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FINALS!!! > Oral Med - revision notes > Flashcards

Oral Med - revision notes Flashcards

1
Q

Type I hypersensitivty

A

immediate ttype - allergy or anaphylaxis

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2
Q

Type II hypersensitivity

A

antibody mediated reaction

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3
Q

Type III hypersensntivity

A

immune complex

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4
Q

Type IV hypersentitivty

A

T cell mediated - cell mediated

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5
Q

Lichen planus

A

Type IV herpsensntivity reaction where an unknown antigen stimulus on the epitthelium

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6
Q

Types of lichen planus

A
  1. Reticular
  2. plq
  3. papular
  4. erosive
  5. bullous
  6. atrphic
  7. desequamive ging
  8. aannular
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7
Q

What are the potential malginant forms

A

erosive
atrophic

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8
Q

Tests

A

Blood tests
patch tests
Biopsy - smokers or painful lesions

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9
Q

Casues of lichen planus

A

idiopathic
stress
geentic deposition
ACE inhibotrs
beta blockers
Viral infection - hep C
trauma
localised skin diseses - herpes zoster

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10
Q

Tx for lichen planus

A

avoid spicy and acididc food
SLS free toothpaste (bland toothpaste
CHX mw
benzadamine mw
beclomethasone inhaler steriod
betamethasone mw steriod
immunosuppressants - hydroxycholorquine
topical tacrolimus

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11
Q

Histology of lichen planus

A

apoptosis cells
macrophages present
blue band of T lyphocytes hug the epithelium
basal cell layer liquification
keratinisation
atrophy/hyperplasia
lyphocytes - epitheliotphism

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12
Q

Local predisposing factors for candida infection

A

dentures
antibiotics
corticosteriods
xerstomia

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13
Q

General factors for candida infection

A

imuunocompromised
denture wearer
stress
nutritional deficiency - anemia
extremes of age
smoker
steriod use
diabetes

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14
Q

Tx for candidia infection

A

impprove OH
remove casues/trauma
oral suspension - nystatin or miconazole
systemic antifungal - fluconazole

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15
Q

Tests for candida

A

biopsy if hyper plastic canddiosis
oral rinse
oral swab
smear

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16
Q

Quantification sample

A

salvia sample via rinse probs

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17
Q

Pseduomembranous candidiosis

A

an fungal infection where there are white patches that can be scarped off to relieve an area of inflammation

elderly, infants, immnuocompromised

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18
Q

Eryhamatous candidous

A

red patcy areas on palate or dorsum of tongue

low CD4 cell count, seen in HIV infections

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19
Q

Hyperplastic candidosis

A

areas of white patches, especially angle of mouth that can’t be scarped off
rough white areas, bilateral and unifocal

can become malgninaint - biopsy!!
Dysplasia can lead to candida leukoplakia

Smoker and poor denture hyg

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20
Q

Histopath for hyperplastic candidosis

A

inflammation of the lamina dura
incrsease netruophils in parakeratin layer
parakeratosis - broad rete processes

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21
Q

Denture induced candidosis

A

seen in denture wears - poor OH hyg, wearin gndeutre at night

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22
Q

Angular chelitis

A

fungal infection tha occur just around the areas of corners of mouth
crusty appaerance and cracked

Candia species or staphlycoccus bacteria

Seen in anemia or excessive saliva at folds of mouth

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23
Q

Sojgrens syndrome

A

an autoimmune inflammatory response which affects the salivary and lacrimal glands

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24
Q

Primary sjorens

A

dry eyes and dry mouth but no systemic involvement

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25
Q

Secondary sjogrens

A

dry eyes and dry mouth wih systemic involvement - primary billary cirrhosos, RA, systemic scelorisis, lupus

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26
Q

Who most likely to get sjorens

A

middle aged women

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27
Q

Features of sjorens

A

dry eyes and dry mouth
gritty eyes
speech problems
difficuly swallowing
swollen salivary glands
oral ulerations, candidosis, erthematous
angular chelitis
wore at night
denture wearing issues
mucosa glazed and shing
tongue fissure, dry, beefy, red, cobbled

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28
Q

Tests for sjorens

A

schrimer test - <5mm in 5mins of lacrimal flow
sialometry tests - tests unstimulated saliva flow <1.5ml in 15mins
Ultrasound salivary glands
Labial gland biospy

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29
Q

+ve sojerns

A

dry eyes >3months
using eye tears > 3 times a day
griity sensation in eyes
dry mouth >3months
frequent drinking of fluids
swelling of salivary glands

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30
Q

Managemetn

A

saliva stimulants - sugar free chewing gum, surgar free pastilles
saliva subs - sprays = orthna, glandosane, saliva stimulants - prilocarpine (miotics), oral care systsmes = oral balance
frequent consumption of water
high flouride toothpaste = 5000ppm
good OHI
flurodie mouthwash

