Oral Medicine Flashcards
1
Q
5 signs / symptoms of TMD
A
Headache Earache/ ear pain Muscle pain Joint pain Trismus Clicking / popping noises Crepitus Masseter Hypertrophy
2
Q
5 Aspects of Causative Advice for TMD
A
Soft diet
Stop parafunctional habits (e.g. nail biting/ chewing gum)
Support mouth upon opening (e.g. when yawning)
Relaxation (e.g. physiotherapy / acupuncture)
Hot/ Cold compresses
Chew Bilaterally
Cut food into smaller pieces
Avoid wide opening
3
Q
Dawn is a final year university student and is a regular attender at your practice. She presents in the Easter
holidays complaining of difficulty opening her mouth widely, facial pain and jaw clicking when chewing food. You
suspect she has temporomandibular joint dysfunction syndrome.
What information could be elicited from your clinical examination in relation to your suspected diagnosis?
A
Range of movement
TMJ clicking / crepitus
MoM hypertrophy
Tenderness on palpation
Intra-oral:
- Interincisal opening distance (measure norm is 35-55mm)
- Signs of bruxism (wear facets / scalloped tongue / linea alba)
4
Q
What factors could predispose to temporomandibular dysfunction?
A
Females more commonly affected than males (2:1 ratio)
Usually in 18-30 yr old range
Stress
Habits - chewing gum / pen / nail biting / bruxism
5
Q
First Line Management for TMD
A
Councilling
Reassurance
Soft Diet
Mastication on both sides
Avoid wide opening / Supported mouth opening
Stop habits - gum/ nails / bruxism etc
Cut food into small pieces
Analgesic advice
Cold/ hot compress
Splint therapy: Hard or soft splint, Michigan (bite raising appliance)
Joint therapy: acupuncture / physiotherapy / relaxation therapy / CBT
Medication: ibuprofen / paracetamol / muscle relaxants (tricyclic antidepressants e.g. amitriptyline)
6
Q
Are there any other conditions that might present with similar signs/symptoms to TMD and how might you exclude these?
A
Myofascial pain syndrome: no clicking
Pericoronitis of L8: no clicking
Temporal/ Giant Cell Arteritis: tender scalp, double vision, generally feeling unwell
Trigeminal Neuralgia: usually has trigger, intense stabbing pain that comes in episodes
Cluster headaches: look up
7
Q
You decide to construct a stabilisation splint for a TMD patient. As your technician is unsure what this is, describe how you would
like your splint made.
A
Cover all teeth Hard acrylic Full occlusal coverage Upper and lower alginates Face bow registration required Requires to be ground in both in the lab and clinically to achieve maximum bilateral intercuspation Wear facets Sloping canine guide plane
8
Q
A 48-year-old male patient presents for the first time in your practise. He is otherwise fit and healthy and takes no
medications. He also wears a complete upper denture which is 9 years old.
What is noticeable about the patient’s palatal tissue?
A
Erythematous
Papillary Hyperplasia
9
Q
A 48-year-old male patient presents for the first time in your practise. He is otherwise fit and healthy and takes no
medications. He also wears a complete upper denture which is 9 years old the palatal mucosa is erythematous and there is papillary hyperplasia. What diagnosis would you make
A
Denture induced stomatitis
10
Q
First line treatment for Denture induced stomatitis
A
Denture hygiene advice inc; cleaning
Tissue conditioner on the fitting surface of the denture
11
Q
Secondary line of treatment for denture induced stomatitis if denture cleaning instruction and tissue conditioner do not work
A
Fluconazole (systemic) (interacts w/ warfarin + statins) Miconazole gel (topical) Chlorhexidine mouthwash (topical) Nystatin (can be used if fluconazole + miconazole are contraindicated)
12
Q
You decide to make a new denture for stomatitis patient. What instructions would you give to the lab technician regarding the
construction of the upper special tray for the new master impression?
A
Please construct an upper special tray with a 2mm wax spacer, intra-oral handles, non-perforated, intra-oral finger
rests in light cure PMMA
13
Q
What features in the clinical appearance would make you highly suspicious that the lesion was potentially malignant?
