oral med scenarios Flashcards
A pt attends c/o recurrent oral ulcers. Examination reveals minor apthous ulcers.
Please give this patient advice on apthous ulcers.
- RAS is a common condition (affects females more).
- No single causative factor - low iron / folate / B12, smoking cessation, trauma, psychological factors e.g: stress.
- CAN BE IDIOPATHIC. - Treatment based on the predisposing factor.
- For symptomatic relief, the pt can use chlorhexidine / sodium bicarbonate / benzoyl amine /tetracycline mouthwash.
- topical steroids (beclometasone / hydrocortisone) can be used or systemic when severe.
A pt attends c/o a dry mouth.
What are the possible causes of dry mouth?
- Medications (e.g: anticholinergics, antihistamines, tricyclic antidepressants).
- Anxiety
- Radiation damage to salivary glands.
- Immune-related diseases (e.g: Sjogren’s)
- Dehydration
- Diabetes
- Renal Failure
- Congenital absence of glands (rare).
What dental complications do pts with dry mouths suffer from?
- Difficulty talking and swallowing.
- Altered taste.
- Uncomfortable mouth.
- Unretentive dentures.
- Erythema of the oral mucosa and lobulated dorsum of the tongue.
- Predisposition to:
- angular chelitis
- cervical caries
- secondary caries
- suppurative sialadenitis
A pt presents at your practice with a SORE unilateral lesion next to a heavily restored LL7.
What is the likely diagnosis?
Reticular lichen planus or lichenoid reaction.
What are the clinical subtypes of lichen planus?
- Erosive / Desquamative - chronic painful ulceration.
- Papular - grey thread-like lines, velvety.
- Atrophic - erythematous.
- Plaque-Like
- Bullous - associated with burning sensation with white striae.
What are the predisposing factors of lichen planus?
- Drugs (antimalarials, andiadiabetics, NSAIDs, antihypertensives).
- Amalgam / gold restorative materials.
- Hepatitis and chronic liver disease.
Where else can lichen planus occur?
- Skin
- Nails
- Genitalia
How would you explain to a patient that they have lichen planus?
- Explain it is a common condition called lichen planus.
- Some people have it on their skin or in their mouth.
- Can last for many years.
- Cause is unknown but it can be set off by certain drugs or dental restorative materials.
- Not infectious.
How would you manage a patient with oral lichen planus?
- Take a biopsy to rule out other causes (potential to be malignant).
- Blood tests.
- Replace any amalgam restorations adjacent to the patch.
- Liaise with GP if drugs are a likely cause for any alternatives.
- Monitor regularly to ensure no progression.
- Advise the pt to avoid spices or salty food as this may make the lesions more sore.
- Tx may include benzydiamine hydrochloride mouthwash (difflam) to numb the sore area, topical steroids or steroids injected into the lesions if these don’t provide relief.
A 24 year old woman is complaining of recurrent cold sores on her lip. OE she has herpes labialis.
Explain to her what the sores are and how to manage them.
- Explain that this is a common condition.
- The sores are caused by herpes simplex virus.
- Explain that she would have been infected in the past, with or without symptoms and although recovered, the virus would have remained dormant in the trigeminal nerve.
- this can be reactivated by factors that cause cold sores (sunlight, menstruation, stress, fever, trauma and immunosuppression. - Reassure that this lesion would normally come and go within 7-10 days.
- Tell her that the lesion is contagious and shouldn’t be touched.
- Treatments include aciclovir (antiviral) but must be used when she feels any tingling.
- apply 5x a day to the lesion at the first sing of an attack.
You are reviewing a pt who has had an incisional biopsy for a white patch in their mouth. The report says that the lesion shows features of mild dysplasia.
Please exolain to the pt what this means, the significance and how it may be managed.
- Explain that the biopsy showed some changes in tissue known as dysplasia (abnormal growth).
- This can range from totally normal to carcinoma (cancer).
- this can further be divided into mild, moderate or severe. - Explain that the biopsy showed MILD which means there were some abnormalities but it is not a carcinoma.
- Some lesions will go on to form a carcinoma but others regress - having the lesion just means she is at higher risk of it progressing/oral diseases.
- Explain the management includes reducing risk factors such as smoking and high alcohol intake and treating any underlying conditions.
- Long term monitoring is needed to check progression (photographs, repeat biopsies, potential future surgical removal).
- Reassure the pt they don’t have oral cancer but they need to be aware of the potential for it to develop.
Which type of biopsy, if any, would be required for a fibroepithelial polyp?
Excisional Biopsy
Which type of biopsy, if any, would be required for a haemangioma?
No Biopsy
Which type of biopsy, if any, would be required for a mucocele?
Excisional Biopsy
Which type of biopsy, if any, would be required for herpes labialis?
No Biopsy
