Oral Med - revision notes Flashcards
1
Q
Type I hypersensitivty
A
immediate ttype - allergy or anaphylaxis
2
Q
Type II hypersensitivity
A
antibody mediated reaction
3
Q
Type III hypersensntivity
A
immune complex
4
Q
Type IV hypersentitivty
A
T cell mediated - cell mediated
5
Q
Lichen planus
A
Type IV herpsensntivity reaction where an unknown antigen stimulus on the epitthelium
6
Q
Types of lichen planus
A
- Reticular
- plq
- papular
- erosive
- bullous
- atrphic
- desequamive ging
- aannular
7
Q
What are the potential malginant forms
A
erosive
atrophic
8
Q
Tests
A
Blood tests
patch tests
Biopsy - smokers or painful lesions
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
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
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
12
Q
Local predisposing factors for candida infection
A
dentures
antibiotics
corticosteriods
xerstomia
13
Q
General factors for candida infection
A
imuunocompromised
denture wearer
stress
nutritional deficiency - anemia
extremes of age
smoker
steriod use
diabetes
14
Q
Tx for candidia infection
A
impprove OH
remove casues/trauma
oral suspension - nystatin or miconazole
systemic antifungal - fluconazole
15
Q
Tests for candida
A
biopsy if hyper plastic canddiosis
oral rinse
oral swab
smear
16
Q
Quantification sample
A
salvia sample via rinse probs
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
18
Q
Eryhamatous candidous
A
red patcy areas on palate or dorsum of tongue
low CD4 cell count, seen in HIV infections
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
20
Q
Histopath for hyperplastic candidosis
A
inflammation of the lamina dura
incrsease netruophils in parakeratin layer
parakeratosis - broad rete processes
21
Q
Denture induced candidosis
A
seen in denture wears - poor OH hyg, wearin gndeutre at night
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
23
Q
Sojgrens syndrome
A
an autoimmune inflammatory response which affects the salivary and lacrimal glands
24
Q
Primary sjorens
A
dry eyes and dry mouth but no systemic involvement
25
Secondary sjogrens
dry eyes and dry mouth wih systemic involvement - primary billary cirrhosos, RA, systemic scelorisis, lupus
26
Who most likely to get sjorens
middle aged women
27
Features of sjorens
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
28
Tests for sjorens
schrimer test - <5mm in 5mins of lacrimal flow
sialometry tests - tests unstimulated saliva flow <1.5ml in 15mins
Ultrasound salivary glands
Labial gland biospy
29
+ve sojerns
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
30
Managemetn
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
31
Submandibular salivary gland
wharton's duct empties into sublingual papilla in the floor of the mouth
32
Parotid gland
Stenson's duct at the upper 2nd moalr
33
Common salivary tumour
plemorphic adenoma
34
Imagining for salivary glands
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
35
Sialography when can it not be used
imaging of the submandibular gland as cannot be cannulated
glands which have inflammation or infection present
36
Casues of dry mouth
drugs - antidepressants, antihistamines, ace inhibitors
anxiety
diabetes
degenerative disesses of salivary glands
conditions - stroke, diabetes, sjogrens,
radio/ chemo
37
Obsturcutive salivary gland disorders
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),
38
Calculi
hard yellow structures/massses
39
Common intraductal obstruction
submandibular then the parotid
40
Sialodentitis
viral - mumps - paramyxovirus - occurs in parotid gland
Bacterial - mainly paorotid - antibiotics, warm salty mw, highly contagioua, massage to encourage flow
41
Sarcodosis
bilateral swelling of the parotid gland casued by chronic granuolmatous
lacrimal glands can also be affect
42
Sialosis
recurrent bilateral swellingof the salivary glands
non inflammatory and non neoplasitc
43
Underlying causes of sialosis
liver diseases
malnutrition
alcoholism
eating disorders
hormonal abnormalities
44
Calculi also know as
sialoliths
45
Casues of hypersalivation
stroke
MS
Alzehiermers
CJD
drugs - nicarclipine
cerbral palsy
percieved - anixety, motor neurone
46
Management of hypersalivation
antimuscarninic drugs - amitriptyline
biomechanical training
treat causes
surgery - gland removal/duct repositioning
47
Mucoceles form
when trauma to the minor salivary glands which spills into an adjacent connectie tissue
48
Mucocele vs mucous retention cysy
Mucocele - occur in lower lip, children, trauma, lined by granulation
Mucous retention cyst - lined by epithelium, upper, adults, cystiic dilation of duct
49
Sialodentitis
a salivary gland infection usually viral or bacterial
50
Tx for salivary stones
endoscopically with form of basket
51
Tx for strictures
balloon duc dilation
52
What is sialography
a washing effect of the glands if there are no stones present
53
Prognosis of salivary gland tumour
stage
grade
type
54
Where are salivary gland tumours most common?