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31
Q

Submandibular salivary gland

A

wharton’s duct empties into sublingual papilla in the floor of the mouth

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32
Q

Parotid gland

A

Stenson’s duct at the upper 2nd moalr

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33
Q

Common salivary tumour

A

plemorphic adenoma

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34
Q

Imagining for salivary glands

A

ultrasound
CT or MRI
Radiogrpahs - submandibular = true occulsal, OPT, laterla oblique of mandible, Parotid = OPT, oblique lateral, AP profile of paoritd
Sialography - injection of a radiopauqe contrast into the duct

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35
Q

Sialography when can it not be used

A

imaging of the submandibular gland as cannot be cannulated
glands which have inflammation or infection present

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36
Q

Casues of dry mouth

A

drugs - antidepressants, antihistamines, ace inhibitors
anxiety
diabetes
degenerative disesses of salivary glands
conditions - stroke, diabetes, sjogrens,
radio/ chemo

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37
Q

Obsturcutive salivary gland disorders

A

casues pain and swelling of the gland just before mealtimes
can sometimes subside as saliva leaks passed and causes a bad taste

Extra ductal obstruction - caused by trauma, neoplasia or squamous carconimoa in floor of mouth (diseases outside the duct wall)

Intra ductal obstruction - caused by mucoclese, salivary calc, strictures (closing of duct),

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38
Q

Calculi

A

hard yellow structures/massses

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39
Q

Common intraductal obstruction

A

submandibular then the parotid

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40
Q

Sialodentitis

A

viral - mumps - paramyxovirus - occurs in parotid gland
Bacterial - mainly paorotid - antibiotics, warm salty mw, highly contagioua, massage to encourage flow

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41
Q

Sarcodosis

A

bilateral swelling of the parotid gland casued by chronic granuolmatous
lacrimal glands can also be affect

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42
Q

Sialosis

A

recurrent bilateral swellingof the salivary glands
non inflammatory and non neoplasitc

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43
Q

Underlying causes of sialosis

A

liver diseases
malnutrition
alcoholism
eating disorders
hormonal abnormalities

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44
Q

Calculi also know as

A

sialoliths

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45
Q

Casues of hypersalivation

A

stroke
MS
Alzehiermers
CJD
drugs - nicarclipine
cerbral palsy
percieved - anixety, motor neurone

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46
Q

Management of hypersalivation

A

antimuscarninic drugs - amitriptyline
biomechanical training
treat causes
surgery - gland removal/duct repositioning

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47
Q

Mucoceles form

A

when trauma to the minor salivary glands which spills into an adjacent connectie tissue

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48
Q

Mucocele vs mucous retention cysy

A

Mucocele - occur in lower lip, children, trauma, lined by granulation

Mucous retention cyst - lined by epithelium, upper, adults, cystiic dilation of duct

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49
Q

Sialodentitis

A

a salivary gland infection usually viral or bacterial

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50
Q

Tx for salivary stones

A

endoscopically with form of basket

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51
Q

Tx for strictures

A

balloon duc dilation

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52
Q

What is sialography

A

a washing effect of the glands if there are no stones present

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53
Q

Prognosis of salivary gland tumour

A

stage
grade
type

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54
Q

Where are salivary gland tumours most common?

A

Parotid gland

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55
Q

Most malgninat salivary gland tumours

A

sublingual gland

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56
Q

Symptoms of salivary gland tumour

A

pain
facial palsy
lump
asymmtery

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57
Q

Benging tumours

A

warthins tumour
Pleomorphic adenoma
Basal cell adenoma

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58
Q

Pleomorphic adenoma

A

major salivary gland - slow growing, painless nodules, soft firm and moveable
minor salivary glands - rubbery and found in palate or upper lip

Excisional removal with margin of normal tissue around

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59
Q

Warthin’s tumour

A

found in men in paorotid gland
<3mm in diameter, bilateral nodule

Factors - smokers
Tx - excision

tan grey multicystic appearance
papillary cystic structure

multifocal - many from the same gland

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60
Q

Cause of warthin’s tumour

A

casues to form from remnants of slaivary ducts which is trapped in lymph nodes and proliferates to form tumour

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61
Q

Soft tissue salivary gland tumours

A

bening fatty tumours
contain saliva parechyma - sialolipoma

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62
Q

Malginant tumours

A

Adenoid cysytic tumour
Mucoepidemoid carcinoma
acininic carcinoma

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63
Q

Adenoid cystic carncinoma

A

middle aged to elderly
minor gland tumour

pain, palsy, paraesthesia due to spreading along nerves

Swiss cheese apearance
darkly stained cells with indistinct outlines

poor prognosis and surgery and radiotherapy likely

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64
Q

Mucoepidermoid carcinoma

A

younger and middle aged -minor salivary gland
mucous (glandular)
sqaumous (epithelim)
not likley to spread lymphatic system

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65
Q

Acinar cell carcinoma

A

rare form
differentiation towards salvary acinar cells

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66
Q

Saliviary gland cysts

A

minor glands due to trauma
blue swelling

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67
Q

Mucous extravasation cyst

A

caused by trauma where the trauma results in tearing and leaking of saliva into the surrounding connective tissue
lower labial and buccal mucosa
granulation capsule

mucin filled foamy macrophages

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68
Q

Mucous retention mucocele

A

occurs due to truama on the upper labial mucosa and containts an epithelium ductal lining
clear saliva, minor inflamation and no macrophages

