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BDS Finals > Oral Medicine > Flashcards

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
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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

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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)

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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

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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)

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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

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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
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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

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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

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10
Q

First line treatment for Denture induced stomatitis

A

Denture hygiene advice inc; cleaning

Tissue conditioner on the fitting surface of the denture

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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)
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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

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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

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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

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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

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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
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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
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18
Q

Candida Infection. Picture showing redness in corner of mouth. Whats likely diagnosis

A

Angular cheilitis

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19
Q

Name 2 microorganisms involved in angular chellitis

A

Staphylococcus aureus

Candida albicans

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20
Q

What microbiological sampling method should you ask for? Testing for angular chellitis

A

Swab

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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

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22
Q

Name one intra-oral disease that would be associated angular chellitis

A

Oral facial granulomatosis

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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

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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

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25
Q

A patient attends with inflamed gingiva extending beyond the mucogingival margin. Give a diagnosis

A

Desquamative gingivitis

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26
Q

Give 1 descriptive term to describe desquamative gingivitis appearance

A

Erythematous

Ulcerated

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27
Q

Give 3 oral mucosal conditions associated with desquamative gingivitis

A

Pemphigus
Pemphigoid
Lichen planus

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28
Q

Give 2 local factors that may contribute to desquamative gingivitis

A

SLS

Plaque

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29
Q

What are 2 typical treatments you could use for desquamative gingivitis

A

Betamethasone mouthwash

Tacrolimus ointment

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30
Q

What is a method of testing for pemphigus vulgaris?

A

Direct immunofluorescence

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31
Q

What would the pathologist report with the result of the test that was positive for pemphigus vulgaris?

A

Supra-basal split
presence of Tzank cells
Basket weave immunofloresence
desmosomes attacked

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32
Q

Reasons behind this pemphigus vulgaris

A

Autoimmune

Type 2 hypersensitivity reaction

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33
Q

Name one condition that would represent the lesion in the same way clinically (pemphigus vulgaris), but would be different histopathologically?

A

Drug-induced pemphigus

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34
Q

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.

A

Alcohol
Smoking
HPV

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35
Q

Stage tumour with TNM system

A

T3 N2 M0

GO BACK AND ADD TNM SYSTEM EXPLANATION

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36
Q

How would you grade the dysplasia histopathologically?

A

Hyperplasia
Dysplasia (mild/moderate/severe)
Carcinoma in situ

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37
Q

What interventions (medical or surgical) other than surgery could the patient have for oral squamous cell carcinoma

A

radiotherapy
chemotherapy
immunotherapy

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38
Q

After removal of the lesion (oral squamous cell carcinoma), how would you restore the function of the tongue?

A

Soft tissue grafting

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39
Q

Organism that causes denture stomatitis

A

C. albicans

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40
Q

3 local factors for denture stomatitis

A 
Poor denture hygiene 
Wearing denture overnight / not removing denture regularly enough
Trauma 
Smoking 
Xerostomia 
Corticosteroid inhaler use
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41
Q

4 management options for denture stomatitis

A 
Chlorhexidine MW 2x daily 
Denture hygiene 
Tissue conditioner
Systemic Antifungal (Fluconazole)
Topical Antifungal (Miconazole gel)
Smoking cessation 
Rinse + gargle after inhaler use
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42
Q

What will be seen on occlusal surfaces of teeth and what should you do short term - denture stomatitis pt

A

Erosion due to inhaler

Rinse mouth after inhaler use
Fluoride varnish

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43
Q

Name 3 types of Recurrent Aphthous Ulcer

A

Major
Minor
Herpetiform

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44
Q

State difference between major/minor recurrent apthous stomatitis/ ulcers

A

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

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45
Q

Causes of Recurrent Aphthous Stomatitis

A

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

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46
Q

Treatment of Recurrent Apthous stomatitis / ulcers

A 
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)
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47
Q

Potential problems of Recurrent Aphthous Stomatitis

A

Dehydration

Infection

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48
Q

Describe the nature of the pain from trigeminal neuralgia

A

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.

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49
Q

The 2 most frequent causes of trigeminal neuralgia are? Name an investigation you could do into these.

A
  1. Focal demyelination of the peripheral nerve
  2. Trigeminal nerve compression from aberrant artery

Investigation: MRI

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50
Q

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.

