Oral Med Tutorial 1

Question 1

what is the epidemiology of OLL

Answer 1

middle-aged females

Question 2

what is the clinical presentation of OLL (4 points)

Answer 2

mostly in buccal mucosa
unilateral
white striations, plaques, erythema, ulcers or blisters
asymptomatic or sensitivity to spicy foods

Question 3

what are the four differences between OLL and OLP

Answer 3

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

Question 4

what is the pathogenesis of OLP

Answer 4

T cell mediated
autoimmune disease
triggering apoptosis of basal cell layer of epithelium

Question 5

what are the six clinical subtypes of OLP

Answer 5

reticular
plaque like
atrophic
erosive
papular
bullous

Question 6

what is the most recognised form of OLP

Answer 6

reticular lesions which appear as a network of connecting and overlapping lines - Wickham’s striae

Question 7

how does erosive OLP present

Answer 7

erythema caused by inflammation or epithelial thinning

Question 8

how does plaque like OLP present

Answer 8

mimics leukoplakia
appears as white, homogenous elevated multifocal smooth lesion

Question 9

name four histological features of OLP

Answer 9

mixed superficial infiltrate
limited to lamina propria
more vascularity
more granulated mast cells in basement membrane degradation area

Question 10

name four histological features of OLL

Answer 10

strict lymphohistocytic infiltrate
deeper distribution to lamina propria and superficial submucosa
no vascularity
focal interruption of the granular later

Question 11

name three potential causes of OLL

Answer 11

restorative materials
GVH disease
hepatitis C

Question 12

what is the cause of OLP

Answer 12

inflammatory auto-immune type disease affecting stratified squamous epithelium

Question 13

how do OLLs commonly present that allows them to be differentiated from OLP

Answer 13

unilateral
asymmetrical
associated with erosions

Question 14

name three features of OLP histology

Answer 14

hyper or parakeratosis
degeneration of the basal layer
T-lymphocytes hugging the basal layer

Question 15

what is the treatment plan for patients with asymptomatic OLP

Answer 15

reassure
monitor
avoid risk factors

Question 16

when should referral be made to Oral Med for OLP

Answer 16

if affecting high risk site

Question 17

what is the treatment plan for symptomatic OLP

Answer 17

referral to oral med
topical corticosteroids

Question 18

what are the two classes of conventional treatment for OLP and OLL

Answer 18

remove or replace any causes or triggers
suppress immune system with corticosteroids

Question 19

what medicines are we allowed to prescribe for OLL or OLP in primary care

Answer 19

beclomethasone MDI
betamethasone rinse

Question 20

what is the dose for beclomethasone MDI

Answer 20

0.5mg/ puff - 2 puffs
2-3 daily

Question 21

what is the dose for betamthasone rinse

Answer 21

1mg in 10ml water
rinse for 2 mins twice daily

Question 22

what is a potential side effect of beclomethasone MDI

Answer 22

oral thrush
dry or sore throat

Question 23

what medications can be prescribe by secondary care dentists only

Answer 23

clobetasol skin steroids cream
hydroxychloroquine
azathioprine, mycophenolate
topical tacrolimus
systemic steroids

Question 24

what are azathioprine and mycophenolate examples of

Answer 24

systemic immunomodulators

Question 25

what is the treatment for mild intermittent lesions of OLP

Answer 25

chlorhexidine mouthwash benzdamine mouthwash avoid SLS containing toothpaste

Question 26

what is sjogren's syndrome

Answer 26

a chronic autoimmune disease which affects exocrine glands

Question 27

name three symptoms of sjogrens syndrome

Answer 27

dry eyes/ mouth pain fatigue

Question 28

what is the epidemiology pf sjogrens syndrome

Answer 28

middle aged women Caucasian women

Question 29

what is the pathogenesis of sjogren's syndrome

Answer 29

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

Question 30

what are the main complaints a patient will have when presenting with Sjogrens syndrome

Answer 30

dry mouth/ eyes difficulty speaking/ swallowing

Question 31

what criteria is used for diagnosing sjogren's syndrome

Answer 31

2016 ACR/ EULAR classification

Question 32

what are the five tests used to diagnose sjogren's syndrome

Answer 32

salivary gland biopsy antibody positivity occular staining score Schirmer test sialometry

Question 33

what is labial gland biopsy examined for when investigating sjogren's syndrome

Answer 33

focal lymphocytic sialadenitis

Question 34

what antibodies are screened for in sjogren's syndrome

Answer 34

anti- SSA/ Ro

Question 35

what is the Schirmer test

Answer 35

analyses volume of lachrymal produced (tears) less than 5mm over 5 mins is indicative

Question 36

what is an indicative score of Sjogren's syndrome for the unstimulated salivary flow test

Answer 36

less than 0.1ml per min

Question 37

name four histological features of the salivary glands in Sjogren's syndrome

Answer 37

ductal and parenchymal changes lymphocytic infiltration and proliferation of lining cells inflammation in salivary gland tissue adipose tissue found

Question 38

what is systemic lupus erythematous

Answer 38

chronic autoimmune disease that affects multiple systems

Question 39

what antibody is found in SLE

Answer 39

anti-nuclear antibody