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69
Q

Diagnosis of mucocele

A

fine needle aspirate and imagining
no intervention unless lymphomatous infiltration = excioinal surgery

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70
Q

Ranula

A

mucous cysts from sublingual gland on the floor of the mouth

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71
Q

Changes of epithelium

A

metaplasia due to chronic irritiaiton

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72
Q

Granuloma

A

a collection of macrophages in the tissues

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73
Q

at type of biopsy for granuoloma

A

deep biopsy as in the underlying muscle

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74
Q

Macrophages

A

mononuclear macrophages
epidermoid macrophages
langer han cells

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75
Q

OFG causes

A

granuolomas in the oral mucosa
lip swelling
assoicted with food allergies - benozate

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76
Q

OFG hypersentitvity

A

Type IV which develops to Type 1 when lymphatics involved

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77
Q

rohn’s diseases

A

chronic granumulotisis of the lining of the GI tract - mainly the ileum

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78
Q

Signs and sympomts o fchron’s diseases

A

cooblestone mucosa
mucosal tags (hyperplasia)
glossitis
angular chelitis
lip swelling
and cheeks

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79
Q

Management of OFG

A

Dietary exclusion and avoidance
Surgery
topical - miconazole or tacrolimus for angular chelitis
Steirods injection
system immune modulators - prednisolone
infliximab - moncolonal antiobies to reduce the inflammation

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80
Q

Vesicubuollous seen in

A

viral infections
drug interactions
autoimuune conditions
genetics

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81
Q

Anging Bullosa haemorigca

A

blood filled blisters - usal the posterior hard and soft palate

Causes - consumption of hoot foods and liquids, rough foods, steriod inhalers without nebulisers

Tx - benzodyamine mouthwash

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82
Q

Erythema multiforme

A

skin and moucous affects and the lips ulcerated
target lesions on skin

recuttent bullous eruptions
younger males
type II hypersentivitiy reaciton - herpes simplex virus

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83
Q

Tx for erythema multiforme

A

long term high dose steriods - prednisolone
anaglesics
hydration
antiseptic mw - chx or benzydamine mw
allergy test
aciclovir

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84
Q

Pemphigoid

A

blisters and erythematous present
valvovaginal region, oral mucosa and conjunctvi

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85
Q

Pemphigoid what is it

A

the IgG antibodies react with targets on the basement membrane and hemidesomomes causing seperation of the basement membrane and the connective tissues casuing subepithelial blisters

No tzank cells are present as no weakneing of attachment in the disease

Can be serious as can cause blindness

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86
Q

Diagnosis of pemphigoid

A

direct immunofluroscence and inderect showing circulating antibodies (C3)

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87
Q

Tx for pemphgoid

A

OHI for desquamative ging
topical steriods
systemic steriods

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88
Q

Pemhigus vulgaris

A

life thereatning potential where there are blisters found on the mucosa - IgG autoantiboes react with components of desmomsomes (desmogleins 1 and 3) which causes intraepithelial blisters by a suprabasal epithelium split

tzank cells are present

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89
Q

Diagnosis of pemphigus

A

direct immunofluorsence shows basket weave appearance

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90
Q

Tx for pemhigus

A

topical steriods
systemic steriods

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91
Q

What type of hypersensitive is pemhpigoid and pemphigus

A

Type II

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92
Q

Ulcerations

A

complete loss of epithellium
mainly on lower lip

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93
Q

Casues of trauma

A

chemical burns - aspirin
thermal burns
mechanical from other teeth
ill fitting dentures
habits - self harming, finger picking
rough/hard food stuffs

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94
Q

Drugs casues of ulceration

A

phenytoin, nicorandil
cytotixic drugs

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95
Q

General causes for ulceration

A

trauama
GI diseases - crohns, ulcerative colititis
smokers
Imuunological, pemphigoid, pemphigus, erthmea multiforme
carcinoma
infections - fungal or bacterial
family hx
Bechet’s diseases
anemia, heamtinic deficiency

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96
Q

Diagnosis of ulcerations

A

clincial exam
blood tests and heamatinics - folate, ferritin, vit B12 serum

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97
Q

Tx for ulcers

A

remove the cause or known trigger
Benzydamine or chx mw
SLS free toothpaste
betamethasone mw
avoid dieting triggers
correct any deficinecies
beclomethansone inhaler

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98
Q

Minor recturrent apthous ulcers

A

<10mm in size
found on non keratinsied mucosa
heal with no scarring
heal within 10-14days
red halo with fibrin base
round and oval

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99
Q

Major RAS

A

> 10mm in size
heal with scarring
can be found anywhere in oral mucosa
lasts for few weeks
oval or irregular shape

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100
Q

Bechet’s Diseases

A

painful disease which invovle ulcerations on mucosa, genitals and eyes
blood vessal inflammation throughout the body