A
exophytic growth
raised rolled margins
indurated
14
Q
A patient presents for a regular check-up when you notice a lesion that is white and lacey in appearance in the left
buccal mucosa. What is your diagnosis?
A
Lichenoid tissue reaction
15
Q
What made you arrive at the diagnosis of Lichenoid Tissue Reaction and how does this condition occur?
A
As lesion is adjacent to large amalgam restoration
Type IV hypersensitivity reaction
16
Q
Name 2 types of biopsy you could carry out to investigate a suspected lichenoid tissue reaction lesion
A
Incisional biopsy (punch) Fine needle aspiration
17
Q
Name 4 histopathological features of Lichenoid Tissue Reaction
A
Keratinisation "Hugging" band of lymphocytes Basal cell liquefaction Apoptosis Sawtooth appearance of rete pegs
18
Q
Candida Infection. Picture showing redness in corner of mouth. Whats likely diagnosis
A
Angular cheilitis
19
Q
Name 2 microorganisms involved in angular chellitis
A
Staphylococcus aureus
Candida albicans
20
Q
What microbiological sampling method should you ask for? Testing for angular chellitis
A
Swab
21
Q
Name one immune deficiency disease and one gastrointestinal intestinal bleeding disease. And why are they more susceptible for angular chelitis.
A
HIV: impaired immune function
Coeliac: impaired nutrient absorption
22
Q
Name one intra-oral disease that would be associated angular chellitis
A
Oral facial granulomatosis
23
Q
Why is miconazole prescribed to patient when microbiological sampling is not available?
A
Its a broad spectrum anti-fungal, effective against both fungi and bacterial pathogens
24
Q
What two instructions should be given to this angular chellitis patient who wears a denture.
A
Denture hygiene: soak in chlorhexidine or sodium hypochlorite (for acrylic only)
Wear as little as possible during treatment phase
25
A patient attends with inflamed gingiva extending beyond the mucogingival margin. Give a diagnosis
Desquamative gingivitis
26
Give 1 descriptive term to describe desquamative gingivitis appearance
Erythematous
| Ulcerated
27
Give 3 oral mucosal conditions associated with desquamative gingivitis
Pemphigus
Pemphigoid
Lichen planus
28
Give 2 local factors that may contribute to desquamative gingivitis
SLS
| Plaque
29
What are 2 typical treatments you could use for desquamative gingivitis
Betamethasone mouthwash
| Tacrolimus ointment
30
What is a method of testing for pemphigus vulgaris?
Direct immunofluorescence
31
What would the pathologist report with the result of the test that was positive for pemphigus vulgaris?
Supra-basal split
presence of Tzank cells
Basket weave immunofloresence
desmosomes attacked
32
Reasons behind this pemphigus vulgaris
Autoimmune
| Type 2 hypersensitivity reaction
33
Name one condition that would represent the lesion in the same way clinically (pemphigus vulgaris), but would be different histopathologically?
Drug-induced pemphigus
34
This patient has a squamous cell carcinoma at the lateral border of the tongue. It is 5cm in width. There are bilateral ipsilateral lymph nodes palpated but <2cm. The presurgical examination shows that the cancer is not
spread to any other structures.
List only two factors for oral squamous cell carcinoma.
Alcohol
Smoking
HPV
35
Stage tumour with TNM system
T3 N2 M0
| GO BACK AND ADD TNM SYSTEM EXPLANATION
36
How would you grade the dysplasia histopathologically?
Hyperplasia
Dysplasia (mild/moderate/severe)
Carcinoma in situ
37
What interventions (medical or surgical) other than surgery could the patient have for oral squamous cell carcinoma
radiotherapy
chemotherapy
immunotherapy
38
After removal of the lesion (oral squamous cell carcinoma), how would you restore the function of the tongue?
