Oral Med Flashcards
5 epithelium layers from surface down?
stratum corneum stratum granulosum stratum spinosum stratum basale lamina propria
CGSBL
cool girls stand by lush
difference between orthokeratinised and parakeratinised epithelium?
orthok = no nuclei para = has nuclei
partaay keratinised epithelium
define keratosis
keratin formation in non- keratinised epithelium. called hyperkeratinisation in keratinised epithelium
define acanthosis
hyperplasia of stratum spinosum
define atrophy
loss of epithelial layers
define erosion
partial thickness loss
define ulceration
loss of epithelial layers with resultant yellow fibrin deposition on surface
define dysplasia
disordered maturation of cells
define atypia
changes in individual cells
define rete peg elongation
hyperplasia of stratum basale
diff diag for pt presenting with TMD like symptoms
pericoronitis
myofascial pain syndrome
but both do not have clicks from TMJ
describe splint fabrication specifics
cover all teeth hard acrylic full occlusal coverage upper and lower alginates facebow ground in lab- max intercuspation wear facets sloping canine guide plane
pt presents with tile like pattern of white patches on roof of mouth, with red dots in the middle of patches. the pt say he did not know it was there. what could this be?
how could you assess whether to is potentially malignant?
smoker’s keratosis.
white patches present on palate, red dots represent inflamed salivary glands.
usually painless
result of heat /chemicals of smoke.
mgmt: smoking cessation.
can be pre-cancerous. send for biospy
can access if potentially maligant by looking at:
hyperchromatism and atypia
would be suspicious of malignancy
if:
indurated, raised rolled margins, exophytic growth.
indurated?
having become firm/hard usually by fibrous deposition
pt present with white, lacy patch on buccal mucosa next to amalgam rest..
what could this be?
what causes this?
4 histological features you would see
lichenoid tissue reaction
type IV hypersensitivity reaction
keratinisation hugging band of lymphocytes basal cell liquefaction saw tooth rete pegs apoptosis
types of biospy and why you’d use them
most important to include in biospy?
incisional- elliptical shape aids healing. used if diff dx is malignancy
excisional- complete removal of lesion for functional or aesthetic purposes. only used if growth definitely benign. elliptical shape incisions.
punch- incisional or excisional
Laser or electrosurgery biopsy - can distort histological results but good for post op discomfort and haemorrhage control
NEED TO INCLUDE: adjacent intact mucosa
pt presents with red corners of mouth.
condition?
organisms involved?
sampling method used?
if sampling not available, what would you do?
pt wears denture. advice to give
angular cheilitis
staphylococcus aureus, candida albicans.
swab
prescribe miconazole as is both antibiotic and antifungal
advice: denture hygiene, CHX/ Hypochlorite cleansing
name three diseases assoc/w/ angular cheilitis
HIV- pt will have impaired immune function .:. more likely to get angular cheilitis
Coeliac - impaired nutrient intake
Orofacial Granulomatosis
difference in presentation of pempigus vulgaris and bullous pemphigoid
vulgaris: mucosal erosions -> erythematous macules -> flaccid blisters -> rupture easily = painful erosions
positive nikolksy sign- skin doesn’t separate when rubbed
bullous: tense fluid filled blisters 1-3cm diameter, unlikely to erode, stable due to being subepidermal - >clear exudate if burst, leave post-inflammatory hyperpigmentation
negative nikolksy sign
diff diag pemphigus vulgaris
what type of condition is it?
acute herpetic stomatitis
erythema multiforme - IgM and C3 instead of IgG
apthous ulcers
bullous lichen planus
type II hypersensitivty
diff diag bullous pemphigoid
mucous membrane pemphigoid
Linear IgA disease
Dermatitis herpetiformis
What skin condition is strongly linked to coeliac disease?