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101
Q

Heptiform ulcerations

A

multiple small ulcers on non keratinised mucousa
heals within 1-2weeks

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102
Q

Non keratnised epithelium

A

soft palate
ventral of tongue
inner lips and cheeks
FOM

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103
Q

Keratnised epithlium

A

Hard palate
gingigvae
dorsal of tongue

104
Q

Casues of ulceration

A

trauma
Bechet’s diseases
infection - bacterial or fungal
immunological
GI - chorns’ UC, coleiac
defiecinecies - anaemia, haeamatininc
carcionanoma
smoking
family hx
hormonal fluctuations

105
Q

Kaposis Sacroma

A

HHV 8 vascualr tumour
starts off as flat brown mucosal esions that dvelop into raised pq and purple nodules
occrus in the palate, retromlar areas, and ging

106
Q

Hairy leukoplaia

A

Casued by when the HHV 4, epistein barr virus proliferates on lateral border of tongue
Can be a sign of HIV and leads to Aids or a very weak immune systtem
lesion not malginaint
white plq areas on tongue that can’t be rubbed off

107
Q

Human Paplillom virus

A

HPV 16 and 18
women are vaccinated against
can be transmitted throught saliva or sexual
finger lesions, orla lesions

high risk causes of orphoarnglea carcinooma

108
Q

Epstein barr virus

A

HHV 4 - the kissing diseases

Symptoms - maliase, sore throat, orpharngeal lymphadenopathy, oral hairy leukoplakia

infects B cells to stimulate the T cells to elinmante B cells

Linked to cancer - Barrhetts lymphoma and nasopharyngeal carcinoma

109
Q

Herpes simplex virus

A

HHV1
1. primary - primary herpietic gingovstomatitis - early casue can provide aciclovir

Diagnosis - serology, swabs for culture, smears cytology - balloning of epithelium and multinucleated
Blood rise in IgG

  1. herpes labalis (cold sores) - HHV 1 may remian in the trigneminal ganglion
    Locak exposure to sunlight in lower lip or depressed immunity

tx - topical acicilovir 5%

110
Q

Varacella zoster

A

Varacella - chickenpox can be vaccinated against
zoster - shingles - can casues facial pain as reactivation of sensory ganglion

Diagnosis - serum, PCR adns wabs, electro microscopy

800mg aciclovir for 7 days 5 times a day

111
Q

Biopsy for squamous cell papilloma

A

excisional biopsy

112
Q

Normal node size

A

1cm

113
Q

Oral cancer sities

A

FOM
lateral vorder of tongue
HP
SP
Buccal mucosa
ging

114
Q

Risk factors

A

smoker - FOM
betal quid - esepcially buccal and labial mucosa
alcohol
socioeconmic status
UV on lip
Diet low on antioxidiants
Virus - HPV -orpharyngeal cancer

115
Q

Symptoms and red flags of oral cacner

A

white/ red patches on oral mucosa>3weeks
Unexplained non healing ulcers on mucosa >3weeks
Unexplained head and neck lump >3weeks
hoarseness in voice
perisistent soreness
crusted non healing lesions on lip
ear pain and no abnormailities
tooth mobility but no perio
unilateral discomfort in throat >4weeks

116
Q

Stages of cacner

A

size
site
spread
tx options
multiple primaries

117
Q

Grading crieiteria

A

ability to carry out same function as tissue of origin
resemebles the same cells to the tissue of origin

118
Q

Staging cancer

A

tumour size:
T1 = <2cm
T2 = 2-4cm
T3 = >4cm
T4 = >4cm with local invasion

Nodal spread:
N0 = none
N1 = <3cm
N2a = 3-6cm single
2b = <6cm single side
2c = <6cm both sides
N3 = >6cm

Metasaisis
0= none
1 = occurs

119
Q

Types of oral cancer

A

malginant melanoma
maliginant lymphoma
lesukaemia
squamous cell carciionma

120
Q

Malginant melanoma

A

palaltal and ging mucosa
brown pigmented patch or raised nodule

121
Q

Malginant lymphoma

A

extranodal lymphoma in Waldery’s ring, soft palate base of tongue and tonsils
lymph nodes involved

122
Q

Leuakemia

A

causes ging bleeding and ulceration
Child leaukaemia - cuases ging enlargement due to direct infiltrate of leaukaematic cells

123
Q

Signs of SCC

A

hard fixed ulcer with rolled margins and necrotic base
tongue can be fixed to FOM
Tongue deviates on rptorusion in oropharnygeal cancer

124
Q

SCC arires from

A

Maxiallry sinus
larynx
nasopharynx

125
Q

Histology of SCC

A

Cohesive/non cohesive front
keratinations
keratin pearls/whorles
increases mittoitc activity
nuclear hyperchromatism
nuclear and cellular pleomorphism

126
Q

SCC carncionma bone invasion

A

MRI or CT
bone invasion due to cortical resorption

127
Q

How to detect cancer in nodes

A

fine needle aspirate or core biopsy

128
Q

SCC tx

A

surgery
radio - mucositis, dry mouth, path fracture, trisumus, osteoradionecorisis, ulcerations
chemo

