oral med general Flashcards
what are tori?
exostosis - completely normal bone formation - swelling of bone
how do tori grow?
grow and enlarge with growth of the mandible and maxilla
how to tori appear?
symmetrical smooth and covered in mucosa
what are fordyce spots?
sebaceous glands
occur on vermillion border and buccal/lingual mucosa
when do fordyce spots become prominent?
age
what is leukodaema?
white and grey areas
odeama in superficial mucosal layers
gives a white appearance
what are other names for geographic tongue?
what are the symptoms of geographic?
erythema migrams, benign migratotry glossitus
can be asympotmatic or irritated by spicy/salty/acidic/rough foods
what is hairy tongue and what is it caused by?
brown/black tongue
staining from smoking, tea, coffee, chx mw
hypoplasia of filiform papillae
how is the appearance of a hairy tongue removed?
tongue brushing
sucking a peach stone
sucking a pineapple
suck vit c tabs
what are vascular lesions and malformations?
long lasting
normal part of circulation
test by encouraging blanching
not prone to rupture because CT layer covering
what are signs that a lesion could be a malignant melanoma?
occur on palatal and maxillary mucosa commonly
border not well defined, colour intensity and varies, quite large, satellite lesions, erythema and ulceration
what bacteria can cause fungal infections?
c. albicans
c. tropicalis
c. galbreta
what are the classifications of candida albicans?
- acute pseudomembranous - thrush
- acute erythematous
- chronic erythematous
- chronic hyperplastic
what are associated lesions of candida albicans?
angular chelitis
denture stomatitis
median rhomboid glossitis
describe acute pseudomembranous thrush?
removeable upper layer of superficial epithelium affected by candida - white yellow plaques - leaves area of inflammation
what are some possible underlying causes of candidiasis?
anaemia haematinic deficiency - B12 folate iron type 2 diabetes asthma - steroid/inhalers immunodeficiency antibiotics HIV/AIDS dry mouth
what is chronic hyperplastic candida?
inside angle of mouth - comissure firmly adherent plaques homogenous appearance inter areas of redness asymptomatic/symptomatic potential malginant mucosal disorder
what is denture stomatitis?
erythme confined to denture wearing area
poss slight hyperplastic appearance
localised/generalised
what is angular chellitis?
cracking, erythema, crusting, bleeding,
denture wearers
underlying systemic conditions
what bacterial infection can cause angular chellitis?
staph aureus
what is medial rhomboid glossitis?
inflammation in middle of tongue
asymptomatic or symptomatic
what meds can treat candidiasis?
topical intra oral and extra oral creams
systemic capsules
chx/hypochlorite mw
how to treat stomatitis?
remove at night
soak in hypochlorite or chx
fluconazole OM gel
nystatin of contra indicated
what is a genodermatoses?
white sponge naevus any area of OM affected rough surface blend with surrounding normal area asymptomatic nasal and genital mucosa also affected no malignant potential
what is frictional/traumatic keratosis?
linear alba
wipe away to leave inflammation
sheets of necrotic epithelium
what is chemical trauma?
apsirin burns can cause/etch burn
wipe away to leave inflammation
sheets of necrotic epithelium
what is stomatitis nicotina?
generalised whitening
combo thermal/chemical trauma
not potentially malignant
what is the incidence of lichen planus?
affects 2/100 people checks, tongues. gingivae, FOM, palate risk of SCC associated with hepC usually bilateral but not symmetrical seen with lupus and graft versus host disease asymptomatic
what is non erosive lichen planus?
no ulceration
reticulrar LP
white plaques/patches
atrophy of epithelium
what is erosive LP?
ulceration
white striation and erythema
where do skin lesions of LP appear on the body and how do they present?
raised red purple patches
scalp = alopecia
nails = vertical ridging/splitting
genitals = discomfort, scarring
how to treat symptomatic LP?
analgesic/antibacterial MW, benzydamine - MW OM spray
chx MW
topical steroids - betamethasone, clenil modulate, hydrocortisone
what drugs can cause lichenoid?
antihypertensives oral hypoglycaemics NSAIDs 2nd line anti arthritics xanthine oxidase inhibitors pyschoactive drugs antiparastic antimicrobial
how do thermal or chemical ulcers present?
white patches
what is TUGSE?
traumatic eosinophillic ulcer and stomal eosinophillia
delayed healing
mimics SCC
what drugs can induce oral ulcers?
NSAIDs
methotrexate
nicorandil
what are recurrent oral apthous ulcers?
recurrent oral ulcers seen in abscess of systemic disease
similar lesions seen with systemic disease including GI disease
what are the types of recurrent apthous ulcers?
minor
major
herpetiform
describe minor apthous ulcerations?
Non K areas >10 lesions at a time <1cm 10-14 days to heal oval, erythema border, yelow base
describe major apthous ulcerations?
K non K areas >1 cm heal with scarring 4 or more weeks to heal >3 lesions at a time
describe herpetiform ulcers?
small >2mm numerous at a time >100 non K 10-14 days to heal
what do ulcers occur in response to?
what are the phases of ulceration?
cell mediated immunie response
pre ulcerative phase - topical steroids most effective
ulcerative phase
healing phase
causes of ulceration?
stress menstrual cycle sensitivity to foods GI disease anaemia haematinic deficiency drug history smoking cessation family history
what GI diseases cause oral ulceration?
crohns
coeliac
what can anaemia and haematinic deficiencies?
epithelial atrophy
compromised cell mediated response
cytoxicity of leucocytes reduced
when does the cause of recurrent apthous ulceration become important?
when pt’s age is outwith norm range and if they seem unexplained - poss increase in severity
where do we get B12 and folate from in the diet?
meat and animal produce
green leafy veg
what percent of coeliac patients present first with recurrent apthous ulceration?
