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Oral medicine Flashcards

1
Q

Give 5 signs and symptoms of TMD

A

* Headache. * Ear pain. * Muscle pain. * Joint pain. * Trismus. * Clicking or popping noises. * Crepitus.

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2
Q

Give 5 aspects of causative advice for TMD

A

* Soft diet. * Stop parafunctional habits ie nail biting. * Support mouth upon opening (yawning). * Relaxation. * Chew on both sides. * Cut food into smaller pieces. * Don’t incise food. * Avoid chewing gum. * Avoid over opening.

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3
Q

What information could be elicited from an examination in cases of suspected TMD?

A

* Range of movement. * Clicking/crepitus. * MoM hypertrophy. * Tenderness on palpation. * Reduced intercisal opening distance. * Signs of bruxism. * Scalloped tongue. * Linea alba

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4
Q

What factors could predispose someone to having TMD?

A

* Females more than males. * Age 18-30 years. * Stress. * Habits such as nail biting, chewing gum.

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5
Q

What would first line management of TMD be?

A

* Counselling, reassurance, soft diet, advice on chewing both sides, cut food, stop chewing gum.
* Splint therapy; soft splint, hot water bottle, hard splint, bite raising appliance
* Joint therapy; accupuncture, physio, relaxation.
* Drugs; Ibuprofen, paracetamol, muscle relaxants - tricyclic antidepressants.

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6
Q

What other conditions may present similarly to TMD and how would you exclude them?

A

* Pericoronitis (no clicking)
* Myofascial pain syndrome (no clicking)

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7
Q

You decide to construct a stabilisation splint. Your technician doesn’t know what this is. How would you write your lab sheet?

A

Please pour upper and lower alginates in 50/50 dental stone/plaster. Please provide contrast vacuum form splint in soft acrylic for lower arch, covering all occlusal surfaces while avoiding gingival margin.

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8
Q

What is your first line treatment for denture induced stomatitis?

A

* Tissue conditioner on the fitting surface of the denture
* Oral and denture hygiene instructions.

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9
Q

If denture induced stomatitis persisted after OH advice, what would be the next line of treatment?

A

Appropriate antifungal (fluconazole; 7 x 50mg capsules. Cannot be taken with warfarin or statins)

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10
Q

What are fordyce granules?

A

Sebaceous glands in the oral mucosa found in 80% of individuals. Cannot be rubbed off with gauze. NTR

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12
Q

What are the key features of geographic tongue?

A

* A common condition, affects 2% of the population at any one time.

* Usually the dorsum of the tongue

* Asymptomatic, irregular smooth map like areas with white raised margins.

* Thin epithelium, loss of filiform papillae.

* Reassure patient

* If symptomatic, treat with antifungal agents combined with topical steroids.

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13
Q

What are the key features of a cleft lip?

A

* Caused by failure of the normal orofacial development 6-12 weeks embryonic life.

* Most cases are idopathic but a number of drugs during pregnancy have been linked including phenytoin, cabazepine, steroids, diazepam. Smoking and folic acid deficiency

* Can be unilateral, bilateral, and incomplete or complete

* Cleft lip with palate can present problems with feeding, speech and hearing

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14
Q

What are Epsteins pearls?

A

* Small developmental lesions of the new born.

* Small, firm white-yellow keratin filled cyst

* Bohn’s nodule occurs on alveolar ridge, maxilla more common than mandible

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15
Q

What is ankyloglossia?

A

Also known as a tongue tie. A congenital oral anomaly that may restrict the mobility of the tongue.

Caused by an unusually short, thick lingual frenulum.

Prevalence reported to be 0.1-10.7%

Can affect feeding, speech, chewing and OH

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16
Q

Name 3 bacterial infections that can present in the oral mucosa

A

* Scarlet fever

* Syphilis

* Gonorrhoea

* Tuberculosis

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17
Q

Describe a cleft lip

A

* Approx 1 in 1000 live births

* Unilateral in 80% of cases

* Lack of fusion between medial nasal process and maxillary process

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18
Q

Describe a cleft palate

A

* Approx 1 in 2000 live births

* Lack of fusion between palatal shelves

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19
Q

What are lip pitts?

A

* Invaginations at commisssures or near midline

* Van der Woude syndrome = cleft and pitts

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21
Q

What is Leukoedema?

A

* White or whitish grey edematous (fluid filled) lesion of buccal mucosa

* Dissipates when cheek is stretched

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22
Q

What are fordyce granules?

A

* Ectopic sebaceous glands

* Benign

* No treatment

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24
Q

What is lingual thyroid?

A

*Thyroid tissue mass at midline base of tongue

* Located along embryonic path of thyroid descent

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25
Q

What is geographic tongue?

