Oral Med Qs Flashcards
atypical odontalgia
dental pain without dental pathology
distinct pattern of pain:
- pain free / mild between episodes
- intense unbearable pain for 2-3wks duration which settles spontaneously
- typical acute pulpitis symptoms with irrational pt behaviour
tx = refer from primary care to OM, opioid analgesics. aim is to reduce chronic pain experience & frequency of episodes
persistent idiopathic facial pain
pain which fits poorly into standard chronic pain syndromes & often has high disability level
mx = refer to OM, believe pt, adopt holistic strategy for pain control & quality of life issues
alcohol & oral cancer
- oral cancer foundation found that alcohol abuse (>21 units/wk) = 2nd largest risk factor for oral cancer
- dehydrates cell wall enhancing ability of other toxins to penetrate tissues
- nutritional deficiencies associated with heavy drinking can lower bodies natural ability to use antioxidants to prevent formation of cancers
- lancet 2018 paper = alcohol damages cells which then try to repair themselves leading to DNA changes that could be the step towards oral cancer
effects of alcohol on health
increased risk of cancers inc oral, stomach, liver, rectum, colon
decay & toothwear due to high acidity & sugar levels
risk of facial / tooth / denture injuries if under influence of heavy alcohol
alcohol limits
no more than 14 units p/wk
spread drinking over 3 or more days if you regularly drink >14
try to have 2 alcohol free days p/wk
14 units = 6 pints of peer, 10 small glasses of wine, 14 singles 25ml
describe abscess in tooth & give symptoms
abscess is pus enclosed in tissues of jaw bone at apex of infected tooth usually originating from bacterial infection that has accumulated in pulp of the tooth
causes = caries / trauma / NCTSL / perio
ask pt re symptoms = swelling, trismus, dysphonia, dysphagia, drooling, poor neck flexion, inability to stick tongue out, pyrexia, tachycardia, tachypnoea. ask about colour / size / duration of swelling
criteria for SIRS
- temp <36 or > 38
- WCC <4 or >12x10 to 9 / L
- heart rate >90bpm
- resp rate >20/min (tachypnoea)
what is SIRS and when to refer
2/4 positive SIRS = sepsis symptoms & requires urgent referral to OMFS/A&E
SIRS = inflammatory state affecting whole body. frequently a response of the immune system to infection.
pt systemically unwell what signs indicated pt requires referral:
- spread of infection to pharyngeal / submandibular space
- systemic manifestations & pt immunocompromised
- trouble swallowing or breathing
- rapidly progressing infection
how to manage dental abscess
local measures first i.e. incise & drain / extract & drain / drain via retraction of socket / instrumentation
systemic = antibiotics
phenoxymethylpenicillin = 250mg 2 x 4 daily send 40 tablets (5 days)
metronidazole 400mg 1 x 3 daily send 15 tablets (5 days)
candidal leukoplakia risk factors & mx
risk factors = OH, steroid inhaler use, diet, diabetes, deficiency, dry mouth, antibiotic, immunosuppression
mx = incisional biopsy (refer to OM), OHI, rinse following inhaler use, systemic antifungal i.e. fluconazole 50mb send 7 tablets x1 / day for 7 days
explain lichen planus, causes & tx
chronic inflammatory immunomediated disease
to de diagnosed with OLP must meet histological & clinical criteria
OLL = cause unknown
OLP = cause known
egs of cause
1. restorative materials i.e. amalgam
2. early signs of GVHD
3. systemic disease e.g. hep c / hypertension / diabetes
4. drug reactions e.g. ACE inhibitors & beta blockers
tx = remove cause i.e. change fillings / dw GP changing meds
primary care = beclomethasone 0.5mg / puff x 2 daily or betamethasone rinse 1mg/10ml 2mins x 2 daily
2ndary care = clobetasol cream, topical tacrolimus ointment, hydroxychloroquine, systemic immunomodulators i.e. azathioprine / mycophenolate
should be treated as potentially malignant as approx 1% chance of SCC in 10yrs
when would you biopsy lichen planus
- concerning features
- changes to lesion
- atrophic / erosive (increased malignant potential)
- symptomatic pts
- confirmation of dx
must say biopsy for histopathological exam
pt c/o dry mouth taking amitriptyline
hx - how is dry mouth affecting pt? do they need water to swallow? affecting speech? what meds is pt taking? smoking / alcohol? med hx i.e. diabetes, epilepsy, anxiety, stroke, sjogren’s
symptoms = difficulty swallowing, clocking speech, discomfort, altered taste, cervical caries, halitosis, candidiasis
mx = treat cause; hydration, chew gum, modify drugs contact GMP, control diabetes, reduce caffeine, stop smoking / alcohol, prevent dx i.e. caries via high F TP, candida / angular cheilitis via CHX & saliva substitutes spray / lozenges: saliva orthana or stimulants i.e. prilocarpine
pt given IDB & suffering from facial palsy; identify & manage
injection into parotid gland through which facial nerve runs
diagnose via testing branches of facial nerve
symptoms = generalised weakness of ipsilateral side of face, inability to close eyelids, obliteration of nasolabial fold, drooping or corner of mouth, deviation of mouth to unaffected side
confirmation = temporal branch affected (if stroke pt can still wrinkle forehead)
mx = reassure, cover eye with patch until blink reflex returns, artificial tears can be used during day & sunglasses to prevent exposure keratitis
pt w swollen lips & bowel problems; potential OFG dx; DWP
OFG = blocks lymphatic channels causing swelling
autoimmune type IV hypersensitivity reaction to additives