Parotid gland
55
Most malgninat salivary gland tumours
sublingual gland
56
Symptoms of salivary gland tumour
pain
facial palsy
lump
asymmtery
57
Benging tumours
warthins tumour
Pleomorphic adenoma
Basal cell adenoma
58
Pleomorphic adenoma
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
59
Warthin's tumour
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
60
Cause of warthin's tumour
casues to form from remnants of slaivary ducts which is trapped in lymph nodes and proliferates to form tumour
61
Soft tissue salivary gland tumours
bening fatty tumours
contain saliva parechyma - sialolipoma
62
Malginant tumours
Adenoid cysytic tumour
Mucoepidemoid carcinoma
acininic carcinoma
63
Adenoid cystic carncinoma
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
64
Mucoepidermoid carcinoma
younger and middle aged -minor salivary gland
mucous (glandular)
sqaumous (epithelim)
not likley to spread lymphatic system
65
Acinar cell carcinoma
rare form
differentiation towards salvary acinar cells
66
Saliviary gland cysts
minor glands due to trauma
blue swelling
67
Mucous extravasation cyst
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
68
Mucous retention mucocele
occurs due to truama on the upper labial mucosa and containts an epithelium ductal lining
clear saliva, minor inflamation and no macrophages
69
Diagnosis of mucocele
fine needle aspirate and imagining
no intervention unless lymphomatous infiltration = excioinal surgery
70
Ranula
mucous cysts from sublingual gland on the floor of the mouth
71
Changes of epithelium
metaplasia due to chronic irritiaiton
72
Granuloma
a collection of macrophages in the tissues
73
at type of biopsy for granuoloma
deep biopsy as in the underlying muscle
74
Macrophages
mononuclear macrophages
epidermoid macrophages
langer han cells
75
OFG causes
granuolomas in the oral mucosa
lip swelling
assoicted with food allergies - benozate
76
OFG hypersentitvity
Type IV which develops to Type 1 when lymphatics involved
77
rohn's diseases
chronic granumulotisis of the lining of the GI tract - mainly the ileum
78
Signs and sympomts o fchron's diseases
cooblestone mucosa
mucosal tags (hyperplasia)
glossitis
angular chelitis
lip swelling
and cheeks
79
Management of OFG
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
80
Vesicubuollous seen in
viral infections
drug interactions
autoimuune conditions
genetics
81
Anging Bullosa haemorigca
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
82
Erythema multiforme
skin and moucous affects and the lips ulcerated
target lesions on skin
recuttent bullous eruptions
younger males
type II hypersentivitiy reaciton - herpes simplex virus
83
Tx for erythema multiforme
long term high dose steriods - prednisolone
anaglesics
hydration
antiseptic mw - chx or benzydamine mw
allergy test
aciclovir
84
Pemphigoid
blisters and erythematous present
valvovaginal region, oral mucosa and conjunctvi
85
Pemphigoid what is it
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
86
Diagnosis of pemphigoid
direct immunofluroscence and inderect showing circulating antibodies (C3)
87
Tx for pemphgoid
OHI for desquamative ging
topical steriods
systemic steriods
88
Pemhigus vulgaris
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
89
Diagnosis of pemphigus
direct immunofluorsence shows basket weave appearance
90
Tx for pemhigus
topical steriods
systemic steriods
91
What type of hypersensitive is pemhpigoid and pemphigus
Type II
92
Ulcerations
complete loss of epithellium
mainly on lower lip
93
Casues of trauma
chemical burns - aspirin
thermal burns
mechanical from other teeth
ill fitting dentures
habits - self harming, finger picking
rough/hard food stuffs
94
Drugs casues of ulceration
phenytoin, nicorandil
cytotixic drugs
95
General causes for ulceration
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
