks All read or speckled patches of oral mucosa >3 weeks Persistent hoarseness >3 weeks (chest X-ray at same time) Dysphagia or odynohahgia (pain on swallowing) >3 weeks Persistent pain in throat >3 weeks
45
What are the possible causes of white patches?
Hereditary Keratosis (smoking, traumatic) Lichenoid Lupus Pseudomembranous or chronic hyperplasticity candidiasis Carcinoma/SCC
46
How can you explain microcytic anaemia to a pt?
Iron deficiency anaemia is a condition where a lack of iron in the body leads to a reduction in the number of red blood cells Iron is used to produce red blood cells, which helps store and carry oxygen in the blood If you have fewer red blood cells than is normal, your organs and tissues wont get as much as they usually would Most common symptoms are tiredness and lack of energy, SoB, heart palpitations and a paler complexion In some cases you can get minor ulceration in the mouth
47
What is the aetiology of iron deficient anaemia?
Lack of iron in diet Heavy menstruation Bleeding in the stomach and intestines - stomach ulcer or NSAIDS Stomach/bowel cancer - don’t say this
48
How is iron deficient anaemia managed?
Iron supplements and increase of iron in diet This will also solve minor ulceration Avoid spicy foods like curries If too sore to eat describe numbing mouthwash - benzydamine
49
What diet advice should be given for anaemia?
Dark green, leafy veg Iron-fortified cereals or bread Brown rice Nuts and seeds Meat Fish Tofu Eggs Dried fruits Vit C rich foods help body absorb Iron Tea, coffee and calcium (dairy) make it harder to absorb iron - only in large quantities
50
How can you take a history for denture stomatitis?
MH - ask about diabetic control and meds Ask if denture worn at night Ask about denture hygiene
51
What is denture stomatitis?
A sore or red area in the mouth usually under a denture Happens when people wear their dentures all the time (at night) and don’t clean them properly
52
How is denture stomatitis managed?
Palate brushing daily to treat condition Advice on cleaning denture: - brush after meals with a soft toothbrush and soap - soaking in NaOCl or CHX for 15 minutes 2x daily (NaOCl only for acrylic) Leave denture out at night and as often as possible during tx period Check denture fit - if a problem, adjust, reline or remake Limit smoking Limit sugar in diet
53
What antimicrobial agent can treat denture stomatitis?
None Chlorhexidine Azole - watch for warfarin interaction (can’t prescribe then)
54
What is the link between alcohol and oral cancer?
Alcohol abuse (more than 21 units/week) is the 2nd largest risk factor for development of oral cancer Alcohol dehydrates the cell walls making it easier for carcinogens to enter mouth tissues Also lowers the bodies natural ability to use antioxidants to prevent the formation of cancers Even one drink a day increases relative risk Smoking and alcohol in combo are multifactorial
55
What are the effects of alcohol on health?
Risk of many cancers including oral, stomach, liver, colon and rectum Causes decay and tooth wear due to high acidity and sugar levels Puts the person at risk of facial and dental injuries if under the influence of
56
What are the recommended alcohol limits?
No more than 14 units/week Spread drinking over 3 days or more if you regularly drink as much as 14 units Try to have at least 2 alcohol free days per week 14 units = 6 pints of beer, 10 small glasses of low strength wine, 14 single 25ml spirits
57
How can you provide brief alcohol intervention?
Ask about how much they drink on a weekly basis Say info shows they are having more than the recommended amount per week Drinking more than this puts you at greater risk of several problems which affect the mouth and the rest of the body Ask if they would like help in cutting down or quitting alcohol Refer
58
What are the risk factors for oral cancer?
Tobacco - smoke and smokeless (betel quid) Alcohol HPV16 Previous cancer FH of SCC Sun exposure Diet low in nutrients - fruit and veg Malnourished Immunocompromised - HIV, GVHD Lichen planus Poor oral health
59
What are the signs and symptoms of denture induced stomatitis?
Erythematous and oedema of denture bearing area Burning sensation Inflamed mucosa under upper denture Discomfort Bad taste and halitosis
60
How can you explain denture stomatitis?
A fungal infection causing inflammation of the tissues in contact with the denture Can occur for various reasons and is more susceptible in pts who are immunocompromised

5 OSCE (23 decks)

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