Soft tissue grafting
39
Organism that causes denture stomatitis
C. albicans
40
3 local factors for denture stomatitis
```
Poor denture hygiene
Wearing denture overnight / not removing denture regularly enough
Trauma
Smoking
Xerostomia
Corticosteroid inhaler use
```
41
4 management options for denture stomatitis
```
Chlorhexidine MW 2x daily
Denture hygiene
Tissue conditioner
Systemic Antifungal (Fluconazole)
Topical Antifungal (Miconazole gel)
Smoking cessation
Rinse + gargle after inhaler use
```
42
What will be seen on occlusal surfaces of teeth and what should you do short term - denture stomatitis pt
Erosion due to inhaler
Rinse mouth after inhaler use
Fluoride varnish
43
Name 3 types of Recurrent Aphthous Ulcer
Major
Minor
Herpetiform
44
State difference between major/minor recurrent apthous stomatitis/ ulcers
Minor: 1-20 ulcers, <10mm, heals in 1-2weeks, heals without scar, generally on non-keratinised mucosa
Major: Usually singular, 1-5, >10mm, heals with scar, heals within 6-12 weeks, can be found on all types of mucosa
45
Causes of Recurrent Aphthous Stomatitis
Haematinic deficiency (iron, B12, folate)
Trauma
SLS toothpaste
Allergy
Dietary problems
Anxiety & stress
Systemic disease: Menorrhoea / Chronic GI blood loss
Dietary malabsorption (Pernicious anaemia, Coeliac, Crohns), Ulcerative colitis
46
Treatment of Recurrent Apthous stomatitis / ulcers
```
Chlorhexidine: x2 daily (0.2%) 10ml
Dietary avoidance (chocolate, cinnamon aldehyde, benzoates)
Toothpaste change (SLS-free)
Blood tests + correct deficiency (e.g. iron), Betamethasone mouthwash (0.5mg x2-4 times daily)
```
47
Potential problems of Recurrent Aphthous Stomatitis
Dehydration
| Infection
48
Describe the nature of the pain from trigeminal neuralgia
Unilateral (usually)
Sharp shooting pain, electric shock like, lasting a few seconds
Pain is episodic
Severe paroxysmal pain
May have trigger e.g. eating, talking, etc.
49
The 2 most frequent causes of trigeminal neuralgia are? Name an investigation you could do into these.
1. Focal demyelination of the peripheral nerve
2. Trigeminal nerve compression from aberrant artery
Investigation: MRI
50
If the patient had Trigeminal Neuralgia due to MS or a brain tumour what symptoms might they experience? 1 for MS, 2 for brain
tumour.
MS: intention tremor / loss of proprioception
Brain Tumour: diplopia / memory loss
51
How would you manage a trigeminal neuralgia patient pain? Give 1 surgical and 1 medical
Carbamazepine 100mg (1 tab) x2 daily
Microvascular decompression
Balloon compression
Gamma Knife
52
What investigation/tests would you take before giving a patient carbamazepine for trigeminal neuralgia and why?
Blood tests - FBC, Liver function test (LFT), urea & electrolytes
Because it reduces sodium and can be toxic to liver / reduce liver function
53
Give 3 side-effects of this Carbamazepine intervention for trigeminal neuralgia
```
GI disturbances
Drowsiness
Headache
Facial dyskinesias (impairment of voluntary movement)
Weight gain
Vomiting
Electrolyte imbalance (hyponatremia)
Thrombocytopenia (low platelet count)
```
54
Intra-oral manifestations of herpes?
Herpes labialis
Primary herpetic gingivostomatitis
Oral ulceration
55
Three causes of vesicles?
Erythema multiforme
Pemphigoid
Pemphigus
56
2 virus groups that cause oral ulceration?
Herpes simplex
Coxsackie virus
Epstein Barr virus
Varicella Zoster virus
57
Example of Coxsackie oral lesions?
Herpangina
| Hand foot and mouth disease
58
Disorders caused by Epstein Barr Virus? (Human Herpes Virus 4)
```
`Hairy Leukoplakia
Glandular fever (infectious mononucleosis) Burkitt’s lymphoma
```
59
How herpes labialis forms?