Describe its main features
Dermatitis herpetiformis
raised red patches with small blisters that burst when rubbed
severe itching and stinging
commonly affects elbows, knees and buttocks
usually appears both sides of body
Neon green diagnostic test. What is it
What you expect to see for…
pemphigus vulg, bullous pemphigoid and dermatitis herpetiformis
direct immunofluorescence
pemphigus vulgaris: epidermal INTERcellular IgG in fishnet pattern
bullous pemphigoid: linear deposition of IgG and c3 along epidermal basement membrane
(uninterupted bright green line running course of basement membrane)
dermatitis herpetiformis: granular deposition of IgA along basement membrane and dermal papilla
(look like bumpy interupted line)
IgG and IgA antibodies will be targeting antigens. direct immunfluorescence shows where the antigens and antibodies are- aiding diagnosis.s
check onenote for pics
Describe how to stage cancer
TNM staging
T- size or direct extent of primary tumour
N - degree of spread to regional lymph nodes
M- metastasis
Tx-cannot be assessed
Tis- Carcinoma in situ
T0- no evidence of tumour
T1-4 size
Nx- cannot be assessed
N0- no evidence
N1- spread to closest/small number of nodes
N2- spread to areas between closest and furthest
N3- spread to distant/ large number of nodes
M0 - no mestasis
M1- spread to distant organs - beyond regional lymph nodes
how to grade cancer?
description of how abnormal cancer is to surrounding tissue
GX- cannot be determined
G1 - low grade
well-differentiated- when cells are similar to normal surrounding tissue
G2 - intermediate
moderately differentiated-
G3 - high
poorly-differentiated- when the cells are very different to surrounding cells
G4- high
un-differentiated- severely abnormal looking cells
How to grade dysplasia
basal cell hyperplasia - > mild, mod, severe, - > carcinoma in situ
CIS= full thickness
mild- low 1/3 - slight nuclear abnormalities, most marked in basal third, a few abnormal mitoses, usually acompanied by keratosis and chronic inflammation. upper layers show maturation and stratification
mod - abnormalities marked in basal 2/3
severe - loss of upper layer maturation
some abnormal mitoses in upper layers
how would you restore function to the tongue after removal of lesion
soft tissue grafting
Features of an aphthous ulcer
Types of Recurrent aphthous stomatitis
well demarcated, shallow, ovoid or round, have a necrotic centre w/ yellow pseudomembrane
minor
- less than 5mm diameter, heals in 1-2 weeks
major
- often >10mm, takes weeks/months to heal, often leaves a scar
herpetiform
- multiple pinpoint ulcers, heal within a month. most common on tongue.
diagnosed based on exclusion and appearance
diff diag recurrent aphthous stomatitis
Herpes simplex
Herpangina
Erythema multiforme
Fixed drug eruption.
How to tell difference between aphthous ulcer and herpes simplex ulcer?
culture or PCR of viral swab from fresh vesicles of ulcer-
if positive if HSV
differences between minor and major recurrent aphthous?
minor / major 1-20 ulcers / usually singular <10mm / >10mm heals without scar / heals with scar heals in 1-2 weeks / heals in 6-8 weeks non keratinised mucosa / any mucosa
causes of recurrent aphthous stomatitis
haematinic deficiency (iron, B12, folate) stress anxiety diet trauma sls toothpaste systemic disease
Treatment recurrent aphthous stomatitis
CHX 0.2% 10ml / 2x daily dietary avoidance - chocolate, cinnamon-aldehyde, benzoates toothpaste change blood tests + then correct deficiency betamethasone MW 0.5% 2xdaily
first line- corticosteroids -beclamethasone inhaler
betamethasone tablets
topical anaesthetics- lidocaine,
topical analgesics- benzydamine
topical antimicrobials - CHX or doxycycline
if severe, short course of systemic- prednisolone
consider: b12 supplementation
risks of recurrent aphthous ulcers
dehydration
infection
what would a pt describe the pain of trigeminal neuralgia like?
worst pain ever
electric shock like -lasts a few seconds
unilateral
severe paroxysmal
2 most common causes of trigeminal neuralgia
test to determine cause
focal demyelination of peripheral nerves causing ischaemia
OR
trigeminal nerve compression from aberrant artery
MRI, FBC tests
can do IDB to check if it is not just TMD pain
If pt has trigeminal neuralgia due to MS or brain tumour what symptoms may they experience?