A

MS: intention tremor / loss of proprioception

Brain Tumour: diplopia / memory loss

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51
Q

How would you manage a trigeminal neuralgia patient pain? Give 1 surgical and 1 medical

A

Carbamazepine 100mg (1 tab) x2 daily
Microvascular decompression
Balloon compression
Gamma Knife

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52
Q

What investigation/tests would you take before giving a patient carbamazepine for trigeminal neuralgia and why?

A

Blood tests - FBC, Liver function test (LFT), urea & electrolytes

Because it reduces sodium and can be toxic to liver / reduce liver function

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53
Q

Give 3 side-effects of this Carbamazepine intervention for trigeminal neuralgia

A 
GI disturbances
Drowsiness
Headache
Facial dyskinesias (impairment of voluntary movement)
Weight gain 
Vomiting 
Electrolyte imbalance (hyponatremia)
Thrombocytopenia (low platelet count)
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54
Q

Intra-oral manifestations of herpes?

A

Herpes labialis
Primary herpetic gingivostomatitis
Oral ulceration

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55
Q

Three causes of vesicles?

A

Erythema multiforme
Pemphigoid
Pemphigus

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56
Q

2 virus groups that cause oral ulceration?

A

Herpes simplex
Coxsackie virus
Epstein Barr virus
Varicella Zoster virus

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57
Q

Example of Coxsackie oral lesions?

A

Herpangina

Hand foot and mouth disease

58
Q

Disorders caused by Epstein Barr Virus? (Human Herpes Virus 4)

A 
`Hairy Leukoplakia 
Glandular fever (infectious mononucleosis) Burkitt’s lymphoma
59
Q

How herpes labialis forms?

A 
Primary infection
Latency
Reactivation (Upper = maxillary, Lower = mandibular)
Secondary infection: causing a
herpes labialis lesion

CHECK THIS

60
Q

2 med conditions associated with acute pseudomembranous candidiasis

A

HIV

Poorly controlled diabetes

61
Q

Swab + rinse – advantages and disadvantages of each

A

Swab - Adv: site specific Dis: uncomfortable, Rinse - Adv: quantifiable amount Dis: more difficult to standardise

62
Q

What to ask pathologist for when sending candida sample

A

Culture and sensitivity

63
Q

2 drugs that interact with Fluconazole and the effects

A

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
Q

2 Investigations for Aphthous Ulcers

A

Haematinics

FBC

65
Q

2 causes of microcytic anaemia

A

Iron deficiency

Thalassaemia

66
Q

3 topical treatments available for apthous ulcers - not brand name

A

Benzydamine
Fluticasone
Beclomethasone
Doxycycline

67
Q

Mid age female complaining of burning mouth with diffuse erythema

A

Oral dysaesthesia

68
Q

Male mid age, dull throbbing pain in maxillary region, made worse by bending over

A

Sinusitis

69
Q

Unilateral episodic pain lasting up to 20 mins, nose dripping + worse when shaking head

A

Chronic Paroxysmal Hemicrania

70
Q

Elderly pt + sharp shooting pain in right cheek when biting + lacrimation

A

Trigeminal Neuralgia

71
Q

Temporal pain + weakness of shoulder muscles

A

Temporal arteritis (accompanied by shoulder girdle weakness)

72
Q

Causes of Denture induced stomatitis

A 
Immunosuppressed
Poor dental hygiene
Dentures worn over night
Trauma from ill fitting dentures
Xerostomia.
Systemic steroids & broad spectrum antibiotics
73
Q

Denture hygiene instructions for denture stomatitis

A

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
Q

Treatment If denture hygiene doesn’t work:

A

Antifungals (Miconazole, Nystatin)
Tissue conditioner
New dentures: when resolved denture induced stomatitis

75
Q

How to restore excessive FWS with worn dentures?

A

Occlusal pivots

Restore occlusal surface with auto polymerising acrylic resin

76
Q

Local causes of pigmented tongue

A 
Smoking 
Medication - eg hydroxychloroquine,
Chromogenic bacteria causing black hairy tongue 
Melanoma 
Melanotic macule 
Amalgam Tattoo
77
Q

Systemic causes of pigmented tongue

A 
Racial 
Lead poisoning 
Addison's 
Kaposi's sarcoma 
Haemochromatosis
78
Q

Histological signs Lichen Planus

A 
Keratosis 
Atrophy or hyperplasia
Lymphocyte hugging band 
Lymphocyte epitheliotropism 
Basal cell liquefaction 
Apoptosis 
Acanthosis 
Saw tooth rete pegs
79
Q