```
Primary infection
Latency
Reactivation (Upper = maxillary, Lower = mandibular)
Secondary infection: causing a
herpes labialis lesion
```
CHECK THIS
60
2 med conditions associated with acute pseudomembranous candidiasis
HIV
| Poorly controlled diabetes
61
Swab + rinse – advantages and disadvantages of each
Swab - Adv: site specific Dis: uncomfortable, Rinse - Adv: quantifiable amount Dis: more difficult to standardise
62
What to ask pathologist for when sending candida sample
Culture and sensitivity
63
2 drugs that interact with Fluconazole and the effects
Warfarin: Fluconazole is a strong inhibitor of an enzyme in Warfarin metabolic pathway which may lead to increased bleeding and risk of myopathy and rhabdomyolysis.
Statins: Hepatotoxicity
64
2 Investigations for Aphthous Ulcers
Haematinics
| FBC
65
2 causes of microcytic anaemia
Iron deficiency
| Thalassaemia
66
3 topical treatments available for apthous ulcers - not brand name
Benzydamine
Fluticasone
Beclomethasone
Doxycycline
67
Mid age female complaining of burning mouth with diffuse erythema
Oral dysaesthesia
68
Male mid age, dull throbbing pain in maxillary region, made worse by bending over
Sinusitis
69
Unilateral episodic pain lasting up to 20 mins, nose dripping + worse when shaking head
Chronic Paroxysmal Hemicrania
70
Elderly pt + sharp shooting pain in right cheek when biting + lacrimation
Trigeminal Neuralgia
71
Temporal pain + weakness of shoulder muscles
Temporal arteritis (accompanied by shoulder girdle weakness)
72
Causes of Denture induced stomatitis
```
Immunosuppressed
Poor dental hygiene
Dentures worn over night
Trauma from ill fitting dentures
Xerostomia.
Systemic steroids & broad spectrum antibiotics
```
73
Denture hygiene instructions for denture stomatitis
Soak in Chlorhexidine mouthwash
Soak denture x2 daily (15mins) and rinse mouth x2 + Alkaline hypochlorite/Sodium
hypochlorite (10 mins CoCr, 20 mins PMMA)
Leave dentures out as often as possible
Brush denture after every meal with soft brush (esp on fitting surface)
Take out at night time and leave in water overnight
Brush palate daily
74
Treatment If denture hygiene doesn’t work:
Antifungals (Miconazole, Nystatin)
Tissue conditioner
New dentures: when resolved denture induced stomatitis
75
How to restore excessive FWS with worn dentures?
Occlusal pivots
| Restore occlusal surface with auto polymerising acrylic resin
76
Local causes of pigmented tongue
```
Smoking
Medication - eg hydroxychloroquine,
Chromogenic bacteria causing black hairy tongue
Melanoma
Melanotic macule
Amalgam Tattoo
```
77
Systemic causes of pigmented tongue
```
Racial
Lead poisoning
Addison's
Kaposi's sarcoma
Haemochromatosis
```
78
Histological signs Lichen Planus
```
Keratosis
Atrophy or hyperplasia
Lymphocyte hugging band
Lymphocyte epitheliotropism
Basal cell liquefaction
Apoptosis
Acanthosis
Saw tooth rete pegs
```
79
Features of Lichen Planus
30-50 yr old
Autoimmune
1% malignant potential
recurrence
80
Causes of Lichen Planus
```
Stress
Autoimmune
Idiopathic
Amalgam
SLS
Medications (NSAIDS / Anti-hypertensive / Anti-malarials / Anti-diabetics)
Hepatitis C
Plaque
```
81
What are the 7 types of lichen plants
```
RUDE PUNKS POO AND EAT BAD DINNERS
Reticular
Plaque like
Papular
Atrophic
Erosive
Bullous
Desquamative gingivitis
```
82
Special investigations for Lichen Planus
Biopsy in:
Smokers
Symptomatic
High risk area
Direct Immunofluorescence (DIF)
83
Treatment of Lichen Planus
Asymptomatic:
Observe
CHX
Remove cause
Symptomatic:
Remove cause
Corticosteroids (betamethasone)
Antiseptic mouthwash
84
Histological signs of Pemphigus
Tzank cells
Supra-basal split: attacks the desmosomes,
Comment on appearance:
Superficial blisters: clear fluid filled (on skin and mucosa)
Rarely intact blisters/non-specific erosions
85
Features of Pemphigus
S - Superficial
S - Serious
S - Steroids
Potentially fatal: Protein and electrolyte imbalance
86
Causes of Pemphigus
Autoimmune: type II hypersensitivity reaction
87
Special investigation and Treatment for Pemphigus
Special investigation for pemphigus: direct immunofluorescence.