96
Diagnosis of ulcerations
clincial exam
blood tests and heamatinics - folate, ferritin, vit B12 serum
97
Tx for ulcers
remove the cause or known trigger
Benzydamine or chx mw
SLS free toothpaste
betamethasone mw
avoid dieting triggers
correct any deficinecies
beclomethansone inhaler
98
Minor recturrent apthous ulcers
<10mm in size
found on non keratinsied mucosa
heal with no scarring
heal within 10-14days
red halo with fibrin base
round and oval
99
Major RAS
>10mm in size
heal with scarring
can be found anywhere in oral mucosa
lasts for few weeks
oval or irregular shape
100
Bechet's Diseases
painful disease which invovle ulcerations on mucosa, genitals and eyes
blood vessal inflammation throughout the body
101
Heptiform ulcerations
multiple small ulcers on non keratinised mucousa
heals within 1-2weeks
102
Non keratnised epithelium
soft palate
ventral of tongue
inner lips and cheeks
FOM
103
Keratnised epithlium
Hard palate
gingigvae
dorsal of tongue
104
Casues of ulceration
trauma
Bechet's diseases
infection - bacterial or fungal
immunological
GI - chorns' UC, coleiac
defiecinecies - anaemia, haeamatininc
carcionanoma
smoking
family hx
hormonal fluctuations
105
Kaposis Sacroma
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
Hairy leukoplaia
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
Human Paplillom virus
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
Epstein barr virus
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
Herpes simplex virus
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
2. 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
Varacella zoster
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
Biopsy for squamous cell papilloma
excisional biopsy
112
Normal node size
1cm
113
Oral cancer sities
FOM
lateral vorder of tongue
HP
SP
Buccal mucosa
ging
114
Risk factors
smoker - FOM
betal quid - esepcially buccal and labial mucosa
alcohol
socioeconmic status
UV on lip
Diet low on antioxidiants
Virus - HPV -orpharyngeal cancer
115
Symptoms and red flags of oral cacner
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
Stages of cacner
size
site
spread
tx options
multiple primaries
117
Grading crieiteria
ability to carry out same function as tissue of origin
resemebles the same cells to the tissue of origin
118
Staging cancer
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
Types of oral cancer
malginant melanoma
maliginant lymphoma
lesukaemia
squamous cell carciionma
120
Malginant melanoma
palaltal and ging mucosa
brown pigmented patch or raised nodule
121
Malginant lymphoma
extranodal lymphoma in Waldery's ring, soft palate base of tongue and tonsils
lymph nodes involved
122
Leuakemia
causes ging bleeding and ulceration
Child leaukaemia - cuases ging enlargement due to direct infiltrate of leaukaematic cells
123
Signs of SCC
hard fixed ulcer with rolled margins and necrotic base
tongue can be fixed to FOM
Tongue deviates on rptorusion in oropharnygeal cancer
124
SCC arires from
Maxiallry sinus
larynx
nasopharynx
125
Histology of SCC
Cohesive/non cohesive front
keratinations
keratin pearls/whorles
increases mittoitc activity
nuclear hyperchromatism
nuclear and cellular pleomorphism
126
SCC carncionma bone invasion
MRI or CT
bone invasion due to cortical resorption
127
How to detect cancer in nodes
fine needle aspirate or core biopsy
128
SCC tx
surgery
radio - mucositis, dry mouth, path fracture, trisumus, osteoradionecorisis, ulcerations
chemo
129
Cohesive front
metatasis to lymph nodes rare
tissue extending at same pace
130
Non cohesive front
metatasis to lypmph nodes high
tissue not extening at same pace
131
Squamous cell pailloma
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
HPV casuing warts
2 and 4
133
Referall for cancer
urgert = 2weeks
very urgen 48hours
134
Trigeminal neaulrgia signs and symptoms