129
Q

Cohesive front

A

metatasis to lymph nodes rare
tissue extending at same pace

130
Q

Non cohesive front

A

metatasis to lypmph nodes high
tissue not extening at same pace

131
Q

Squamous cell pailloma

A

caluiflower like appearance
HPV 6,11,14
no mlaginant potential
excisonal biopsy

overgrowth of the soft tissues casued by HPV and is non malginant

pdenucelated/sessile - appears pink
kolicytes present
finger like projection with attached stalk present
epithelium hyperplasitc and kertanised
no atypia or invasion

132
Q

HPV casuing warts

A

2 and 4

133
Q

Referall for cancer

A

urgert = 2weeks
very urgen 48hours

134
Q

Trigeminal neaulrgia signs and symptoms

A

short stabbing pain that lasts a few seconds to a few minutes
casues eltric shock pain
does not usually cross the midline
mask like face
pain on chewing/eating/ touching face

135
Q

Trigeminal nuealrgia occur in

A

more females than males and elerly or over 50years old

136
Q

Causes of trigeminal neaurlgia

A

it affects the 2nd and 3rd branch oft he trigeminal nerve
idopathic
due to facial trauma
secondary to CNS lesion

137
Q

Concerns of trigeminal neurlagia

A

in younger pts - tumour compressing the nerve
Multiple scelorisos

138
Q

Diagnosis of trigeminal neualgia

A

take a good pain hx and medical hx
good clinical exam
MRI - to look at trigeminal root and blood vessels

139
Q

Mangaement of trigeminal neuralgia

A

carbamzepine or oxcarbamzipine
gabapentin
pregablin
phenytoin

140
Q

Carbamzepine

A

starting dose is 100mg and woring up to 200-1200mg a day
start low as side effects - dizziness, ataxia, nausea, skin reactions, thrombocytopenia

141
Q

What to monitor for when on carbazepine

A

LFT
FBC
Renal function test
urea and electrolytes
serum creatine

Thia or chinese test for HLA-B 1502 and if positive avoid as can causes steven johnson’s syndrome

142
Q

Surgery for trigeminal neuarlgia

A

microvascular decompression
LA injected into trigger zone gives temp relief (bupivacine as long duration of action)
gamma knife surgery
streostatic radiosurgery

143
Q

When would you carry out surgery for trigeminal neaulagia

A

if max dose of meds is reached and uncontrollable for pt
pt has severe allergy to drugs
pt is younger and uses a large amount of drugs

144
Q

Pleomoprphism

A

change in szie, shape, strucutre or testure of a cell

145
Q

Tacrolimus onitment

A

immunosupresive agents

146
Q

Pemphigus

A

type 2 hyprsensitvity reaction

147
Q

Inflammatory cells

A

lymphocytes - b - for making antiobides, T cells for killing tumour cells

Marcopharges - kills bacterial and are white blood cells

148
Q

Hyperplasia

A

increase in cell epithelium layers

149
Q

Imunnoloigcal contains

A

apoptotic cells and epithelitropism (lymphocytes on the eipithelium)

150
Q

Keratincovtyes

A

keratin in epidermis for repair

151
Q

Kolicyes

A

found in viral infections - HPV
squamous epithelial cell undergoes changes

152
Q

Mononuclear inflammatory cell infiltraiton around vesicles

A

delays herpsensitivty

153
Q

Epithelium in lymph nodes not normal

A

suggests metaastatic tumour
or part of development anaomaly

154
Q

Metastatic tumour spreads

A

tumour goes in lymp
small clumps of tumour breaks free and into surround lymph nodes
can have growth into lymphatics

155
Q

Migraine

A

affects females more than males
unilateral stabbing pain and persistent

Factors - stress, hormonal imbalance, sleep disturbance
Disturbance of viosion and flashing lights

Special tests - MRI and CT to rule out intracrainal lesions

156
Q

Tension headaches

A

Females more than males - 20-40 years
pressure tightness and bilateral
Factors - stress, sleep distubrance, caffiene consumption high
associated with TMD and myofacial pain

Tx - acupuntuce, anaglesics, antidepressants

157
Q

Cluster headaches

A

affects males more than females , 50years
periods of remission and then reaccurence
Unilateral, periorbial, temporal region, cheek, orbit, forehead

Factors - smoking, alcohol, vasodilateros, high altitiudes
Symptoms - eye watering, droopy eyelid, nasal congestion, periorbital pain, sweeting of cheeck

Tx - oxygen therapy or ca channel blockers (verapamil)

158
Q

Paraoxysmal headaches

A

very similar to cluster headaches but affects females

159
Q

Secondary headaches - giatn cell artiertis (temporal arteritis)

A

It results as a disorder known to casues headaches

Can be seen in people with inflammatory disroder polymyalgia rheumatica
Medical emeergnecy seen in 24hrs
Females >males, 50 years
severe throbbing pain that is unilateral that affects the tempooral region, temporal artery pain and MOM oneating
Vision disturbance, fever, mliase, weight loss

Investigations - FBC, C reactive protein, platlelt count, erythmoycin sedative,
Ultrasounf and biopsy of temporal arterty