MS: intention tremor
Brain tumour: diplopia/ memory loss
mgmt trigeminal neuralgia?
carbamazepine - anti-epileptic
100mg 2x daily
if pt not reacting to medication or having adverse effects:
Microvascular decompression Balloon compression cryosurgery Gamma Knife radiosurgery long acting bupivicaine
investigations needed before giving medical mgmt of trigeminal neuralgia
blood tests- FBC
LFT liver function test
U&E
liver tests as function may be reduced
3 side effects of carbamazepine
GI disturbances headache drowsiness visual disturbance folate deficiency hypertension facial dyskinesia
2 intraoral manisfestations of herpes
- symptoms of both
herpes labialis - cold sores
burning pain followed by small blisters. first attack accompanied by fever, sore throat and enlarged lymph nodes.
primary herpetic gingivostomatitis- intraoral presentation of primary herpes simplex virus - inflammation of both the gingiva and oral mucosa
- fever, anorexia, irritability, malaise occur before numerous pinhead vesicles appear
these burst to form irregular ulcerations covered by yellow membranes.
three vesicle forming conditions/
erythema multiforme
pemphigus vulgaris
bullous pemphigoid
2 groups that cause ulceration
herpes simplex
ebv - HHV4, ebstein barr virus - glandular fever, hairy leukoplakia, burkitt’s lymphoma.
coxsackie virus - hand foot and mouth
varicella zoster - HHV3, chicken pox
virus causing hand foot and mouth? how does it present orally?
symptoms
how does it differ to gingivostomatitis?
herpangina- aka mouth blisters
typically found posterior oropharynx
- .:. differ to herpetic gingivostomatitis which are anterior oro or mouth
usually present in children, in summer
symptoms: sore throat, headache, loss of apetite, neck pain
self limiting
process by which herpes labialis progresses?
- primary infection
- latency
- reactivation
- secondary infection
5 types of candidiasis & presentation & tx
pseudomembranous - thick white plaque, scrapped off easily to leave erythematous bleeding surface.
- systemic: fluconazole tabs 50mg/ 1 x daily/ 14 days
- topical: nystatin lozenges, qid
erythematous- diffuse erythema, soreness. aka atrophic
- systemic: same^
- topical: nystatin ^
angular cheilitis - cracking and inflammation of corners of mouth, soreness, burning
- systemic: same^
- topical: miconazole gel qid
hyperplastic - chronic form - firm white non-scrapeable leathery plaque
- systemic: same^
- topical: miconzaole ^
medial rhomboid glossitis
2 med conditions assoc/w/candidiasis
HIV
diabetes - poorly controlled
pros and cons swabs and rinse
swab
pros: site specific
cons: uncomfortable for pt, can be contaminated
rinse
pros: quantifiable amount, can record whole mouth
cons: more difficult to standardise as not site specific. some pt may find difficult.
what to ask path for when sending sample
culture, sensitivity
2 drug interactions with fluconazole and effect caused
warfarin (increased bleeding)
statins (hepatotoxicity)
pt contraindicated to fluconazole, what could you prescribe for candidiasis
fluconazole systemic
could use
itraconazole 50mg capsules / 1 x daily / 15 days
tx aphthous ulcers
first line- corticosteroids -beclamethasone inhaler
betamethasone tablets
topical anaesthetics- lidocaine,
topical analgesics- benzydamine
topical antimicrobials - CHX or doxycycline
if severe, short course of systemic- prednisolone
consider: b12 supplementation
CHX 0.2% 10ml / 2x daily dietary avoidance - chocolate, cinnamon-aldehyde, benzoates toothpaste change blood tests + then correct deficiency betamethasone MW 0.5% 2xdaily
pt presents with headache surrounding one eye, comes in sharp attaches
chronic paroxysmal hemicrania
nose dripping
worse when shaking head
pt presents with severe head pain, scalp tenderness, jaw pain, and fever. what could this be?
