oral medicine Flashcards
aetiological factors for recurrent apthae
- genetic predisposition
- immunological abnormalities
- haematological deficiencies
- stress
- hormonal changes
- gastrointestinal disorders
- infections
types of recurrent apthae
how to differentiate
Minor apthae may occur singly or in crops and they affect the non-keratinised and mobile mucosa, usually less than 4mm diameter
Major apthae occur as a single ulcer, which may be greater than 1cm diameter, masticatory mucosa and dorsum of tongue often affected
Herpetiform apthae ususally occur in crops of ulcers which are 1-2mm in diameter, altough they may coalesce to form larger uclers, on non-keratined mucosa
tx options for recurrent apthae
- treat underlying systemic disease
- benzydamine (Difflam) mouthwash
- corticosteroids (betnesol mouthwash)
- tetracycline mouthwashes
- CHX mouthwash
angulat cheilitis (stomatitis)
inflammation of skin and the labial mucos membrane at the commisures of the lips
angular chelitis Vs actinic cheilitis
actinic chelitis is a premalignant condition in which keratosis of the lip is caused by UV radiaition from sunlight
predisposing factors for angular chelitis
- wearing dentures
- having denture stomatitis
- nuturional deficies e.g. iron
- immunocompromised
- decreased vertical dimension resulting in infolding of the tissues at the corner of the mouth allowing the skin to become macerated
organisms that commonly cause angular chelitis
staphylococcus aureus and candida albicans
tx for angular chelitis
- Miconazole cream 2% 20g tube apply to angles of mouth twice daily
- Contraindicated for those on warfarin or statins
- Sodium fusidate ointment 2% 15g tube
acute pseudomembranous candiasis appearance
whitish-yellow plaques or flecks cover the mucosa but they can be wiped off leaving erythematous mucosa underneath
2 azole drugs and 2 non azole drugs used to treat candida infections
azoles
- miconazole
- fluconazole
- itraconazole
- ketoconazole
non azoles
- nystatin
- amphotercin
common white pathces and their causes
frictional keratosis - friction
leukoedma - variation of normal
candidal infection - candida albicans infection
fordyce spots/granules - development (sebaceous glands in the muocsa)
lichen planus - unknown
lichenoid reaction - gold/antimalarials/amalgam
skin grafts
white patch that cannot be characterised clincally or pathologically as any other disease and is not associated with any physical or chemical causative agents except smoking tobacco
leukoplakia
types of leukoplakias
- homogenous leukoplakia
- nodular leukoplakia
- speckled leukoplakia
tx for leukoplakia
- removal of causatve agent (smoking)
- surgical removal (traditional surgical techniques or with a laser)
- photodynamic therapy
- retinoids
- specialist referral
- regular review and biopsy as appropriate
causes of dry mouth
- Sjorgens syndrome
- radiotherapy in salivary gland region
- diabetes
- dehydration
- mumps
- HIV infectin
- anxiety states
- diuretics
- sarcoidosis
- amylodosis
- drugs e.g. antimuscarincis, antihistamines, antidepressants, polypharmacy
difference between primary and secondary Sjorgens syndrome
primary sjorgens compromises of dry mouth and dry eyes
secondary sjorgens there is dry mouth and eyes in association with a connective tissue disease e.g. rheumatoid arthritis, systemic lupus erythamatous
tests to dx Sjorgens
- biopsy
- labial salivary gland (minor glands are usually involved at a microscopic level even though they may not be enlarged)
- focal collections of lymphoids cells are seen adjacent to blood vessels, greater no. = worse
- also acinar atrophy
- blood tests
- antinuclear antibodies SSA, SSB; rheumatoid factor; erythrocyte sedimentation rate
- parotid salivary flow rate
- Schirmer test
- Sialography
erythroplasia
any lesion of the oral mucosa that presents as red velvety plaque, which cannot be characterised clincally or pathologically as any other condition
lesions often show dysplasia or carcinoma in siu or frank carcinoma histologically
malignant potential (most to least)
white sponge naevus
erythroplasia
leukoplakia
speckled leukoplakia
erythroplasia
speckled leukoplakia
leukoplakia
white sponge naevus
colour of lesion, generalised or localised for
Kaposi sarcoma
reddish purple
localised
colour of lesion, generalised or localised for
irradiation muositis
red
generalised in region of irradiation
colour of lesion, generalised or localised for
amlagam tattoo
blue/black
localised
colour of lesion, generalised or localised for
haemangiona
red/purple
localised to area of haemangioma
colour of lesion, generalised or localised for
addison’s disease
brown patches
localised to certain areas e.g. occlusal line
lump on palate
possible Dx
factors about history useful
clincial features to help dx
investigations needed
possible Dx
- torus palatinus
- unerupted tooth
- dental abscess
- papilloma
- neoplasm (benign/malignant) - salivary (pleomorphic adenoma/adenocarcinoma); squamous cell carcinoma; lymphoma
factors about history
- duration
- assoaciated features e.g. tooth ache, periodontal involvement
- change in size/consitency
- exacerbating factors e.g. loose denture, trauma
- medical conditions e.g. neurofibromatosis, drugs
clincal features of use
- position e.g. midline - torus palatinus
- consistency
- fluid - pus, blood, cystic fluid
- soft, firm, hard - tumour
- bony hard - tooth, torus palatinus
