oral med - ALL OF NATS Flashcards
- What are the benign mucosal lesions caused by congenital defects?
Leukoedema, fordyce spots
- What are the benign mucosal lesions associated with trauma?
Aphthous ulcers,
frictional keratosis,
linea alba,
cheek biting,
polyps,
amalgam tattoo,
denture induced hyperplasia,
mucocele,
ranula,
melanotic macule
- What are the benign mucosal lesions associated with frictional keratosis?
Linea alba,
cheek biting
- What are the benign mucosal lesions associated with primarily fungal infection?
Pseudomembranous candidosis, chronic hyperplastic candidosis
- What is the benign mucosal lesions associated with viral infection?
Secondary herpes, papilloma
- What are the benign mucosal lesions of inflammatory cause?
Geographic tongue,
lichenoid lesion,
fibrous epulis,
pyogenic granuloma
- What are the benign mucosal lesions of autoimmune inflammatory cause?
Oral lichen planus, vesiculobullous conditions
- What is the metabolic disease that is presented as pigmentation intraorally, e.g. buccal mucosa?
Addison’s disease
- What is the condition that is associated with benign mesenchymal neoplasms?
Lipoma
- What are the conditions that are of idiopathic cause?
Lipoma,
melanotic macule
- What are the clinical features of leukoedema?
Bilateral diffuse, grey white on buccal mucosa
+/- folded, wrinkling, corrugation
X rub off, disappears when stretched
- What are the causes of fordyce spots?
Ectopic sebaceous glands,
hormonal - puberty
- What are the causes of leukoedema?
Secondary to lower grade mucosal irritation → intracellular oedema
- What is the epidemiology of leukoedema?
More common among smokers
24-90% prevalence
Blacks > whites
- What is the epidemiology of fordyce spots?
Adults > kids
- What are the signs and symptoms of fordyce spots?
Multiple yellow / yellow-white papules
Buccal mucosa & lateral portion of vermillion of upper lip > retromolar area & anterior tonsilar pillar
- What are the possible sequelae of fordyce spots?
May become hyperplastic
Form keratin-filled pseudocysts
- What are the histopathological features of fordyce spots?
No hair follicles
Otherwise normal sebaceous glands
Acinar (polygonal sebaceous cells) lobules beneath epithelial surface, communicate thru central duct
- What is the epidemiology of aphthous ulcers?
20% population
- What is the mnx for aphthous ulcers?
Remove source
HSMW
Deal with it bruh
- What are the causes of aphthous ulcers?
Traumatic stimulus - dentures, restorations, direct trauma etc
Haematinic deficiency, hormonal
- What are the causes of linea alba?
Pressure,
fictional irritation,
sucking trauma,
clenching
- What is the epidemiology of cheek biting?
Under stress, exhibit psychological conditions
35+
F>M
Glass blowers
- What are the clinical presentations of cheek biting?
Bilateral on anterior buccal mucosa
Unilateral / combined w/ lesions of lips / tongue
Thickened, shredded, white areas +/- interviewing zones of erythema, erosion, focal traumatic ulceration
Irregular ragged surface
Can remove shreds of white material
@ midportion of anterior buccal mucosa along occlusal plane
Not to be confused with dysplastic leukoplakia - have more sharply demarcated borders, periphery gradually blends w/ adj mucosa
- What is the cause of polyp?
Benign growth from mucosa
- How to treat polyp?
EXCISION
- How is amalgam incorporated into oral mucosa?
Previous areas of mucosal lesion contaminated w amalgam dust w/n oral fluids
Broken amalgam pieces fall into extraction sites
Floss contaminated w amalgam particles of a recently placed restoration
Amalgam from endo retrofill left w/n soft t/s at surgical site
Fine metallic particles driven thru oral mucosa from P of high speed air turbines
- What are the clinical features of amalgam tattoo?
Macules / slightly raised lesions
Black / blue / grey
Borders - well defined / irregular / diffuse
- What can you see in the R/G of amalgam tattoo?
R/O
- What to do if you can’t find any R/O in the R/G of a suspected amalgam tattoo?
Biopsy to rule out possibility of melanocytic neoplasia
- What happened in mucocele?
Submucosal cystic swelling d/t damage to minor salivary gland / ducts - mucous extravasation cyst
Saliva escapes from damaged duct into surrounding lip → swelling
- Is mucocele more commonly found in the lower or upper lip?
Lower lip
- If mucocele is found in the upper lip, what is it more likely to be?
Minor salivary gland tumour
- What are the clinical features of mucocele?
Bluish translucent hue d/t swelling, dome shaped, range from 1-2mm - few cm, some firm to palpation but can be fluctuant
- What is the treatment of mucocele?
Excision of cyst & associated gland under LA
- What is a ranula?
Mucocele of sublingual gland and its draining ducts
- What are the clinical features of ranula?
Painless swelling
Blue, dome shaped, fluctuant swelling in FOM
- What is the non-oral presentation of ranula?
Plunging ranula passes thru mylohyoid m/s → neck swelling
- How to manage ranula?