temporal arteritis
inflammation of temporal arteries are inflammed and constricted
name some systemic and some local causes of pigmented tongue
systemic:
- racial
- karposi’s sarcoma
- haemochromatism
- addison’s
- lead poisoning
local:
- smoking
- hydroxychloroquine - malaria meds
- chromogenic bacteria - black hairy tongue
- melanoma
- melanotic macule
Histological features of lichen planus
hugging band of t lymphocytes basal cell liquefaction - > colloid bodies apoptosis keratosis lymphocytes acanthosis saw tooth rete pegs atrophy / hyperplasia
Types of lichen planus
bullous reticular atrophic papular plaque erosive desquamative
Causes lichen planus
stress automimmune bowel disease food allergies dental materials drugs- NSAIDs, beta blockers, ACE inhibitors, antimalarials Diabetes Hypertension Betel Nut CHewing Toothpaste flavourings- cinnamates
SI lichen planus
would biopsy lichen planus if:
smoker, high risk area or symptomatic
send for DI direct immunfluorescence
Tx lichen planus
assymptomatic & reticular: monitor and reduce risk factor
if symptomatic and other types: remove cause if known, topical steroids, systemic steroids, difflam MW and CHX MW
histology of pempigus
H&E staining:
tzank cells
suprabasal split
acantholysis
direct immunofluorescene- basket wire appearance intercellular IgG
salivary gland tumours in order of incidence?
pleomorphic adenoma warthin's tumour adenoid cystic carcinoma mucoepidermoid carcinoma acinic cell carcinoma
histological features of pleomorphic adenoma
which sign related to recurrence?
patterns: duct like structures, trabeculae
tissue: myxoid and chrondroid
cells: plasmacytoid, fusiform, cuboidal
encapsulation - if no capsule or poorly encapsulated likely to recur
invasive nature .:. likely to recur
pseudopodia - finger- like structures extend beyond pseudocapsule or capsule
histological features of Warthin’s tumour
cystic
distinct epithelium
lymphoid tissue
clinical features of growth that was lead to suspicion of malignancy
firm
attached to underlying structures
rapid growth
histology of adenoid cystic carcinoma
presents as mixed tumour
consists of tubular, cribriform +/- solid growth patterns
68 y/o male attends with now ill fitting denture
what could be causing this? He says he is taking medication for a bone disorder.
dental implications
paget’s disease
increases bone turnover- increased osteoclast and osteoblast activity, altering shape of ridge
implications:
- pt may be taking bisphosphonates- care with XLA
- hypercementosis- opacities periradicular on rads
- high caries rate - polypharmacy and xerostomia- aging pt, reduced OH due to reduced manual dexterity, poorly fitting denture- plaque trap, increased sugar intake
two types of hemangioma
differences histologically
hemangioma- birth mark, rubbery, bright red nodule of extra blood vessels
capillary - groups of smaller vessels
cavernous - large dilated vascular spaces
what nerve supplies temporomandibular?
auriculotemporal nerve
Give 3 management techniques for TMD
athrocentesis arthroscopy condylectomy total joint replacement high condylar shave
common triggers for reactivation of herpes
Sunlight
stress
run down/unwell
immunosuppression
nerve assoc w herpes
trigeminal
what is anaemia?
reduction in oxygen carrying capacity of the blood due to reduction in red blood cells or haemoglobin
general signs and symptoms of anaemia?
general oral signs?