6%
what is the tx of Recurrent apthous ulceration?
chlorhexidine hydrocortisone oral tabs SLS free toothpaste betamethasone MW clenil modulate doxycylcline MW benzydamine MW spray lidocaine ointment
what can non healing mouth ulcers be a sign of?
neoplastic cells
squamous cell carcinomas
what is the appearance of SSC?
red and granular
yellow and smooth
what herpes simplex disease is most common orally? and how is it transmitted?
HSV1
skin to skin direct contact
droplets - body excretions
sharing cups etc
when a child first encounters HSV1?
infection can be subclinical or clinical
what are clinical features
general feeling of unwell - fever, lymphadenopathy inflammation orally vesicles - small blisters (under few mm) bulla - > few mm bullae rupture and become ulcers
where does PHGS affect?
mucosal surfaces including external lips
gingivae - erythematous and vesicles
who is PHGS most common in?
children and young infants
how long does PHGS last?
10-14 days
what is the tx of PHGS?
analgesics - paracetamol diflam - analgesic MW chx gluconate - dilute half and half bland soft diet and fluids avoid direct physical contact and other individuals esp babies and immunocompromised systemic aciclovir
what is herpes labialis?
HSV1 reactivated in 40% of patients
HSV1 lies in trigeminal nucleus and lies dormant. Travels down sensory neurones and effects epithelium and surrounding tissue
what are the first signs of a coldsore developing?
burn and tingle in area that coldsore will develop
what is a coldsore?
vesicle rupturing to form area of ulceration
when does aciclovir cream work best for coldsore tx?
works best with burn/tingle phase
what is herpetic whitlow?
herpetic infection of the skin adjacent to the nail bed
what are the primary and secondary infections of varicella zoster?
primary - chicken pox
secondary - herpes zoster and shingles
where does a shingles rash present?
follows distribution of the trigeminal nerve - e.g opthalmic, maxillary, mandibular
what type of pain comes form pre lesion of shingles?
pre herpetic pain
what does a shingles rash comprise of?
vesicles and bullae
what can persist after shingles?
residual burning in area of rash
>3 months and still persisting = post herpetic pain
what is ramsay hunt syndrome?
facial palsy associated with varicella zoster
geniculate ganglion affected
rash in external ear
what is epstein barr?
glandular fever HHV4
petechial palatal haemorrhages
ulceration
hairy leukoplakia
what can coxsackie virus cause?
herpangina
hand food mouth disease
acute lymphoodular pharyngitis
how does hand foot and mouth disease?
pre clincal - generally unwell lesions on hands fingers and mouth gingivae unaffected, stomatitis paracetamol and diflam 10-14 days
what presents orally with measles?
koplicks spots
what presents orally with mumps?
facial swelling
bilateral swelling or unilateral salivary gland swelling
trismus
what can HPV cause orally?
squamous cell papilloma
verrucus vulgaris
condylema acumination
where can squamous cell papilloma’s occur?
any area of oral mucosa
cauliflower projection like wart
cryotherpay
what is an ulcer?
breach in epithelium to expose underlying CT
what is a vesicle?
small fluid filled lesion
what is a bulla?
larger fluid filled swelling
what is the appearance of Kaposi’s sarcoma?
who are these common in?
found most commonly where?
can also present with what lesions?
dark/red/purple/blue lesion
present in over 50% of AIDS patients
palate
ocular and skin lesion
how can you tell if something is a vascular lesion?
blanches with pressure
what is a haemangiomata?
developmental lesion present from birth
what is an erythroplakia?
atrophic red velvety patch
what might cause a traumatic white lesion?
aspirin burn
what is a leukoplakia?
uncommonly found where?
leukoplakias are premalignant, what % go on to be cancerous?
adherent white patch that cannot be categorised as any other morphological or histological diagnosis
gingivae
4%
what areas of the mouth are risky to have a white patch?
what appearance would you be worried about?
FOM/ventral surface tongue - greater chance of being cancerous
dense verroucous surface
ulceration, hyperplastic
what are some potential causes of a white patch?
smoking alcohol betel nut chronic trauma radiation
what is leukokeratosis?
white sponge naevus = developmental anomaly
non malignant
how might a squamous cell carcinoma present?
white/red patches
warty/granular lesions
ulcers or swelling
types of candidiasis?
- acute pseudomembranous - white removable plaque with erythematous surface
- acute atrophic - diffuse red (meds)
- chronic hyperplastic - angular chelitis
- chronic mucotaneous - affecting tongue and nails
- chronic erythematous - diffuse erythem mimicing denture stomatitis - may be seen in HIV and AIDS
what are local risk factors for candidiasis?
systemic?
local - denture wearing, xerostomia, topical steroids
systemic - medication, diabetes, haematininc deficiency
how does an amalgam tattoo present?
flat grey blue discolouration of the mucosa = bc amalgam particles
where do malignant melanomas commonly present from?
30% arise from area of hyperpigmentation
how does dequamative gingivitis present?
redness/fiery red
smooth shiny thinned gingivae
with or without lichenoid striae, ulceration or vesicles/bullae
what is lichen planus?
what may it present with?
mucotaneous inflammatory condition
may present as desquamative gingivitis with or without non ulcerating white lichenoid striae
what can be seen orally with addisons disease?
diffuse brown pigmentation of gingivae