A

* Also called benign migratory glossititis and erythema migrans

* White ringed lesions surrounding central red islands that migrate over time

* Occasionally hurt and burn

* No treatment - can adjust diet if symptomatic

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26
Q

What is fissured tongue?

A

* Folds and furrows of dorsum of tongue.

* Melkersson-Rosenthal syndrom = fissured tongue and granulomatous chelitis (red, inflammed lips), and facial paralysis.

* Remember with; Mels Bells, Rosy Red

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27
Q

What is angioma?

A

Tumours composed of blood or lymph vessels

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28
Q

What is a hemangioma?

A

* Congenital focal proliferation of capillaries

* Most undergo involution, but some persistent lesions are excised

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29
Q

What are lymphangioma?

A

* Congenital proliferation of lymph vessels. Oral lymphangiomas are very rare, purple spots on the tongue. Called cystic hygroma when it occurs in the neck.

* Sturge-weber syndrome = angiomas of the arachnoid and pia mater and skin along the distribution of the trigeminal nerve

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30
Q

What are exostoses/tori?

A

Excessive cortical bone growth

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31
Q

What is a dermoid cyst?

A

* If it appears above the mylohyoid it will be a mass in the midline of the FoM

* If it appears below the mylohyoid it will be a mass in the upper neck

* Contains adnexal structures like hair and sebaceous glands.

* Doughy consistency

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32
Q

What is an oral lymphoepithelial cyst?

A

* Epithelial cyst within lympoid tissue of oral mucosa.

* Palatine and lingual tonsils are common locations

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33
Q

What is Stafne Bone defect?

A

* A radiolucency in posterior mandible below IAC

* Due to lingual concavity

* May appear as cyst but is not a pathology

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34
Q

What is a nasopalatine duct cyst?

A

* Heart shaped radiolucency in nasopalatine canal

* Casued by cystification of canal remnants

* Treatment; exision

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35
Q

What is a traumatic bone cyst?

A

* Also called a simple bone cyst and idiopathic bone cavity.

* Large radiolucency scalloped around roots

* No epithelial lining (dead space) in middle of teenagers mandible.

* Usually associated with traumatic injury

* Treatment; aspirate to diagnose and monitor

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36
Q

What is linea alba?

A

* White line in buccal mucosa

* Type of focal hyperkeratosis due to chronic friction on mucosa

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37
Q

What is a traumatic ulcer?

A

Very common ulcer caused by trauma (biting, sharp food etc)

Erosion = incomplete break

Ulcer = complete break through epithelium

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38
Q

What is a chemical burn?

A

A burn caused by aspirin, hydrogen peroxide, silver nitrate, phenol

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39
Q

What is nicotine stomatitis?

A

Red dots are inflammed salivary duct openings.

Only premalignant if related to reverse smoking.

More common in chronic heavy smokers

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40
Q

What is an amalgam tattoo?

A

Traumatic implantation of amalgam particles into the mucosa.

Tiny radiopaque particles in xray

41
Q

What is smoking associated melanosis?

A

Chemicals in tobacco stimulate melanocytes.

Brown, diffuse, irregular macules.

Typically seen in anterior gingiva.

Reversible is smoking discontinued

42
Q

What is melanotic macule?

A

Benign hyperpigmentation in mucous membrane.

Basically, a freckle of the mucosa.

Peutz-Jeghers Syndrome = freckles and intestinal polyps (think of someone spotty in their PJs with an upset stomach)

43
Q

What is hairy tongue?

A

Elongated filiform papillae

44
Q

What is dentifrice associated sloughing?

A

Toothpaste related.

Related to surfactant ingredient sodium lauryl sulfhate.

Recommend SLS free toothpaste

45
Q

What are the different categories of submucosal heamorrhage?

A

All of these are extravascular lesions that do not blanch.

In contrast, vascular lesions like haemangiomas do blanch.

Petechiae = 1mm haemorrhages (valsalva maneuver, violent cough, fallatio)

Purpura = slightly larger than petechiae

Ecchymosis 1cm or bigger bruise

Hematoma = mass of blood within tissue caused by trauma such as an LA needle

Treatment = eliminate cause if possible

46
Q

A patient presents for a regular check up and you notice a white and lacey appearing lesion in the buccal mucosa. What is your diagnosis?

A

Leukoplakia until confirmed histopath diagnosis

lichenoid tissue reaction

47
Q

There is an amalgam restoration in the lower molar. What made you arrive at the diagnosis of lichenoid tissue reaction and how does it occur?

A

Reaction adjacent to restoration, type iv hypersensitivity reaction

48
Q

Name 2 biopsies you could carry out to investigate this lesion

A

Punch biopsy and incisional biopsy

49
Q

Name four histological features of lichenoid tissue reaction?