fatigue, malaise, pallor, weakness, dizziness
recurrent oral ulceration, candidiasis, glossitis (-iron), beefy (-vit b12, folate), oral dysaesthesia, mucosal pallor
MCVs for types of anaemia
microcytic <80fL - iron deficiency, thalassaemia
normocytic 80-95fL - pregnancy, bleeding, sickle cell
macrocytic >96fL - vit B12, folate
Give two local, four systemic causes of xerostomia
local -
- sialolith
- salivary gland tumour
- developmental defects of salivary gland
- radiotherapy problems in area
- mouth breathing
systemic
- medications - diuretics, cytotoxics, antidepressants
- anxiety
- diabetes
- HIV
- sjogren’s
- dehydration
how to assess xerostomia intraorally (3)
visual check of saliva pooling FoM
mirror sticking to buccal mucosa
saliva flow rate test
signs and symptoms xerostomia
frothy saliva increased cervical caries rate increased perio halitosis difficulty eating difficulty swallowing difficulty speaking candidiasis
mgmt xerostomia
hydration modify drugs control diabetes control somatoform disorder prevent candida infection salivary substitute- saliva orthana saliva stimulants- pilocarpine
name 3 saliva substitutes
saliva orthana,
glandosane,
biotene
name 3 saliva proteins
histatin
IgA
PRP
mucins
name 3 saliva enzymes
lipase
amylase
lysozyme - antimicrobial
Indications for antibiotic use in dentistry
- temporary treatment of acute infection where drainage or XLA not possible
- in cases of spreading infection e.g cellulitis
- as an adjunct to surgery e.g in aggressive periodontitis
- in immunocompromised pt s
5 ways in which antibiotics work
CPDDC
cell wall destruction protein synthesis inhibition DNA synthesis inhibition DNA replication inhibition cell membrane inhibition
3 cons ABs
GI disturbance
drug interactions
resistance
hypersensitivity
mechanisms of antibiotic resistance
drug inactivation
altered target site
reduced accumulation
altered metabolism
How can you differentiate between upper and lower motor neuron disease?
everything above eyebrows still functions in upper -
“upper spares upper”
- as upper part of facial motor nucleus receives innervation from both crossed and uncrossed fibres so frontalis and obicularis oculi are spared.
classification of motor neuron diseases
give 4 mnds
classified as to whether they are inherited or sporadic
and whether they affect upper, lower motor neurons or both.
Most common
- ALS - amyotrophic lateral sclerosis, affects both U and L, has inherited and sporadic forms
- Primary lateral sclerosis – upper only affected
- Progressive muscular atophy – lower only affected
- Progressive bulbar palsy - lowest motor neurones of brain stem affected .:. difficulty eating, swallowing and speaking.
what is geographic tongue?
incidence
implications
intraoral psoriasis of dorsum of tongue
affects 1-2%
no implications barr appearance- not related to any pathology!
what is geographic tongue?
incidence
implications
mgmt
intraoral psoriasis of dorsum of tongue
affects 1-2%
no implications barr appearance- not related to any pathology!
reassure and monitor
what is coxsackie virus?
name 4 conditions it causes
RNA virus
hand foot and mouth
herpangina
haemorrhagic conjunctivitis
aseptic meningitis
What is epstein barr virus?
name 3 conditions it causes
human herpes virus 4
hairy leukoplakia
burkitt’s lymphoma
infectious mononucleosis - glandular fever
two types of inhaler for asthma what are they
blue- salbutamol- beta 2 agonist
brown - beclomethasone - corticosteroid
What is asthma?
Reversible airflow obstruction. characterised by: 1. smooth muscle contraction. 2. inflamed mucosa - causing swelling 3. increased mucous secretion
dental effects of inhalers and advice to give
increased candida - due to steroid effects
increased erosion - due to acidity
increased xerostomia - exacerbates erosion and candida
drink water after taking inhaler, use inhaler correctly as advised, use a spacer if poss.
+ follow good OH
pt presents with asthma. you want to give fluoride therapy. what considerations should you make?
pt may be allergic to colophony and .:. fluoride varnish.
consideration to med emergencies.