Features of Lichen Planus

A

30-50 yr old
Autoimmune
1% malignant potential
recurrence

80
Q

Causes of Lichen Planus

A 
Stress 
Autoimmune 
Idiopathic 
Amalgam 
SLS
Medications (NSAIDS / Anti-hypertensive / Anti-malarials / Anti-diabetics)
Hepatitis C
Plaque
81
Q

What are the 7 types of lichen plants

A 
RUDE PUNKS POO AND EAT BAD DINNERS
Reticular
Plaque like 
Papular
Atrophic 
Erosive 
Bullous 
Desquamative gingivitis
82
Q

Special investigations for Lichen Planus

A

Biopsy in:
Smokers
Symptomatic
High risk area

Direct Immunofluorescence (DIF)

83
Q

Treatment of Lichen Planus

A

Asymptomatic:
Observe
CHX
Remove cause

Symptomatic:
Remove cause
Corticosteroids (betamethasone)
Antiseptic mouthwash

84
Q

Histological signs of Pemphigus

A

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
Q

Features of Pemphigus

A

S - Superficial
S - Serious
S - Steroids

Potentially fatal: Protein and electrolyte imbalance

86
Q

Causes of Pemphigus

A

Autoimmune: type II hypersensitivity reaction

87
Q

Special investigation and Treatment for Pemphigus

A

Special investigation for pemphigus: direct immunofluorescence.

Azathioprine and steroids,
Betamethasone mouthwash
Tacrolimus ointment

88
Q

Order the salivary gland tumours by incidence

Acinic Cell carcinoma
Warthin’s tumour 
Adenoid Cystic Carcinoma
Pleomorphic adenoma 
Mucoepidermoid Carcinoma
A 
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
Q

What are the histological features of a pleomorphic adenoma?

A

Complete/incomplete capsule
duct-like structures
chondroid and myxomatous tissue epithelium.

90
Q

What histological feature is related to pleomorphic adenoma recurrence?

A

Non/poorly encapsulated

91
Q

What are the histological signs of Warthin’s tumour?

A

Cystic
Distinct epithelium
Lymphoid tissue

92
Q

Histology of adenoid cystic carcinoma?

A

No capsule
Tubular/swiss cheese like
Solid.

93
Q

What features of a parotid swelling would make you suspicious of malignancy?

A

Firm
Attached to underlying structures
Fast growth

94
Q

Describe Desquamative gingivitis

A

Clinically descriptive, Erythematous shedding and ulceration which involves the full width of the gingiva

95
Q

Name two other conditions that you would see Desquamative gingivitis in?

A

Pemphigus
Pemphigoid
Lichen planus

96
Q

Describe how you would manage Desquamative gingivitis

A

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
Q

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?

A 
Traumatic lesions
Lichenoid reaction: amalgam
Chronic periodontal disease
Lichen planus
Oral cancer: squamous cell carcinoma
98
Q 
What are Mrs Patel’s options for management of these problems? 
Traumatic Lesions 
Lichenoid Reaction 
Chronic Perio 
Lichen Planus 
Oral Cancer
A

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
Q

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?

A

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
Q

Padget’s disease patient with radiopacities on radiograph

Most likely cause

A

Padget’s caused Hypercementosis

101
Q

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?

A

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
Q

Name a life-threatening Vesicullo-bullous disease

A

Pemphigus

Bullous Pemphigoid

103
Q

Name 2 methods of testing for Pemphigus and describe the histology of a positive result

A

Direct Immunofluorescence: basket-weave appearance

H&E staining microscopy: Tzank cells, supra-basal split, acanthoylsis

104
Q

Describe how your management of Pemphigus

A

Topical/systemic steroid - beclometasone inhaler/prednisolone
Immunomodulating drug: azathioprine
Analgesics

105
Q

give symptoms/signs to identify Primary herpetic gingivo-stomatitis

A

Generalised Ulceration
Blood crusted lips
Pyrexia

Treatment:
Fluid and electrolyte balancing / Self limiting - 10-14 days / Rest

106
Q

Generalised white plaque that scrape off easily and leave an erythematous base
Diagnosis?