Excision (i/o or e/o approach) under GA
- What is the complication associated with mucocele?
Reduced sensation to region d/t damaged sensory nerve branch
- What are the causes of denture induced hyperplasia?
Ill-fitting denture, worn 24/7
- What are the clinical features of denture induced hyperplasia?
Tumour like hyperplasia of fibrous c t/s
Single / multiples folds of hyperplastic t/s in alveolar vestibule
Most often - 2 folds of t/s, flange of denture fits into fissure b/w folds
Redundant t/s - firm, fibrous
- How do you Mx denture induced hyperplasia?
Excision,
new dentures
- What is pseudomembranous candidosis associated with?
Candida albicans
- What are the local and / or systemic predisposing factors associated with pseudomembranous candidosis?
Dry mouth, steroid inhaler, anaemia, nutritional deficiency,
DM, immunosuppressed / immunocompromised,
extremes of age,
dentures,
broad-spectrum antibiotics,
systemic / inhaled corticosteroid
- What are the signs and symptoms of pseudomembranous candidosis?
Relatively mild, burning sensation of oral mucosa,
unpleasant taste - salty / bitter, ℅ ‘blisters’ - in fact the elevated plaques rather than true vesicles
- What are the clinical features of pseudomembranous candidosis?
White (cottage cheese PANEER / curdled milk)
Removable patches
Erythematous / bleeding base / normal
- How to investigate pseudomembranous candidosis?
Culturing w KOH prep - budding yeasts, hyphae, pseudohyphae
- What are the local measures for pseudomembranous candidosis?
if on corticosteroid inhaler - rinse mouth w/ water / brush teeth STAT after use
- What are the treatment options for pseudomembranous candidosis?
Fluconazole 50mg OD max 14/7 for oropharyngeal candidosis
c/i warfarin & statins
Miconazole 20mg/g pea sized after food QDS
Continue for 7/7 after lesions healed
c/i warfarin & statins
Nystatin 1ml after food QDS for 7/7
Rinse around mouth for 5 mins before swallowing
Continue for 48 hours after lesions healed
- What is a significant aetiological factor in chronic hyperplastic candidosis?
Smoking
- What are the clinical features of chronic hyperplastic candidosis?
Firmly adherent (x scrapable) white plaques
+/- intermingled erythema & nodularity
@ commissure / anterior region of buccal mucosa
Bilateral, may also affect tongue
Fine intermingling of red & white areas → speckled leukoplakia
- How do you diagnose chronic hyperplastic candidosis?
Biopsy
Swab may be non-diagnostic cuz candida infiltrates deeply into epithelium
Presence of candidal hyphae + complete resolution post antifungal Tx
- Is chronic hyperplastic candidosis a malignant mucosal disorder?
NO - so x call candida leukoplakia
- What is papilloma associated with?
HPV
- What are the clinical features of papillomas?
Sessile (immobile) / pedunculated
Can become traumatised; look like pomelo flesh
- How do you manage papilloma?
Excision
- What is secondary herpes caused by?
Reactivation of latent virus in the trigeminal system
E.g. UV light, stress, immunocompromised
- What are the signs and symptoms associated with secondary herpes?
Tingling sensation before vesicles develop on the lip
Cold sore
- How to mnx secondary herpes?
Topical antivirals
- What is geographic tongue also associated with?
Fissured tongue, vitamin B
Possible a/w psoriasis
Hereditary but unclear genetic links
- What is the epidemiology of geographic tongue?
1-2% population
M=F
All ages, less common in kids
Fam Hx
- What are the signs and symptoms of geographic tongue?
Sore / sensitive tongue when eating spicy / acidic foods
- What are the clinical features of geographic tongue?
Affect tongue surface
Can move around tongue → erythema migrans
Map looking, irregular outlined red patches
Red areas surrounded by white / yellow / cream border
Can disappear / return after some time
- Where else can geographic tongue affect?
Lips / cheeks / palate
- How to diagnose geographic tongue?
Hx, C, x need special investigations
Some pt may have ‘fissured tongue’ a/o psoriasis
- How to manage geographic tongue?
Analgesic m/w or lozenges to numb tongue before meals is sore
Avoid alcohol containing m/w
Use sugar free lozenges
Avoid spicy / acidic foods, carbonated drinks, vinegars, tomatoes
Stop / cut down on smoking
Confine alcohol intake
Regular dental visits
- What is a lichenoid reaction?
Inflammatory reaction to metal / medication
- What are the causes of lichenoid reaction (medication)?
Antihypertensives
- ACEi - captopril
- ARBs - losartan
- Beta-blocker - propranolol, atenolol
- CCBs - amlodipine, nifedipine, verapamil
- Thiazide diuretics - hydrochlorothiazide
- Loop diuretics - furosemide
Oral hypoglycaemics
- Tolbutamide
- Chlorpropamide (sulphonylureas)
NSAIDs
- Ibuprofen, naproxen, phenylbutazone
- What are the clinical features of lichenoid reaction?
White lesion next to possible source
X wipeable
- What is fibrous epulis?
Growth on gum, chronic irritation