% in scotland treated for asthma
7%
List 10 histological signs of epithelial dysplasia
- hyperchromatism
- pleomorphism
- basal cell hyperplasia
- drop shaped rete pegs
- altered basal cell polarity
- increase/ abnormal mitoses
- enlarged nuclei
- abnormal stratification
- abnormal keratisation
- loss of intercellular adhesion
most common sufferers of oral dysaesthesia
common symptoms
50 y/o menopausal women
xerostomia
burning mouth
parasthesia
mucosa appears clinically normal
SI oral dysaesthesia
salivary flow rate FBC haematinics Hba1c parafunction assessment denture assessment psychiatric assesment
diff diag oral dysaesthesia
lichen planus diabetes denture problems dental effect Recurrent oral ulceration
mgmt oral dysaesthesia
reassure correct any deficiencies treat possible causes- diabetes correct parafunction or denture fault difflam MW CBT gabapentin - antineuropathic/ antidepressant
pt presents with swelling of the lips and surrounding tissues, lips are slightly crusted. what could you ask the patient to help diagnose?
what could this most likely be?
any systemic inflammatory conditions e.g sarcoidosis or Crohn’s disease
OFG can precede these conditions for years!
orofacial granulomatosis - swelling of lips and surrounding tissues secondary to an underlying granulomatous inflammatory process.
- Type IV hypersensitivity reaction
- lymphomatous swelling due to blockage of lymph channels
sarcoidosis - groups of inflammatory cells form lumps- in lungs, skin or lymphs
aetiology of OFG
autoimmune
hypersensitivity to SLS, cinnamon, benzoates
non- caseating giant cell granulomas
histological appearance OFG
non- caseating giant cell
oedema
dilated lymph
Signs and symptoms OFG
lip swelling and crusting angular cheilitis stag horned sublingual folds buccal cobblestoning ulceration of buccal sulcus
Mgmt OFG
dietary advice - re: avoidance allergens antibiotics: erythromycin tacrolimus on lips oral steroids no surgery!!
benzoates: e210-e219
preservative in processed foods, drinks and occur naturally in fruit, tea, chocolate
risks of radiotherapy
mucositis xerostomia increased infection poor wound healing osteoradionecrosis
grades of mucositis
- sore and erythematous
- erythematous and ulcers - can eat
- ulcers - liquids only
- cannot take anything orally
mgmt mucositis
prevention good oh analgesics topical lidocaine sls- free toothpaste ice chips CHX tea tree oil
histological difference between pemphigus and pemphigoid
Pemphigoid - Sub-basal split, autoantibodies attack hemidesmosomes
Pemphigus - Supra-basal split, autoantibodies attack desmosomes, Tzank cells, acantholysis
risk factors oral cancer
Multifactorial → Smoking, alcohol (combo x35), poor OH, diet, viral e.g. HPV 16&18, age, betel quid
signs and symptoms oral cancer
> 3 months unexplained ulcer, white patch, red patch, welling
hoarseness
unexplained mobility
dysphagia
ulcer –» rolled border, indurated, bleeding, numbness, late presentation pain, exophytic
metastatic cascade
primary tumour formation -> local invasion -> intravasation -> survival in circulation -> arrest at distant organ site -> extravasation -> initial proliferation -> metastasis colonisation
high risk areas oral cancer
lateral border of tongue
FoM
Soft palate
pt presents with 2cm ulcerated lesion on palate. diff diag?
how would you aid diagnosis
necrotising sialometaplasia
squamous cell carcinoma
mucoepidermoid carcinoma
biospy for histology
if decide NS (benign) then rebiopsy in 3 months if still present
what is necrotising sialometaplasia?
aetiology?
SI?
Mgmt?
benign, self-limiting inflammatory reaction of salivary gland tissue
appears v similar to SCC.
aetiology:ischaemia of salivary gland tissue, due to smoking, trauma or LA
SI: biopsy for histology - would be expecting to see
Surface slough necrotic tissue, hyperplasia, metaplasia of the ducts, necrosis of salivary acini & inflammatory exudate,
would expect to heal in <3 months - spontaneous healing. no mgmt bar reassure pt.
pt presents with swollen lower lip. diff diag?
mucocele
OFG
SCC
trauma
What is a mucocele
Histological appearance?
mgmt
recurrent lip swelling due to damaged salivary gland- recurrent
macrophage lined cavity w/ saliva and granulation tissue - foam cells
mgmt: excision of mucocele and gland.
Name for mucocele on FoM
RANULA
Where does median rhomboid glossitis occur?
3 histological features?
dorsum of tongue anterior to sulcus terminalis.