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
Trigeminal nuealrgia occur in
more females than males and elerly or over 50years old
136
Causes of trigeminal neaurlgia
it affects the 2nd and 3rd branch oft he trigeminal nerve
idopathic
due to facial trauma
secondary to CNS lesion
137
Concerns of trigeminal neurlagia
in younger pts - tumour compressing the nerve
Multiple scelorisos
138
Diagnosis of trigeminal neualgia
take a good pain hx and medical hx
good clinical exam
MRI - to look at trigeminal root and blood vessels
139
Mangaement of trigeminal neuralgia
carbamzepine or oxcarbamzipine
gabapentin
pregablin
phenytoin
140
Carbamzepine
starting dose is 100mg and woring up to 200-1200mg a day
start low as side effects - dizziness, ataxia, nausea, skin reactions, thrombocytopenia
141
What to monitor for when on carbazepine
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
Surgery for trigeminal neuarlgia
microvascular decompression
LA injected into trigger zone gives temp relief (bupivacine as long duration of action)
gamma knife surgery
streostatic radiosurgery
143
When would you carry out surgery for trigeminal neaulagia
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
Pleomoprphism
change in szie, shape, strucutre or testure of a cell
145
Tacrolimus onitment
immunosupresive agents
146
Pemphigus
type 2 hyprsensitvity reaction
147
Inflammatory cells
lymphocytes - b - for making antiobides, T cells for killing tumour cells
Marcopharges - kills bacterial and are white blood cells
148
Hyperplasia
increase in cell epithelium layers
149
Imunnoloigcal contains
apoptotic cells and epithelitropism (lymphocytes on the eipithelium)
150
Keratincovtyes
keratin in epidermis for repair
151
Kolicyes
found in viral infections - HPV
squamous epithelial cell undergoes changes
152
Mononuclear inflammatory cell infiltraiton around vesicles
delays herpsensitivty
153
Epithelium in lymph nodes not normal
suggests metaastatic tumour
or part of development anaomaly
154
Metastatic tumour spreads
tumour goes in lymp
small clumps of tumour breaks free and into surround lymph nodes
can have growth into lymphatics
155
Migraine
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
Tension headaches
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
Cluster headaches
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
Paraoxysmal headaches
very similar to cluster headaches but affects females
159
Secondary headaches - giatn cell artiertis (temporal arteritis)
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
Idiopathic facial pain
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
Burning mouth syndrome
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
Frctional keratosis
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
Smokers keratosis
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
Fibroeptihelial polp
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
Denture irritiation hyperplasia
denture flanges are overextedned due to alveolar bone resoprtion which casoues a leafy fibroepithelial tissue to develop under the denture
166
Lipoma
yellow swelling with normal mucosa
also know as a neoplasm
167
Lymphagioma
clear fluid caused by dilated lyphmatic channels
common on base of tongue
168
Haemangiomas
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
Child haemangioma
regresses after 6months
170
Fordyce spots
are raised sebaccous glands
171
Black hairy tongue
overgrowth of filliform papillae and bacterial pigmentation from commensal flora
Tx - sucking on peach stones or soft brsitle toothbrush
172
Amaglam tatoos
grey/black discoouration on mucosa from amalgam
macrpohages taken up the particles and collagen fibres become stained from the silver
exciosional biopsy
173
Whit sponge navus
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