A

Keratinisation, ‘hugging’ band of lymphocytes, basal cell liquefaction, apoptosis, sawtooth rete pegs

50
Q

What is your diagnosis?

A

Angular cheilitis

51
Q

Name two microorganisms involved in angular cheilitis

A

staphylococcus aureus, candida albicans

52
Q

What microbiological sampling method should you ask for to diagnose angular cheilitis?

A

Swab

53
Q

Name one immune deficient disease and one GI bleeding disease and why are they more susceptible to angular cheilitis?

A

HIV; impared immune function.

Coeliac; impared nutrient absorption

54
Q

Name one intraoral disease that would be associated with angular cheilitis

A

Any one of the following;

* Denture induced stomatitis

* Orofacial granulomatosis

* Crohns

55
Q

Why is miconazole prescribed to a patient with angular cheilitis when microbiological sampling is not available?

A

It is effective against both fungal and bacterial pathogens

56
Q

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

A

Desquamative gingivitis

57
Q

Give one descriptive term for the appearance of desquamative gingivitis

A

Firey, erythmatous, ulcerated

58
Q

Give 3 oral mucosal conditions associated with desquamative gingivitis

A

Pemphigus, pemphigoid, lichen planus

59
Q

What are two typical treatments that could be used for desquamative gingivitis?

A

Betamethasone mouthwash. Tacrolimus ointment

60
Q

Define what is a cyst?

A

An epithelial lined cavity containing fluid or semi fluid

61
Q

What are the two broad types of odontogenic cysts?

A

Inflammatory and Developmental

62
Q

What are the two types of inflammatory odontogenic cysts?

A

Radicular and residual

63
Q

What are the four types of developmental odontogenic cysts?

A

Keratocyst, eruption cyst, dentigerous cyst, lateral periodontal cyst

64
Q

List four diagnostic tools in cyst identification?

A

Any four of;

* Sensibility tests

* Radiographic features

* Aspiration

* Protein content

* Biopsy of the cyst lining

65
Q

What is the aetiology of radicular cysts?

A

* Accounts for 60% of odontogenic cysts

* Associated with a non vital tooth

* Epithelial source; epithelial cell rests of malassez

* Sequential to pulp necrosis in areas of chronic inflammation

66
Q

What is the radiographic appearance of a radicular cyst?

A

* Well demarcated

* Associated with the apex of a tooth

* Can be apical lateral or residule

* Residule cysts occur when there has been a cyst associated with a tooth which has been extracted, but the cyst remains

67
Q

What is the relavant histology for radicular cysts?

A

* Uniform layer of squamous cell epithelium

* Epithelium desquamates into the lumen which contains necrotic debris and protein rich fluid

* Epithelium may have Rushton bodies

* Lumen or wall may contain cholesterol cleft, dystrophic calcifications, RBCs and haemosiderin pigmentation

68
Q

What diagnostic notes are associated with a radicular cyst?

A

* Straw coloured aspirate

* Sensibility tests will show an unresponsive tooth.

69
Q

What is the aetiology of a dentigerous cyst?

A

* Commonist type of developmental cyst

* Associated with an unerupted tooth

* Epithelial source; reduced enamel epithelium

* Accounts for 18-24% of jaw cysts

* Can lead to displacement and root resorption of other teeth

70
Q

What are the radiographic features of a dentigerous cyst?

A

* Central, lateral and circumferential radiolucencys

*Unilocular radiolucent area associated with crown of an unerupted tooth.

* Large cyst - pseudo impression of multilocular bhowever this is because trabecular bone persistently tries to grow through.

* Well defined and often sclerotic border, but an infected cyst may show less defined borders.

* Usually 3-4mm in diameter, if below this diameter likely to be an enlarged dental follicle

71
Q

What are the histological features of a dentigerous cyst?

A

* Connective tissue layer; loosly arranged fibrous wall. Island of inactive epithelial cell rests.

* Epithelial lining; 2-4 layers of cuboidal epithelium. Flat interface connecting the epithelium and connective tissue.

* Inlammation; collagen increase in connective tissue layers. Infiltrate of inflammatory cells. Epithelial hyperplasia. Development of retentions ridges. Squamous features

72
Q

What is the aetiology of an eruption cyst?

A

* Epithelial source; reduced enamel epithelium. Soft tissue equivalent of a dentigerous cyst

* Produce a round, soft, blue cyst over the gingivae

* They occur when the dental follicle separates from the erupting tooths crown in the soft tissue

* Can relf resolve or require a small excision to drain the fluid and allow the tooth to erupt

* No radiograph is required

73
Q

What are the histological features of an eruption cyst?