Azathioprine and steroids,
Betamethasone mouthwash
Tacrolimus ointment
88
Order the salivary gland tumours by incidence
```
Acinic Cell carcinoma
Warthin’s tumour
Adenoid Cystic Carcinoma
Pleomorphic adenoma
Mucoepidermoid Carcinoma
```
```
Pleomorphic adenoma (75%)
Warthin’s tumour (15%)
Adenoid Cystic Carcinoma (5%) (NB most common MINOR salv gland tumour)
Mucoepidermoid Carcinoma (3%)
Acinic Cell carcinoma (<1%)
```
89
What are the histological features of a pleomorphic adenoma?
Complete/incomplete capsule
duct-like structures
chondroid and myxomatous tissue epithelium.
90
What histological feature is related to pleomorphic adenoma recurrence?
Non/poorly encapsulated
91
What are the histological signs of Warthin’s tumour?
Cystic
Distinct epithelium
Lymphoid tissue
92
Histology of adenoid cystic carcinoma?
No capsule
Tubular/swiss cheese like
Solid.
93
What features of a parotid swelling would make you suspicious of malignancy?
Firm
Attached to underlying structures
Fast growth
94
Describe Desquamative gingivitis
Clinically descriptive, Erythematous shedding and ulceration which involves the full width of the gingiva
95
Name two other conditions that you would see Desquamative gingivitis in?
Pemphigus
Pemphigoid
Lichen planus
96
Describe how you would manage Desquamative gingivitis
Change of toothpaste (SLS–free)
Improve oral hygiene (Plaque aggravates the lesions)
Topical steroids - rinse or meter dose inhaler (MDI; or Steroid cream in (gum shield)
Topical tacrolimus (immune modulator, rinse or cream)
Systemic immunosuppression if required (rarely needed)
97
Mrs Patel is a 45 year old patient who is new to your practice. She is fit and well but complains of some soreness
in her right cheek which she has had for a number of years. Your examination reveals a reddened area of buccal
mucosa with a white lacy edge immediately adjacent to tooth 47. This tooth is almost entirely restored with a
perfectly sound amalgam and is the abutment for rest seats and clasps on a chrome/cobalt partial denture which
Mrs Patel has happily worn for the past 5 years and has a bleeding 6mm mesio-buccal pocket with associated
grade I mobility. A periapical radiograph of tooth 47 reveals some mesial bone loss but no periapical pathology. All
the other teeth are sound or minimally-restored with composite and the partial denture is well fitting.
What are your provisional diagnoses?
```
Traumatic lesions
Lichenoid reaction: amalgam
Chronic periodontal disease
Lichen planus
Oral cancer: squamous cell carcinoma
```
98
```
What are Mrs Patel’s options for management of these problems?
Traumatic Lesions
Lichenoid Reaction
Chronic Perio
Lichen Planus
Oral Cancer
```
Traumatic lesions: smooth or take off the clasp
Lichenoid reaction: amalgam replacement with composite
Chronic periodontal disease: HPT
Lichen planus: correct deficiency, medication, SLS free toothpaste
Oral cancer: squamous cell carcinoma (remove the suspected possible causes and see if it resolves in 3 weeks. 3 weeks review, if not resolved. Refer.