- colour e.g. red - vascular
- discharge
- surface texture
- uniform, nodular, ulcerated
investigations needed
- imaging - radiographs
- CBCT
- biopsy
- blood test
30 y.o. male presents with weakness on the left side of his face
possible intracranial and extracranial causes
intracranial
- Bell’s palsy
- malignant parotid neoplasm
- post-partotidectomy
- sarcoidosis
- incorrect administration LA
extracranial
- stroke
- intracranial tumour
- multiple sclerosis
- HIV
- lyme disease
- ramsey- hunt syndrome
- trauma to base of skull
nerve issue causing facual weakness
how to tell is lower or upper motor neurone cause
lower motor neroune lesion - pt cannot wrinkel their forehead on the affected side (Bells)
upper motor neurone lesion - retain movement of the forehead (stroke)
Herpes zoster is caused by the X which lies latent in X
tends to affect X pt
main complaint is X or X
lesions are in the form of X, X or X
tx is X at dose of X five times a day for 7 days
medication for pain relief is also prescribed and X may also help with the pain and speed healing
postherpetic neuralgia is X and persisting more than X months
Herpes zoster is caused by the varicella zoster virus which lies latent in dorsal root ganglia
tends to affect middle age or older pt
main complaint is pain or tenderness to dermatomes
lesions are in the form of rash, vesicles or ulcerations
tx is systemic aciclovir at dose of 200-800mg five times a day for 7 days
medication for pain relief is also prescribed and systemic corticosteroids may also help with the pain and speed healing
postherpetic neuralgia is pain developing during the acute phase of herpes zoster and persisting more than 6 months
localised ginigival swellings causes
- periodontal abscess
- fibrous epulis
- denture induced granuloma
- pregnancy epulis
- papilloma
- giant cell lesion/epulis
- tumour
features of, additional investigation to aid
periodontal abscess
associated with deep periodontal pocket and/or non-vital tooth
features of, additional investigation to aid
fibrous epulis
firm, pin/red may be associated with poor oral hygiene
excisional biopsy
features of, additional investigation to aid
denture induced granuloma
excisional biopsy and treat the cause i.e. poorly fitting denture
features of, additional investigation to aid
pregnancy epulis
red lesion associated with pregnancy ginigvitis, excised post partum if still present
features of, additional investigation to aid
papilloma
white cauliflower like lesion
excisional biopsy
features of, additional investigation to aid
giant cell lesion/epulis
purple red lesion
radiograph, excisional biopsy and curettage, blood test to exclude central giant cell granuloma and hyperpathyroidism
features of, additional investigation to aid
tumour
urgent referral to surgeon for incisional biopsy
radiograph/CBCT to look for bony involvement
MRI to stage the disease
signs/symptoms of primary herpetic gingivostomatitis
multiple vesicles in their mouth, which burst and leave painful ulcers
often gingivitis
pt feel generally unwell with fever and malaise
cervical lymphadenotpathy
causative agent of primary herpetic gingivostomatitis
herpes simplex virus (DNA virus)
tx for primary herpetic gingivostomatitis
- bed rest, soft diet, fluids, analgesics
- CHX or tetracycline mouthwash to prevent secondary infection of the ulcers
- aciclovir in severe cases or medically compromised pts
primary herpetic gingivostomatitis can be followed by recurrent herpers labalis
how?
virus remains dormant in the trigeminal ganglion and can be reactivated by factors such as sinlight, stress, menstruation, immunosuppression, common cold or fever
describe lesions of herpes labalis and how to manage them
lesions appear at the mucocutaneous juntion of lips
pt often has prodromal itching/prickling sensation prior to the appearance of the lesion, which starts off as a papule and then forms vesicles that burst leaving a scab
usually heal withut scarrinng after 7-10 days
lesions will health without tx but if given early (i.e. in prodromal phase) antiviral cream such as penciclovir or aciclovir may prevent lesions from occurring or at least speed of healing
possible presenatations of lichen planus
- reticular
- atrophic
- desquamative gingivitis
- erosive
- papular
- plaque like
sites for lichen planus lesions
buccal mucosa
dorsum of tongue and gingiva
possible extraoral sites for lichen planus
- flexor surfaces of wrists (purplish, papular, itchy)
- genitals (similar to oral lesions)
- nails (ridges)
- head (alopecia)
drugs which can cause lichen planus
- beta blockers
- oral hypoglycaemics
- NSAIDs
- gld
- penicillamine
- some tricyclic antidepressants
- antimalarials
- thiazide diuretics
- allopurinol
X disease is due to sensititvity to X
pts may suffer from malabsorption of X, X and X and may have the following oral signs X, X, and X
X disease is a chronic X that may affect any part of teh GI tract, but most commonly affects the X
Oral signs may be see such as mucosal tags X, X and X
Coeliac disease is due to sensititvity to gluten
pts may suffer from malabsorption of vitamin B12, folate and iron and may have the following oral signs oral ulceration, angular cheilitis, and glossitis
Crohn’s disease is a chronic granulomatous that may affect any part of the GI tract, but most commonly affects the ileum
Oral signs may be see such as mucosal tags cobblestone mucosa, lip swelling and oral ulceration