Geopgraphic tongue
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
Pathological igmentation
exogenous - amalgam tatoos
endogenous - 1. mealin, 2. blood dervided pigments, 3. lipofuscin
176
Melanin
casued by mealnocytes in basal layer of epithelium
Secondary mealonisis due to smoking
177
Pigmenttation
extricinsic - smoking, paan chewing, chx, drugs
intriisci - melaninin incontini, addisions disease, jaundice
178
Epiuiles
an localsied swelling on the gingiivae only
Polp elesewhere
Radiographs and hisot to rule out cancer
179
Pyogenical granuloma
a lesion that dvelops anywhere then on the ging
180
Fibrous epulis
fibroeptihelial polpy on the ging
Casued by calc or plq or overhanging resotrations
can be recurrent
181
Vascular epulis
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
Giant cell epulis (perpheral giatn cell granuloma)
recurrence is high
red and brown friable swelling
radiographs to rule out giant cell graunoloma and hyperparathroydism (intrabony lesions)
183
Granulation tissues contains
macrophages
fibrboblasts
enodthelial cells
184
What are giatn cells
large and many nuclei
185
Upper lip
canicular adenoma
186
Pleomorphic adenoma
soft palate and the paoritd gland
187
Anaemia with low microcytic anemia
iron defiecinecy
thalssemia
188
Median rhoboid glossitis
casues burning mouth syndrome
189
Mouth swab advantages/dis
site specfic
dis - painful and uncomfortable, usually contaminated
190
Oral rinse adv/dis
mainly organsism as gets from whole side
dis - not site specific adn gets microbes that are not relveant
191
Casues of lichen planus
idopathic
amaglam reaction
drugs - beta blockers or ace
stress
trauma
skin disease
genetic predisposition
hep c
192
Geographic tongue
loss of tiny papillae found on the dorsum of the tongue
193
Cosackie virsu
RNA - hand - foot and mouth, herpagina, aseptic menigintis
194
Adenodi cystic histo
no capsule present
cribiform, swiss cheese, tubular
195
Warthins tumour
cystic sturucture
monocystic
lyphoid tissues
distincitve epithelium
196
Pleomorphic adenoma
complete/incplete capsule
epithelium
duct like structures
mixomatous tisse (soft tumour)`
197
Mucositis grading
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
Aciclovir tabs
200mg x1 tab x 5 daily for 5 days
199
Aciclovir topical
5%, x2g x 5 daily for 5 days
200
Amoxicillcin
500mg x 1 tab x 3 daily for 5days
201
Metronidazole
400mg x1 tab x3 daily x5 days
202
Pen V
250mg x2tabs x4 daily x 5days
203
Saliva proteins
mucins
PRP
IgA
204
Saliva enzymes
lipase
lisozymes
amalyase
205
TMJ surgery
joint replacement
condylectomy
arthroplasty
206
Metastatic cascade
intravasation
survive in circulation
arrest in tissue
extravasation
survive extravasation
intial proliferation
established growth
207
Epulis
confined to ging only
208
Polyp
overgrowth elesewhere in the mucosa
209
Antifungals
nystain
miconazole
fluconazole
econazole
ketoconazole
210
Testing for HIV
ELISA
211
Treatment for HIV
HAART
Highly active antiretroviral therapy
212
HPV diagnosis
PCR testing
213
Verrucca vulgaris
HPV which casues a common wart - upside down v shaped
214
HIV/AIDS staging
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
Pyogenic granuloma
benigin proliferation of capillary blood vessels
children and young adults
216
Casues of pyogenic granuloma
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
Paget's diseases
abnormal formation and resoprtion of bone
polystotic fibrous dysplasia
occurs in middle to old age and males greater than females
218
PAget's disease signs and symptoms
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
Histology of paget's disase
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
Radiology of paget's disease
cottown wool appearance
hypercemtnosis
bone resoprtion - cortical thining and loss of lamina dura
221
Mangement of paget's disease