99
Arthur is a 68 year old retired mechanic who presents at your practice after an absence of 2 years. He is partially
dentate in the upper and lower arch and wears upper and lower acrylic prostheses. These prostheses were well
fitting when provided by you 2 years ago. He now complains that the upper prosthesis no longer fits well and is
uncomfortable. On examination the upper prosthesis does not seat fully in the edentulous regions. In addition,
there are numerous early to moderately deep primary carious cavities. Periodontal examination reveals no
periodontal pockets greater than 3-4 mm and minimal bleeding on probing. Radiographic examination confirms no
obvious peri-radicular radiolucencies. To the contrary, there are large radio-opacities in relation to the roots of
several teeth. There is minimal periodontal bone loss. In relation to his medical history he says he is taking
medication for Paget’s disease.
Describe the anatomical changes, pathology and incidence behind the reason why the denture no longer fits?
Paget’s is a disease causing increased bone turnover.
Bone swelling occurs as a result and thus the dentures don't fit anymore.
(increased osteoclastic and osteoblastic activity.)
>55yrs
M>F
100
Padget's disease patient with radiopacities on radiograph
Most likely cause
Padget's caused Hypercementosis
101
Arthur needs to have extraction of a lower molar which does not have a radio-opacity associated with its root and you are aware he is taking bisphosphonates. What precautions would you take when you extract the
tooth?
Chlorhexidine x2 daily 1 week pre-operatively, immediately before the extractions, post-operative chlorhexidine
Maintain OH
Achieve Primary intention closure
Use an atraumatic extraction technique
Refer to a specialist if complications develop Avoid raising flaps
102
Name a life-threatening Vesicullo-bullous disease
Pemphigus
| Bullous Pemphigoid
103
Name 2 methods of testing for Pemphigus and describe the histology of a positive result
Direct Immunofluorescence: basket-weave appearance
H&E staining microscopy: Tzank cells, supra-basal split, acanthoylsis
104
Describe how your management of Pemphigus
Topical/systemic steroid - beclometasone inhaler/prednisolone
Immunomodulating drug: azathioprine
Analgesics
105
give symptoms/signs to identify Primary herpetic gingivo-stomatitis
Generalised Ulceration
Blood crusted lips
Pyrexia
Treatment:
Fluid and electrolyte balancing / Self limiting - 10-14 days / Rest
106
Generalised white plaque that scrape off easily and leave an erythematous base
Diagnosis?
Pseudomembranous candidosis
107
Two medical conditions that we might see Pseudomembranous Candidosis in
HIV
| (Poorly controlled) Diabetes
108
Advantages and disadvantages of mouth swab and oral rinse
Advantage: Non-invasive
Disadvantage: Often not diagnostic
109
3 causes for generalised pigmentation around the mouth
Racial
Medication
Smoking
Addisons
110
3 causes of localised pigmentation (brownish grey) in the mouth
Vascular malformations (Haemangiomas, Sturge-Weber)
Macule/naevus
Pigmentary incontinence
Amalgam tattoo
111
Name two types of haemangioma
Capillary
| Cavernous
112
What is the histological difference between Capillary and Cavernous haemangioma?
Capillary: groups of smaller vessels, most of which are capillaries
Cavernous: larger, dilated vascular spaces
113
2 clinical investigations for trigeminal neuralgia
MRI
| Blood: FBC / haematinics / blood glucose
114
First line drug management for trigeminal neuralgia
Carbamazepine
115
What blood tests would you have to do before giving carbamazepine
Must check:
FBC
Liver Function Test (LFT)
Urea &Electrolytes for reduced Na (causes forgetfulness)
116
Trigeminal Neuralgia: 2 indications for surgery
Medical intervention ineffective
| Medical intervention contraindicated
117
Trigeminal Neuralgia: Name one type of surgery
Microvascular decompression
Balloon compression
Gamma knife
118
Trigeminal neuralgia – What conditions may this be a side effect of?
MS
| Brain tumour
119
What are the side effects of carbamazepine?