Tx - urgernt referal to rhematology or opthamology
High does pred

160
Q

Idiopathic facial pain

A

affects females more than males >50years
daily nagging pain that lasts for 2hrs and over 3months
affects maxilla, unilateral
associated with depressiona and anxiety

Tx - CBT, relation, hyponosis, Antidepressants

161
Q

Burning mouth syndrome

A

a burning sensation within the oral cavity affecting the oral mucosa but no mucosa abnoramialties present
Does not causes sleep disturbance
females >males and 50 years
daily pain for 2 hrs and over 3months
hurts tongues, lips and palate

Special tests - silometry, allergy/patch test
diabetes test
FBC - iron, folate, vit B12
candida - rinse, swab, saliva sample, smear

Tx - capasacin mouthwash
CBT and reassurance

162
Q

Frctional keratosis

A

due to mechanical, thermal or chemical problems
occurs on the buccal mucosa which casues keratnisation and excessive kertanisation

Diagnosis - clinical and exclusions, biopsy if ino doubt
Histopathology - parakeratosis or hyperkeratosis, widening of the prickle cell layer, bacterial plq and parakeratin layer macerated

163
Q

Smokers keratosis

A

smokers nictionic
occurs mainly due to pipe smoking
seen on the palate
- white and cracked
keratin plugs in the duct openings
red spots on the minor salivary glands
stop smoking

164
Q

Fibroeptihelial polp

A

over growth of tissue found on buccal or labial mucosa
pdenucualted and sessile, firm

cause - mechanical trauma
Tx incision under La and stop the truama to prevent reoccurence
Hisotpathlogy - dense fibrous tissue covered by stratified squamous

165
Q

Denture irritiation hyperplasia

A

denture flanges are overextedned due to alveolar bone resoprtion which casoues a leafy fibroepithelial tissue to develop under the denture

166
Q

Lipoma

A

yellow swelling with normal mucosa
also know as a neoplasm

167
Q

Lymphagioma

A

clear fluid caused by dilated lyphmatic channels
common on base of tongue

168
Q

Haemangiomas

A

malformations of blood vessels
blue and blanch on pressure
it is a tumour like overgrowth of tissuee but not continiued growth like a neoplasm (haemartoma) which is a developmental lesion as supposed to acquired heamatoma
blood present in the vessels and continuation with the rest of the body

169
Q

Child haemangioma

A

regresses after 6months

170
Q

Fordyce spots

A

are raised sebaccous glands

171
Q

Black hairy tongue

A

overgrowth of filliform papillae and bacterial pigmentation from commensal flora
Tx - sucking on peach stones or soft brsitle toothbrush

172
Q

Amaglam tatoos

A

grey/black discoouration on mucosa from amalgam
macrpohages taken up the particles and collagen fibres become stained from the silver

exciosional biopsy

173
Q

Whit sponge navus

A

autosmola dominant - mutation in keratin gense 4 and 13
oral muscose white soft thicking, affects whole area and casues folded white areas

Biopsy if concerned - epithelial hyperplasia, parakeratosis and basket weave appearance

174
Q

Geopgraphic tongue

A

benign disorder which cauases a sore and painful tongue
irregular smookth red areas with sharply defined edges on dorsal
Histo - chronic inflammation with neutrophils

Tx -anglesic - benzydamine mw

175
Q

Pathological igmentation

A

exogenous - amalgam tatoos
endogenous - 1. mealin, 2. blood dervided pigments, 3. lipofuscin

176
Q

Melanin

A

casued by mealnocytes in basal layer of epithelium
Secondary mealonisis due to smoking

177
Q

Pigmenttation

A

extricinsic - smoking, paan chewing, chx, drugs
intriisci - melaninin incontini, addisions disease, jaundice

178
Q

Epiuiles

A

an localsied swelling on the gingiivae only
Polp elesewhere

Radiographs and hisot to rule out cancer

179
Q

Pyogenical granuloma

A

a lesion that dvelops anywhere then on the ging

180
Q

Fibrous epulis

A

fibroeptihelial polpy on the ging
Casued by calc or plq or overhanging resotrations
can be recurrent

181
Q

Vascular epulis

A

contain many blood vessels
red flesh ging swelling
occurs in hormanal changes and preganancy or local irriative factors

vascular granulation wih chronic infiltrate and fibrounous crust

182
Q

Giant cell epulis (perpheral giatn cell granuloma)

A

recurrence is high
red and brown friable swelling
radiographs to rule out giant cell graunoloma and hyperparathroydism (intrabony lesions)

183
Q

Granulation tissues contains

A

macrophages
fibrboblasts
enodthelial cells

184
Q

What are giatn cells

A

large and many nuclei

185
Q

Upper lip

A

canicular adenoma

186
Q

Pleomorphic adenoma

A

soft palate and the paoritd gland

187
Q

Anaemia with low microcytic anemia

A

iron defiecinecy
thalssemia

188
Q

Median rhoboid glossitis

A

casues burning mouth syndrome

189
Q

Mouth swab advantages/dis

A

site specfic
dis - painful and uncomfortable, usually contaminated

190
Q

Oral rinse adv/dis

A

mainly organsism as gets from whole side
dis - not site specific adn gets microbes that are not relveant

