Oral Med Tutorial 1 Flashcards
what is the epidemiology of OLL
middle-aged females
what is the clinical presentation of OLL (4 points)
mostly in buccal mucosa
unilateral
white striations, plaques, erythema, ulcers or blisters
asymptomatic or sensitivity to spicy foods
what are the four differences between OLL and OLP
OLL singular lesions in localised area
OLL appears on less well established sites also (gingiva)
OLL has an aetiological cause
OLL has higher malignancy transformation rate
what is the pathogenesis of OLP
T cell mediated
autoimmune disease
triggering apoptosis of basal cell layer of epithelium
what are the six clinical subtypes of OLP
reticular
plaque like
atrophic
erosive
papular
bullous
what is the most recognised form of OLP
reticular lesions which appear as a network of connecting and overlapping lines - Wickham’s striae
how does erosive OLP present
erythema caused by inflammation or epithelial thinning
how does plaque like OLP present
mimics leukoplakia
appears as white, homogenous elevated multifocal smooth lesion
name four histological features of OLP
mixed superficial infiltrate
limited to lamina propria
more vascularity
more granulated mast cells in basement membrane degradation area
name four histological features of OLL
strict lymphohistocytic infiltrate
deeper distribution to lamina propria and superficial submucosa
no vascularity
focal interruption of the granular later
name three potential causes of OLL
restorative materials
GVH disease
hepatitis C
what is the cause of OLP
inflammatory auto-immune type disease affecting stratified squamous epithelium
how do OLLs commonly present that allows them to be differentiated from OLP
unilateral
asymmetrical
associated with erosions
name three features of OLP histology
hyper or parakeratosis
degeneration of the basal layer
T-lymphocytes hugging the basal layer
what is the treatment plan for patients with asymptomatic OLP
reassure
monitor
avoid risk factors
when should referral be made to Oral Med for OLP
if affecting high risk site
what is the treatment plan for symptomatic OLP
referral to oral med
topical corticosteroids
what are the two classes of conventional treatment for OLP and OLL
remove or replace any causes or triggers
suppress immune system with corticosteroids
what medicines are we allowed to prescribe for OLL or OLP in primary care
beclomethasone MDI
betamethasone rinse
what is the dose for beclomethasone MDI
0.5mg/ puff - 2 puffs
2-3 daily
what is the dose for betamthasone rinse
1mg in 10ml water
rinse for 2 mins twice daily
what is a potential side effect of beclomethasone MDI
oral thrush
dry or sore throat
what medications can be prescribe by secondary care dentists only
clobetasol skin steroids cream
hydroxychloroquine
azathioprine, mycophenolate
topical tacrolimus
systemic steroids
what are azathioprine and mycophenolate examples of
systemic immunomodulators
what is the treatment for mild intermittent lesions of OLP
chlorhexidine mouthwash
benzdamine mouthwash
avoid SLS containing toothpaste
what is sjogren’s syndrome
a chronic autoimmune disease which affects exocrine glands
name three symptoms of sjogrens syndrome
dry eyes/ mouth
pain
fatigue
what is the epidemiology pf sjogrens syndrome
middle aged women
Caucasian women
what is the pathogenesis of sjogren’s syndrome
increase in cytokine production and lymphocyte infiltration
innate - derangement of innate barriers through IFN pathway
adaptive - activation of B cells and proliferation of Th1 and Th17
what are the main complaints a patient will have when presenting with Sjogrens syndrome
dry mouth/ eyes
difficulty speaking/ swallowing
what criteria is used for diagnosing sjogren’s syndrome
2016 ACR/ EULAR classification
what are the five tests used to diagnose sjogren’s syndrome
salivary gland biopsy
antibody positivity
occular staining score
Schirmer test
sialometry
what is labial gland biopsy examined for when investigating sjogren’s syndrome
focal lymphocytic sialadenitis
what antibodies are screened for in sjogren’s syndrome
anti- SSA/ Ro
what is the Schirmer test
analyses volume of lachrymal produced (tears)
less than 5mm over 5 mins is indicative
what is an indicative score of Sjogren’s syndrome for the unstimulated salivary flow test
less than 0.1ml per min
name four histological features of the salivary glands in Sjogren’s syndrome
ductal and parenchymal changes
lymphocytic infiltration and proliferation of lining cells
inflammation in salivary gland tissue
adipose tissue found
what is systemic lupus erythematous
chronic autoimmune disease that affects multiple systems
what antibody is found in SLE
anti-nuclear antibody