serum alkaline phosphate levels montoired
bispohpsohnates and calitionin
serum, calcium and phosphate levels normal
222
Cherubism
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
Stafne's cavity
radioloucent area at the angle of the amandible just below the inferior dental canal
depression of cortextf submandibular salivary gland
224
Fibrous dysplasia
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
Histopathlogy of fibrous dysplasia
cellular fibrous tissue
irregular islands and metaplstic woven bone
connective tissue matures and bone forms lammelar pattern
loss of lamina dura
226
txo of fibrous dysplasia
bisphosphnates to inactive osteoclasts
surgery
227
osteoblasts
form bone
228
osteoclasts
resorb bone
229
Albrighs syndrome
polystotic fibrous dysplasia
fermale
hypothyrodism
hyoparathyroidsmm
230
Gardner's syndrome
hundres of polyps form on the rectum and colon
fibrous fluid cysts, unerupted teeth
bony growht in jaw, fused molars, carious teeth
231
Osteopetosis
failure of osteoblasts - bone resoprtion
prone to fractures
marble bone disease
partial failure of tooth eruption little or no bone marrow
232
Hyperparathyroidsm
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
achondraplasia
dwarfism
autosomal dominatpoor endochonaral ossificaiton
234
osteoma
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
Osteoblastoma
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
Osteoprotisis
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
Cementoblastoma
neoplasm attached to the apex of a tooth
238
Cemento osseou dysplasia
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
Osteomalcia
lack of sunglish, vit d
poor enchdonral ossification
law calcium and high alkaline phospahtase
240
Dysplasia
abnormal growth
241
Aricterutal dysplasia signs
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
Cytological dysplasia signs
cytoplasmic changes
nuclear changes
243
Cellular changes for dysplasia
hyperchromatism (darnk nucleus due to DNA content)
pleomorphism (change in size/shape of cell)
atypical mititoci figuers
abnormal cell size
variationin nuclear size
244
carcionoma in situ
miotic abnormailities
malgninat but not onivasive
aricture abnormalities throughout layer
245
Basal cell hyperplasia
increase in basal cell number
no cellular atypia
regualr stratification
246
mild dysplasia
occurs in lower thrid
artiteure changes
basal cell hyperplasia mild plemophorhism and hyperchormatism
247
Moderate dysplasia
aritteutre changes in middle third
pleomorphisma dn hyperchromatism
248
Severe dysplasia
occurs in upper third - ariteture changes
serve mitotic cells throughout
249
Poteitinally malgninat diseases
leukoplakia
erythroplakia
oral submucous fibrous
lichen planus
iron diefiency
teritary syphillis
250
Tertiarty syphillis
a mass of granualtion tissue on the tongue
251
Leukoplaikia
homogenous - white plq lesions with uniform smooth/wrinkled surface - less malgnancy
non homegenous - keratin and ulceration and nodules present, multiofcsl - higher malignancy
252
Risks of leaukokplaia
smoking, tobacco, paan, alocohl, HPV, candida
253
Erythroplakia
bright red change in the mucosa - high risk of trasnformation
servre dysplasia - drop rete pegs, nuclear and cellular pleomorphism
254
Oral submous fibrosis
occurs in poeple how use paan
fibrous bands on buccal mucosa and pale contrictiing fibrosis on palate
mouth opening is restricted
255
Why white patches white
thickening of epithelium and keratin formation
256
Factors for poteintally malgninat issues
female
extensive or spreading lesions
lesions on FOM, ventral or, retromolar area, palate, pillar of fauces
red specked and verrucous
multifocal lesions
257
Formation of cancer
Initiaitn - mutation in gene
promotion - cell multiplication
transoformation - malgnancy occurs
progression - divides