191
Q

Casues of lichen planus

A

idopathic
amaglam reaction
drugs - beta blockers or ace
stress
trauma
skin disease
genetic predisposition
hep c

192
Q

Geographic tongue

A

loss of tiny papillae found on the dorsum of the tongue

193
Q

Cosackie virsu

A

RNA - hand - foot and mouth, herpagina, aseptic menigintis

194
Q

Adenodi cystic histo

A

no capsule present
cribiform, swiss cheese, tubular

195
Q

Warthins tumour

A

cystic sturucture
monocystic
lyphoid tissues
distincitve epithelium

196
Q

Pleomorphic adenoma

A

complete/incplete capsule
epithelium
duct like structures
mixomatous tisse (soft tumour)`

197
Q

Mucositis grading

A

1 - soreness and erythema
2 - eryhtema, ulcers pt can swallow solid foods
3 - ulcers with extensive, pt cannot swallow foods
4 - mucisitis that cannot swallow and signs of manourhsiment

198
Q

Aciclovir tabs

A

200mg x1 tab x 5 daily for 5 days

199
Q

Aciclovir topical

A

5%, x2g x 5 daily for 5 days

200
Q

Amoxicillcin

A

500mg x 1 tab x 3 daily for 5days

201
Q

Metronidazole

A

400mg x1 tab x3 daily x5 days

202
Q

Pen V

A

250mg x2tabs x4 daily x 5days

203
Q

Saliva proteins

A

mucins
PRP
IgA

204
Q

Saliva enzymes

A

lipase
lisozymes
amalyase

205
Q

TMJ surgery

A

joint replacement
condylectomy
arthroplasty

206
Q

Metastatic cascade

A

intravasation
survive in circulation
arrest in tissue
extravasation
survive extravasation
intial proliferation
established growth

207
Q

Epulis

A

confined to ging only

208
Q

Polyp

A

overgrowth elesewhere in the mucosa

209
Q

Antifungals

A

nystain
miconazole
fluconazole
econazole
ketoconazole

210
Q

Testing for HIV

A

ELISA

211
Q

Treatment for HIV

A

HAART
Highly active antiretroviral therapy

212
Q

HPV diagnosis

A

PCR testing

213
Q

Verrucca vulgaris

A

HPV which casues a common wart - upside down v shaped

214
Q

HIV/AIDS staging

A

1 - acute early infection - asymptomatic, lymphadenopathy >6months, CD4+ cells >500 cells u/L
2 - early infection - weight loss <10%, recurrent respiratory probs, herpes zoster, angular chelitis, recurrent oral ulcerations, CD4+ cells 350-449u/L
3 - late infection - weight loss >10%, NUS, ging, perio, oral hairy leukoplakia, CD4+ cells 200-344u/L
4 - AIDS - <200u/L, Kaposi’s sarcoma, HIV wasting syndrome, extrapillunoary tuberculosis, CNS toxoplasmosis

215
Q

Pyogenic granuloma

A

benigin proliferation of capillary blood vessels
children and young adults

216
Q

Casues of pyogenic granuloma

A

trauma, hormonal, meds (protease inhiborots for AIDS), infection
bleeds with minor trauma - red homogenous and distnict keratnised border
Histo - capillary haemangioma and granulation tissue

217
Q

Paget’s diseases

A

abnormal formation and resoprtion of bone
polystotic fibrous dysplasia
occurs in middle to old age and males greater than females

218
Q

PAget’s disease signs and symptoms

A

mainly the maxilla
bilateral swelling
spacing of teeth
XLA hard due to spacing of teeth
hypercementosis and ankylosis
bleeding increased due to increased blood vessels and slow healing
risk of sacroma

219
Q

Histology of paget’s disase

A

osteoclastic activity predominatoes normal bone resoprtion and replaces with firbous tissue
surface of bone has giant cell osteoclasts in howship lacunae
new bone forms with firbous tissue
osteoblastic actinty continues and bone fuses together to give dense scelortic bone and avascular

220
Q

Radiology of paget’s disease

A

cottown wool appearance
hypercemtnosis
bone resoprtion - cortical thining and loss of lamina dura

221
Q

Mangement of paget’s disease

A

serum alkaline phosphate levels montoired
bispohpsohnates and calitionin
serum, calcium and phosphate levels normal

222
Q

Cherubism

A

automsal dominant condition
wide jaw, puffy cheeks, upwards turning eyes, round cheeks, mobile teeth
perio probs, chewing, swallowing and breathing probs

tx - after puberty as can regress

223
Q

Stafne’s cavity

A

radioloucent area at the angle of the amandible just below the inferior dental canal
depression of cortextf submandibular salivary gland

224
Q

Fibrous dysplasia

A

normal bone is replaced with fibrous bone which grafdual calcifies
facial asymmetry and AOB
mutation of gen eGNAS1
maxilla more common, asymmerty and unilateral
occurs in childhood <10years, swelling, gaps in teeth