A

Pseudomembranous candidosis

107
Q

Two medical conditions that we might see Pseudomembranous Candidosis in

A

HIV

(Poorly controlled) Diabetes

108
Q

Advantages and disadvantages of mouth swab and oral rinse

A

Advantage: Non-invasive

Disadvantage: Often not diagnostic

109
Q

3 causes for generalised pigmentation around the mouth

A

Racial
Medication
Smoking
Addisons

110
Q

3 causes of localised pigmentation (brownish grey) in the mouth

A

Vascular malformations (Haemangiomas, Sturge-Weber)
Macule/naevus
Pigmentary incontinence
Amalgam tattoo

111
Q

Name two types of haemangioma

A

Capillary

Cavernous

112
Q

What is the histological difference between Capillary and Cavernous haemangioma?

A

Capillary: groups of smaller vessels, most of which are capillaries

Cavernous: larger, dilated vascular spaces

113
Q

2 clinical investigations for trigeminal neuralgia

A

MRI

Blood: FBC / haematinics / blood glucose

114
Q

First line drug management for trigeminal neuralgia

A

Carbamazepine

115
Q

What blood tests would you have to do before giving carbamazepine

A

Must check:
FBC
Liver Function Test (LFT)
Urea &Electrolytes for reduced Na (causes forgetfulness)

116
Q

Trigeminal Neuralgia: 2 indications for surgery

A

Medical intervention ineffective

Medical intervention contraindicated

117
Q

Trigeminal Neuralgia: Name one type of surgery

A

Microvascular decompression
Balloon compression
Gamma knife

118
Q

Trigeminal neuralgia – What conditions may this be a side effect of?

A

MS

Brain tumour

119
Q

What are the side effects of carbamazepine?

A 
Diziness
Drowsiness
Dry Mouth
Fatigue
Headache
Nausea 
Weight gain
120
Q

Trigeminal Neuralgia - 2 causes

A

1 → demyelination causing CNV ischaemia

2→ aberrant arteriole in the cerebello-pontine region lying on the nerve

121
Q

Trigeminal Neuralgia - Surgical Management Options

A 
Balloon compression → necrosis of nerve
Microvascular decompression to separate blood vessel and nerve
Cryosurgery
Gamme Knife
Long acting bupivacaine
122
Q

TMD - What nerve supplies the Temporalis muscle

A

auriculotemporal nerve

123
Q

TMD - What are the mechanisms of a bite splint?

A

Minimise parafunctional habits
Minimise load on TMJ
Provide stable occlusion
Eliminate occlusal interferences

124
Q

TMD - What is arthrocentesis?

A

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
Q

TMD - Surgical Management Options

A 
arthroscopy
arthroplasty
condylectomy
total joint replacement
high condylar shave
126
Q

Lichen Planus - 7 histological features

A
  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
Q

Lichen Planus - Aetiology

A 
Idiopathic
OR 
LTR → drugs (NSAIDS, beta-blockers, hypoglycaemics, diuretics, anti-malarials) Hep C
Amalgam
Gold
SLS
128
Q

Lichen Planus - When do you biopsy?

A

All symptomatic

All smokers and high risk site

129
Q

Lichen Planus - How is it managed?

A

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
Q

Herpes - Which cranial nerve does herpes become associated with?

A

Trigeminal Nerve

131
Q

Herpes - Name the common triggers for reactivation

A

stress
being unwell
sunlight
immunosuppression

132
Q

Anaemia - What is it?

A

A reduction in the oxygen carrying capacity of the blood due to a deficiency of haemoglobin or red blood cells.

133
Q

Anaemia - What are the general signs and symptoms

A 
Fatigue
Malaise
Pallor
Weakness
Cold hands or feet
Dizziness
134
Q

Anaemia - What are the oral signs

A 
Recurrent oral ulceration
Candida
Glossitis/smooth tongue (- iron)
Beefy tongue (-VitB12/folate)
Oral disaesthesia
Mucosal pallor
135
Q

Anaemia - Name the type of anaemia from MCV results (Mean corpuscular volume)

A

Microcytic <80fL → Iron deficiency, Thalassemia
Normocytic 80-95fL → pregnancy bleeding, sickle cell anaemia,
Macrocytic >96fL → VitB12 and Folate.

136
Q

Xerostomia - Causes

A

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
Q

Xerostomia - How can you assess this intraorally?

A

Mirror stick test to cheek and tongue, check saliva pooling, salivary flow rate test, challacombe scale

138
Q

Xerostomia - What are the oral signs and symptoms?

A 
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
Q

Xerostomia - Management

A 
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
Q

Xerostomia - Name 3 saliva substitutes

A

Glandosane
Saliva orthana
Biotene

BDS Finals (1 decks)

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