A

The same epithelial lining found in a dentigerous cyst

74
Q

What is the aetiology of a keratocyst?

A

* Associated with a missing tooth

* Can be linked with inferior alveolar nerve paraesthesia.

* Linked with Gorlin-Goltz syndrome.

* Difficult to enucleate and high recurrence rate due to its thin friable lining

75
Q

What are the radiological features of a keratocyst?

A

* Well defined radiolucency

* Can be unilocular or multilocular

* Typically found in the posterior of the mandible (thinking logically, the 3rd molars are commonly abscent, hence this is why keratocysts could be most commonly found here)

76
Q

What are the histological features of a keratocyst?

A

* Thin friable wall meaning they are difficult to enucleate.

* 6-8 uniform layers of stratified squamous epithelium.

* Flat epithelial-connective tissue interface.

* Inconspicuous rete ridges

* Basal palisading evident in the basal layer

77
Q

Describe the management of cysts

A

* Enulcleatuion involves the complete removal of the cyst.

* Incomplete removal can lead to recurrence.

* Marsupulization can be used if there is a high risk of IAN damage or mandibular fracture. This is where a surgical window is created allowing the contents to drain. This is sutured open and can be maintained with a packing material.

* The enucleation can then take place once the cyst has decreased in size

78
Q

What are the categories of herpes simplex virus?

A

Primary - pan oral (in and around mouth). Self limiting (will go away on its own), typically occurs in childhood. Treatment involves treating painful symptoms. Latent in trigeminal ganglion.

Recurrent - appears on keratinized tissue. Herpes labialis (cold sore, fever, blisters), vermillion border. Recurrent intraoral herpes - attached gingiva, hard palate.

Reactivation is triggered by stress, sunlight or immunosupression

79
Q

What are the different categories of varicella zoster virus?

A

Primary = chicken pox. Self limiting and generally occurs in childhood. Latent in trigeminal ganglion.

Recurrent = herpes zoster aka shingles.

Ramsay Hunt Syndrome - herpes zoster reactivation

80
Q

What is the oral presentation of measles?

A

Kopliks spots (Buccal mucosa spot ulcers) that precede skin rash.

Primary is self limiting and tends to occur in childhood.

81
Q

What is a Papilloma?

A

A wart.

CAused by several strains of HPV.

Benign epithelial pedunculated or sessile proliferation on the skin or mucosa

82
Q

What is actinomycosis?

A

Caused by actinomyces israali (filamentous) NOT fungal!

Opportunistic infection, chronic and granulomataous.

Periapical - jaw infections.

Cervicofacial - head and neck infections

Sulfer granules in purulent exudate

83
Q

What is Scarlet fever and what is its oral presentation?

A

Caused by group A strep

When strep throat becomes a systemic infection

Strawberry tongue = white coated tongue with red inflammed fungiform papillae

84
Q

What is candidiasis?

A

Thrush.

Pseudomemranous - white plaque that rubs off

Atrophic - red

Median rhomboid glossitis - loss of lingual papilla

Angular chelitis - corner of mouth.

Treat with antifungal such as azole or statin

85
Q

What would you likely notice on a pts palate who has been wearing the same F/- for 10+ years?

A

Erythematous palate

Papillary hyperplasia

86
Q

A patient presents with an erythematous palate and paplillary hyperplasia. What diagnosis would you make?

A

Denture induced stomatitis

87
Q

If you see brown pigment in a histology slide, what is it likely to be?

A

Melanin. Possibly from nicotine

88
Q

Name two possible aetiological factors for the development of a white patch with some areas of brown spots on the palate?

A

Smoking (reverse smoking)

Chronic inflammation

Drugs - hydroxychloroquine

89
Q

What features in the clinical appearance of a white patch would make you suspicious that it was potentially malignant?

A

Exopytic growth

Raised, rolled margins

Indurated

90
Q

Name an intra oral disease associated with angular chelitis

A

Oral facial granulomatosis

91
Q

What are some diagnostic featurs of pemphigus vulgaris?

A

History - soreness and blistering in the mouth, other mucosa and skin

92
Q

Clinical features of pemphigus vulgaris

A

* Blisters, erosions and or desquamative gingivitis

* Bullaw appear on any part of the oral mucosa but break rapidly so rarely seen

* Pt usually presents with large, painful, irregular and persistant red lesions, by the time they become secondarily infected turn into erosions with yellowish fibrinous slough

93
Q

What is the management of pemphigus vulgaris

A

Aim to promote healing, prevent infection, decrease formation and relieve pain

Take steps to reduce blistering by avoiding trauma from hard foods/contact sports

Corticosteroids

Final Flashcards (13 decks)

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