```
Diziness
Drowsiness
Dry Mouth
Fatigue
Headache
Nausea
Weight gain
```
120
Trigeminal Neuralgia - 2 causes
1 → demyelination causing CNV ischaemia
2→ aberrant arteriole in the cerebello-pontine region lying on the nerve
121
Trigeminal Neuralgia - Surgical Management Options
```
Balloon compression → necrosis of nerve
Microvascular decompression to separate blood vessel and nerve
Cryosurgery
Gamme Knife
Long acting bupivacaine
```
122
TMD - What nerve supplies the Temporalis muscle
auriculotemporal nerve
123
TMD - What are the mechanisms of a bite splint?
Minimise parafunctional habits
Minimise load on TMJ
Provide stable occlusion
Eliminate occlusal interferences
124
TMD - What is arthrocentesis?
Washing of the upper superior joint space of the TMJ
Carried out under LA
Solution injected in which breaks fibrous adhesion and washes away inflammatory exudate
125
TMD - Surgical Management Options
```
arthroscopy
arthroplasty
condylectomy
total joint replacement
high condylar shave
```
126
Lichen Planus - 7 histological features
1. Keratinisation
2. Lymphocytes/macrophages
3. Atrophy/hyperplasia
4. Apoptosis
5. Basal Cell liquefaction leading to colloid bodies
6. Blue band of chronic inflammatory cells
7. Saw tooth rete ridges (not always).
127
Lichen Planus - Aetiology
```
Idiopathic
OR
LTR → drugs (NSAIDS, beta-blockers, hypoglycaemics, diuretics, anti-malarials) Hep C
Amalgam
Gold
SLS
```
128
Lichen Planus - When do you biopsy?
All symptomatic
| All smokers and high risk site
129
Lichen Planus - How is it managed?
Asymptomatic and reticular → monitor and reduce risk factor
Others →remove cause if known, topical steroids, systemic steroids, immunomodulators. Can use difflam MW and CHX MW.
130
Herpes - Which cranial nerve does herpes become associated with?
Trigeminal Nerve
131
Herpes - Name the common triggers for reactivation
stress
being unwell
sunlight
immunosuppression
132
Anaemia - What is it?
A reduction in the oxygen carrying capacity of the blood due to a deficiency of haemoglobin or red blood cells.
133
Anaemia - What are the general signs and symptoms
```
Fatigue
Malaise
Pallor
Weakness
Cold hands or feet
Dizziness
```
134
Anaemia - What are the oral signs
```
Recurrent oral ulceration
Candida
Glossitis/smooth tongue (- iron)
Beefy tongue (-VitB12/folate)
Oral disaesthesia
Mucosal pallor
```
135
Anaemia - Name the type of anaemia from MCV results (Mean corpuscular volume)
Microcytic <80fL → Iron deficiency, Thalassemia
Normocytic 80-95fL → pregnancy bleeding, sickle cell anaemia,
Macrocytic >96fL → VitB12 and Folate.
136
Xerostomia - Causes
Local:
Mouth breathing, Candida, Alcohol, Smoking, Sialolith
Salivary gland diseases: Sjogren’s, CF, HIV, Sarcoidosis, Amyloidosis, Haemochromatosis
Drugs:
Tricyclic Antidepressants, Antipsychotics, Antihistamines, Diuretics, Atropine, Cytotoxics
Dehydrating conditions: Diabetes (1+2), Renal disease, Stroke, Addison’s, Persisting vomiting
Radiotherapy and cancer treatments
Anxiety and somatisation disorders
137
Xerostomia - How can you assess this intraorally?
Mirror stick test to cheek and tongue, check saliva pooling, salivary flow rate test, challacombe scale
138
Xerostomia - What are the oral signs and symptoms?
```
Increased cervical caries
Frothy saliva
Loss of gingival architecture
Glossy appearance of gingiva
Tongue fissuring
Increased perio
Difficulty eating/ speaking/ swallowing
Poor denture retention
Halitosis
Candida
```
139
Xerostomia - Management
```
Treat cause:
Regularly hydrate
Modify drugs
Control diabetes
Control somatoform disorder
```
Prevent diseases: caries, candida/angular cheilitis.
Saliva substitute/stimulator: Saliva Orthana/Pilocarpine tablets
140
Xerostomia - Name 3 saliva substitutes
Glandosane
Saliva orthana
Biotene