(where tongue divides into post 1/3, from ant 2/3)
candida hyphae infiltration
PMNL infiltration
elongated/hyperplastic rete ridges
Name 5 antifungal agents
miconazole fluconazole CHX nystatin Itraconazole
5 virulence factors of candida
germ tube formation phenotype switching extracellular enzymes adhesion acidic metabolites
what hormones would adrenal insufficiency affect?
how would this affect the body
signs
steroids e.g cortisol
mineralcorticoids e.g aldosterone
.:. stress response - mood, motivation fear
+
sodium conservation, potassium secretion,water retention
signs: oral pigmentation, hair loss, weakness, anorexia, postural hypertension, lethargy
adrenal crisis!
What information should be written on a prescription
patient name, address pt age if <12 date number of days of treatment generic drug name SEND LABEL score out extra space GDP name Signature GDP stamp
Common dosages for two antibiotics used for dental abscessed
amoxycillin 500mg SEND: 15 capsules LABEL: 1 capsule 3 times daily
metronidazole 400mg SEND: 15 capsules
LABEL: 1 tablet 3 times daily
Rate of infection of
HIV
HEP B
HEP C
on exposure
HIV: 0.3%
HEP B: 30%
HEP C: 3%
6 oral lesions assoc/w/ HIV
- candidiasis esp. pseudomembranous and erythematous
- karposi’s sarcoma
- hairy leukoplakia
- non hodgkins lympoma
- Periodontal disease - NUG
- herpetic like ulcers
how is HIV diagnosed and treated?
ELISA
enzyme linked immunosorbent assay
HAART
highly active anti-retroviral therapy
What is a fibrous epulis?
aetiology?
histological appearance?
a localised fibrous enlargement of gingival tissues
- called a fibroepithelial polyp elsewhere
caused by low grade chronic irritation
ulceration, granulation, metaplastic bone
3 GI diseases that may cause microcytic anaemia?
crohns
ulcerative colitis
coeliac disease
What to write on lab sheet for sample
pt name, address, contact
GDP name and details
clinical description and provisional diagnosis
specimen type and site
drawing if applicable
tests- done previously and to be tested now - culture, viral
ABs- current, today, resistance
MH
DRUG HISTORY
DH
signature
date
time of sample
what is sjogren’s
autoimmune condition with lymphocytic infiltration of exocrine glands, causing glandular dysfunction
characterised by dry eyes, dry mouth
what conditions are commonly associated with sjogren’s
rheumatoid arthritis
SLE
scleroderma
6 investigations used to diagnose sjogren’s
subjective/objective for dry eyes, mouth
subjective dry eyes: >3months gravel/sand feeling, using tear sub 3xdaily
objective dry eyes: schirmer test - <5mm in 5 mins
subjective dry mouth: >3 months needing liquid for swallowing/ gland swelling
objective dry mouth: <1.5ml in 15 minutes unstimulated salivary flow
autoantibody findings: anti-Ro and anti-La
histology: biopsy of labial gland @premolar region of inner lip w/ >5 minor glands
what are the histological findings - minor and major
sjogrens
minor: acinar loss, fibrosis, focal lymphocytic sialadenitis
major: acinar loss, lymphocytic infiltration, myoepithelial islands, epithelial hyperplasia,
4 oral complications of sjogrens
increased caries rate increased perio increased infection e.g candida denture retention difficulty salivary lymphoma
systemic drug to manage sjogrens
prilocarpine
name a hereditary white patch
how does it appear histologically
white sponge naevus
how does smokers keratosis appear histologically
oedema in prickle layer
PARAkeratosis
pt presents with tumour like, fibrous growth around where denture sits. diff diag?
denture induced hypoplasia
leaf fibroma
SCC
pyogenic granuloma
factors that cause denture induced hypoplasia
histological features
mgmt
ill fitting denture causing trauma,
fibrous reaction of gingiva
pseudoepithelial hyperplasia
candida often present
mgmt: LA, excise hyperplastic area,
short term tissue conditioner on denture
then remake denture
