Oral Med Flashcards
What are the guidelines for referral of a mucosal lesion to oral med?
Nice and SIGN Head & Neck Cancer guidelines
What are the symptoms of Geographic tongue?
Sensitive with spicy/acidic foods
Intermittent
Sometimes none
Something else is causing deficiency - ask GP to take bloods, haematinic deficiency (B12, folate, ferritin)
What investigations are required for glossitis?
Haematinics (B12, ferritin, folate)
Fungal cultures
What cellular changes result in white lesions?
Thickening of the mucosa or keratin - less visibility of blood cells in connective tissue beneath
Less blood in the tissues
What is leukoplakia? % that become malignant
A white patch which cannot be scraped off or attributed to any other cause
Diagnosis of exclusion
1-5% become malignant
Where are areas of concern for finding white or red patches? What group of people and why?
Lateral border of the tongue
floor of the mouth
Soft palate area
More predisposed to developing squamous cell carcinomas in drinkers and smokers
Why are red lesions red?
Blood flow increases -inflammation, dysplasia
Reduced thickness of the epithelium which is making connective tissue redness more visible
Do white or red lesions cause more concern?
Red
What are the 3 types of recurrent aphthous ulcers?
Minor
Major
Herpetiform
Oro-genital ulcer syndromes- Behcet’s syndrome
What are minor aphthous ulcers?
Yellow oval ulcerative area on the mucosa
Erythematous halo of inflammatory change
Less than 10mm diameter
Last up to 2 weeks
Only affect non-keratinised mucosa
Heal without scarring
Most common type
What are major aphthous ulcers?
Can last for months
Affect both keratinised and non-keratinised mucosa
May scar when healing
Usually larger than 10mm
What is herpetiform aphthae?
Rarest form of aphthous ulcers
Multiple small ulcers on non-keratinised mucosa
Heal within 2 weeks
Can coalesce into larger areas of ulceration
What investigations are carried out for aphthous ulcers?
Blood tests- haematinics
Coeliac disease
Allergy testing
What is the non-steroid topical therapy treatment of recurrent aphthae?
Correct blood deficiencies
Avoid dietary triggers
Benzdamine spray or mouthwash
Chlorhexidine m/w
What is the steroid topical therapy treatment of recurrent apthae?
Betamethasone tablets for use as m/w
Hydrocortisone tablets- dissolve tablet next to the lesion
What questions should you ask in an oral ulceration history?
Where?
Size and shape?
Blister or ulcer?
How long for?
Recurrent? same site? different site?
Painful?
Ulcer free period?
What are recurrent herpetic lesions?
Ulceration limited to one nerve group/branch
Often of the hard palate
Most common with herpes simplex 1 or 2 but herpes zoster can also give recurrent lesions
How do you treat recurrent herpetic lesions?
Systemic acyclovir
What are the contributing factors to lichen planus?
Most are idiopathic
Some related to medication
Some related to amalgam restorations
When the cause is known the oral lesion is described as a lichenoid reaction
What are the common medications that cause lichen planus?
ACE inhibitors - ramipril
Beta-adrenergic blockers - propanolol
Diuretics - frusemine, bendroflumethiazide
NSAIDs - ibuprofen, aspirin
DMARDs- pencillamine
What is the management of lichen planus?
Remove any cause
Biopsy
Blood tests- Haematinics, FBS
Topical remedies- benzdamine, chlorhexidine or topical steroids the same as oral ulcers
What is the % chance that lichen planus will become malignant?
1-5%
What is the presentation of trigeminal neuralgia?
Unilateral maxillary or mandibular division pain
Stabbing pain
5-10 seconds duration
What are the triggers for TN?
Cutanous - to touch
Wind, cold
Chewing
