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SAQs for dentistry > oral medicine > Flashcards

oral medicine Flashcards

1
Q

aetiological factors for recurrent apthae

A
  • genetic predisposition
  • immunological abnormalities
  • haematological deficiencies
  • stress
  • hormonal changes
  • gastrointestinal disorders
  • infections
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2
Q

types of recurrent apthae

how to differentiate

A

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

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3
Q

tx options for recurrent apthae

A
  • treat underlying systemic disease
  • benzydamine (Difflam) mouthwash
  • corticosteroids (betnesol mouthwash)
  • tetracycline mouthwashes
  • CHX mouthwash
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4
Q

angulat cheilitis (stomatitis)

A

inflammation of skin and the labial mucos membrane at the commisures of the lips

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5
Q

angular chelitis Vs actinic cheilitis

A

actinic chelitis is a premalignant condition in which keratosis of the lip is caused by UV radiaition from sunlight

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6
Q

predisposing factors for angular chelitis

A
  • 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
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7
Q

organisms that commonly cause angular chelitis

A

staphylococcus aureus and candida albicans

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8
Q

tx for angular chelitis

A
  • 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
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9
Q

acute pseudomembranous candiasis appearance

A

whitish-yellow plaques or flecks cover the mucosa but they can be wiped off leaving erythematous mucosa underneath

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10
Q

2 azole drugs and 2 non azole drugs used to treat candida infections

A

azoles

  • miconazole
  • fluconazole
  • itraconazole
  • ketoconazole

non azoles

  • nystatin
  • amphotercin
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11
Q

common white pathces and their causes

A

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

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12
Q

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

A

leukoplakia

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13
Q

types of leukoplakias

A
  • homogenous leukoplakia
  • nodular leukoplakia
  • speckled leukoplakia
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14
Q

tx for leukoplakia

A
  • 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
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15
Q

causes of dry mouth

A
  • Sjorgens syndrome
  • radiotherapy in salivary gland region
  • diabetes
  • dehydration
  • mumps
  • HIV infectin
  • anxiety states
  • diuretics
  • sarcoidosis
  • amylodosis
  • drugs e.g. antimuscarincis, antihistamines, antidepressants, polypharmacy
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16
Q

difference between primary and secondary Sjorgens syndrome

A

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

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17
Q

tests to dx Sjorgens

A
  • 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
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18
Q

erythroplasia

A

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

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19
Q

malignant potential (most to least)

white sponge naevus

erythroplasia

leukoplakia

speckled leukoplakia

A

erythroplasia

speckled leukoplakia

leukoplakia

white sponge naevus

20
Q

colour of lesion, generalised or localised for

Kaposi sarcoma

A

reddish purple

localised

21
Q

colour of lesion, generalised or localised for

irradiation muositis

A

red

generalised in region of irradiation

22
Q

colour of lesion, generalised or localised for

amlagam tattoo

A

blue/black

localised

23
Q

colour of lesion, generalised or localised for

haemangiona

A

red/purple

localised to area of haemangioma

24
Q

colour of lesion, generalised or localised for

addison’s disease

A

brown patches

localised to certain areas e.g. occlusal line

25
Q

lump on palate

possible Dx

factors about history useful

clincial features to help dx

investigations needed

A

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
26
Q

30 y.o. male presents with weakness on the left side of his face

possible intracranial and extracranial causes

A

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
27
Q

nerve issue causing facual weakness

how to tell is lower or upper motor neurone cause

A

lower motor neroune lesion - pt cannot wrinkel their forehead on the affected side (Bells)

upper motor neurone lesion - retain movement of the forehead (stroke)

28
Q

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

A

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

29
Q

localised ginigival swellings causes

A
  • periodontal abscess
  • fibrous epulis
  • denture induced granuloma
  • pregnancy epulis
  • papilloma
  • giant cell lesion/epulis
  • tumour
30
Q

features of, additional investigation to aid

periodontal abscess

A

associated with deep periodontal pocket and/or non-vital tooth

31
Q

features of, additional investigation to aid

fibrous epulis

A

firm, pin/red may be associated with poor oral hygiene

excisional biopsy

32
Q

features of, additional investigation to aid

denture induced granuloma

A

excisional biopsy and treat the cause i.e. poorly fitting denture

33
Q

features of, additional investigation to aid

pregnancy epulis

A

red lesion associated with pregnancy ginigvitis, excised post partum if still present

34
Q

features of, additional investigation to aid

papilloma

A

white cauliflower like lesion

excisional biopsy

35
Q

features of, additional investigation to aid

giant cell lesion/epulis

A

purple red lesion

radiograph, excisional biopsy and curettage, blood test to exclude central giant cell granuloma and hyperpathyroidism

36
Q

features of, additional investigation to aid

tumour

A

urgent referral to surgeon for incisional biopsy

radiograph/CBCT to look for bony involvement

MRI to stage the disease

37
Q

signs/symptoms of primary herpetic gingivostomatitis

A

multiple vesicles in their mouth, which burst and leave painful ulcers

often gingivitis

pt feel generally unwell with fever and malaise

cervical lymphadenotpathy

38
Q

causative agent of primary herpetic gingivostomatitis

A

herpes simplex virus (DNA virus)

39
Q

tx for primary herpetic gingivostomatitis

A
  • 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
40
Q

primary herpetic gingivostomatitis can be followed by recurrent herpers labalis

how?

A

virus remains dormant in the trigeminal ganglion and can be reactivated by factors such as sinlight, stress, menstruation, immunosuppression, common cold or fever

41
Q

describe lesions of herpes labalis and how to manage them

A

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

42
Q

possible presenatations of lichen planus

A
  • reticular
  • atrophic
  • desquamative gingivitis
  • erosive
  • papular
  • plaque like
43
Q

sites for lichen planus lesions

A

buccal mucosa

dorsum of tongue and gingiva

44
Q

possible extraoral sites for lichen planus

A
  • flexor surfaces of wrists (purplish, papular, itchy)
  • genitals (similar to oral lesions)
  • nails (ridges)
  • head (alopecia)
45
Q

drugs which can cause lichen planus

A
  • beta blockers
  • oral hypoglycaemics
  • NSAIDs
  • gld
  • penicillamine
  • some tricyclic antidepressants
  • antimalarials
  • thiazide diuretics
  • allopurinol
46
Q

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

A

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

SAQs for dentistry (5 decks)

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