225
Q

Histopathlogy of fibrous dysplasia

A

cellular fibrous tissue
irregular islands and metaplstic woven bone
connective tissue matures and bone forms lammelar pattern
loss of lamina dura

226
Q

txo of fibrous dysplasia

A

bisphosphnates to inactive osteoclasts
surgery

227
Q

osteoblasts

A

form bone

228
Q

osteoclasts

A

resorb bone

229
Q

Albrighs syndrome

A

polystotic fibrous dysplasia
fermale
hypothyrodism
hyoparathyroidsmm

230
Q

Gardner’s syndrome

A

hundres of polyps form on the rectum and colon
fibrous fluid cysts, unerupted teeth
bony growht in jaw, fused molars, carious teeth

231
Q

Osteopetosis

A

failure of osteoblasts - bone resoprtion
prone to fractures
marble bone disease
partial failure of tooth eruption little or no bone marrow

232
Q

Hyperparathyroidsm

A

excessive parathyroid hormone
bone resption
1. primary - tumour
seoncdary - hypocalciemai, vit d, liver or kidney disease
middle aged women
teeth lose, exfoliate, loss of lamina dura
tx - increase in serum and pth serum, decrease in serum phosphatase

233
Q

achondraplasia

A

dwarfism
autosomal dominatpoor endochonaral ossificaiton

234
Q

osteoma

A

solitary benign
osteoblasts lay down osteoid and woven bone
occurs in paransal, ethmoidal and frontal sinues
occurs more in males than females
surgery - caldwell luc apporach

235
Q

Osteoblastoma

A

painful fast growing radiopque mass like looking like it attaches to apex
has the poteinaly to become malginant
osteiod bone adn woven bone laid down

236
Q

Osteoprotisis

A

tends to occur more in females
bone reosprtion exceeds bone formation, loss of mineral content of bone and incrased risk of fracutre

casues - age, sex, calcium, physical activty, hormones, cushings, hyperapthryoidism

tx - HRT, bisphosphonates, vit d, anti-reposrtive drugs, fluoride

237
Q

Cementoblastoma

A

neoplasm attached to the apex of a tooth

238
Q

Cemento osseou dysplasia

A

non neoplastic fibrous osseus lesion
middle aged africin women
pa radiolucency but the teeth are vital and don’t reosrb adjacent teeth
Tx - leave alone and avoid xla of adjacent teeth as can cause secondary infeciton

239
Q

Osteomalcia

A

lack of sunglish, vit d
poor enchdonral ossification
law calcium and high alkaline phospahtase

240
Q

Dysplasia

A

abnormal growth

241
Q

Aricterutal dysplasia signs

A

drop shape rete pegs
mitiotic figures incrased
irregular epithelium stratification
keratin pearls with rete pegs
loss of eitheplium stratification
diviosn and keratin throughout epithelium

242
Q

Cytological dysplasia signs

A

cytoplasmic changes
nuclear changes

243
Q

Cellular changes for dysplasia

A

hyperchromatism (darnk nucleus due to DNA content)
pleomorphism (change in size/shape of cell)
atypical mititoci figuers
abnormal cell size
variationin nuclear size

244
Q

carcionoma in situ

A

miotic abnormailities
malgninat but not onivasive
aricture abnormalities throughout layer

245
Q

Basal cell hyperplasia

A

increase in basal cell number
no cellular atypia
regualr stratification

246
Q

mild dysplasia

A

occurs in lower thrid
artiteure changes
basal cell hyperplasia mild plemophorhism and hyperchormatism

247
Q

Moderate dysplasia

A

aritteutre changes in middle third
pleomorphisma dn hyperchromatism

248
Q

Severe dysplasia

A

occurs in upper third - ariteture changes
serve mitotic cells throughout

249
Q

Poteitinally malgninat diseases

A

leukoplakia
erythroplakia
oral submucous fibrous
lichen planus
iron diefiency
teritary syphillis

250
Q

Tertiarty syphillis

A

a mass of granualtion tissue on the tongue

251
Q

Leukoplaikia

A

homogenous - white plq lesions with uniform smooth/wrinkled surface - less malgnancy
non homegenous - keratin and ulceration and nodules present, multiofcsl - higher malignancy

252
Q

Risks of leaukokplaia

A

smoking, tobacco, paan, alocohl, HPV, candida

253
Q

Erythroplakia

A

bright red change in the mucosa - high risk of trasnformation
servre dysplasia - drop rete pegs, nuclear and cellular pleomorphism

254
Q

Oral submous fibrosis

A

occurs in poeple how use paan
fibrous bands on buccal mucosa and pale contrictiing fibrosis on palate
mouth opening is restricted

255
Q

Why white patches white

A

thickening of epithelium and keratin formation

256
Q

Factors for poteintally malgninat issues

A

female
extensive or spreading lesions
lesions on FOM, ventral or, retromolar area, palate, pillar of fauces
red specked and verrucous
multifocal lesions

257
Q

Formation of cancer

A

Initiaitn - mutation in gene
promotion - cell multiplication
transoformation - malgnancy occurs
progression - divides

FINALS!!! (20 decks)

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