Oral Medicine Flashcards
Give examples of oro-facial soft tissue infections
Viral - primary herpes, MMR, hand foot and mouth
Bacterial - staphylococcal, streptococcal, TB
Fungal - candida
What is primary herpetic gingivostomatitis?
An acute infectious disease from the Herpes Simplex Virus I
Common in children
Almost 100% of the adult population are carriers
What are the signs and symptoms of Primary Herpetic Gingivostomatitis?
Fluid filled vesicles - painful ragged ulcers intra-orally
Fever
Headache
Malaise
Cervical lymphadenopathy
What is the treatment for Primary Herpetic Gingivostomatitis?
Bed rest
Soft diet/hydration
Paracetamol
Antimicrobial gel or mouthwash
Aciclovir for immunocompromised children
Common complication is dehydration
What is the outcome of Primary Herpetic Gingivostomatitis?
Lasts 14 days
Heals with no scarring
What are common causes of Primary Herpetic Gingivostomatitis?
Sunlight
Stress
Other causes of ill health
What can be caused by the Coxsackie A Virus?
Herpangina
Hand, foot and Mouth
What is oral ulceration?
A localised defect in the surface oral mucosa where the covering epithelium is destroyed leaving an inflamed area of exposed connective tissue
What are the causes of oral ulceration?
Infection
Immune mediated disorders
Vesiculobullous disorders
Immunodeficiency disorders
Neoplastic/Haematological
Trauma
Vitamin deficiencies
Recurrent Apthous Stomatitis
What is the most common cause of ulceration in children?
Recurrent Apthous Stomatitis
How does RAU present?
Ulcers are round in shape with a grey or yellow base
Minor - <10mm
Major - >10mm
Herpetiform - 1-2mm
What initial investigations are used for oral ulceration?
Diet diary
Full blood count
Haematinics
Coeliac screen
How can aetiological causes of oral ulceration be managed?
Diet analysis may suggest exacerbating food groups
Low ferritin - 3 months of iron supplementation
Low folate/B12 or positive anti-transglutaminase antibodies then refer to paediatrician
How can oral ulceration be managed pharmacologically?
Prevention of superinfection - corsodyl 0.2% mouthwash
Protect healing ulcers - Gengigel topical gel or Gelclair mouthwash
Symptomatic relief - Difflam (0.15% benzydamine hydrochloride) or LA spray
What is orofacial granulomatosis and who is most affected?
An uncommon chronic inflammatory disorder
Idiopathic or associated with Crohn’s or Sarcoidosis
Average age of onset 11, affects males over females
Describe characteristic pathology of orofacial granulomatosis
Non caseating giant cell granulomas which then result in lymphatic obstruction
What are the clinical features of OFG?
Lip swelling
Full thickness gingival swelling
Swelling of non labial facial tissues
Peri-oral erythema
Cobblestone appearance of the buccal mucosa
Linear oral ulceration
Mucosal tags
Lip/tongue fissuring
Angular cheilitis
Which allergens are associated with OFG?
Cinnamon compounds
Benzoates
Much higher IgE mediated atopy rates
How is OFG diagnosed?
Clinically - no lip biopsy needed
What investigations can be used for OFG?
Measure growth
Full blood count
Haematinics
Patch testing
Diet diary to ID any triggers
Faecal Calprotectin
Endoscopy - risky in children
Serum Angiotensin Converting Enzyme
How is OFG managed?
OH support
Symptomatic relief as per oral ulceration
Dietary exclusions
Manage nutritional deficiencies
Topical steroids
Topical tacrolimus
Short corses of oral steroids
Intralesional corticosteroids
Surgical intervention - if unresponsive long standing disfigurement
Describe mucosal lesions of the tongue
Idiopathic and non-contagious
May be seen at a young age
Shiny red areas on the tongue with loss of filiform papillae are surrounded by white margins
Can cause discomfort with spicy food, tomato and citrus fruit/juice
How are mucosal lesions of the tongue managed?
Bland diet during flare ups
Likely to become less troublesome with age
Give examples of solid swellings
Fibroepithelial Polyp
Epulides
Congenital epulis
HPV-associated mucosal swellings
Neurofibromas
Describe a fibroepithelial polyp
Common
Firm pink lump
Mainly in the cheeks, along occlusal line or tongue
Once established remains constant size
Thought to be initiated by minor trauma
Surgical excision is curative
What are epulides?
Common solid swelling of the oral mucosa
Benign hyperplastic lesion
3 types:
- fibrous epulis
- pyogenic granuloma
- peripheral giant cell granuloma
Describe a fibrous epulis
Pedunculated or sessile mass
Firm consistency
Similar colour to surrounding gingivae
Inflammatory cell infiltrate and fibrous tissue
Describe a pyogenic granuloma
Soft, deep red/purple swelling
Often ulcerated
Haemorrhage spontaneously or with mild trauma
Probably a reaction to chronic trauma eg - calculus
Tend to recur after removal
Describe a peripheral giant cell granuloma
Pedunculated or sessile swelling
Typically dark red and ulcerated
Usually interproximal with an hour glass shape
Radiographs may reveal superficial erosion of the interdental bone
May recur after surgical extraction
Describe a congenital epulis
Rare lesion occurring in neonates
Most commonly affect the anterior maxilla
Affects females over males
Benign and simple excision is curative
Give examples of HPV associated swellings
Verruca Vulgaris
Squamous cell papilloma
Give examples of fluid swellings
Mucoceles
Ranula
Bohn’s nodules
Epsteins Pearls
Haemangiomas
Vesiculobullous lesions
What is a mucocele?
A bluish, soft transparent cystic swelling affecting minor or major salivary glands
Most will rupture spontaneously
When are mucoceles surgically excised?
Only if lesion fixed in size as will likely damage adjacent glands leading to recurrence
Involves removal of the cyst and the adjacent damaged minor salivary gland
What is a ranula?
A mucocele in the floor of the mouth
What are Bohn’s nodules?
Gingival cysts filled with keratin
Remnants of the dental lamina
Found in neonates and usually disappear in the early months of life
What are Epstein Pearls?
Small cystic lesions found along the palatal midline
Thought to be trapped epithelium in the palatal raphe
Found in about 80% of neonates and disappear in the 1st few weeks
What characterises TMJDS?
Pain
Masticatory muscle spasm
Limited jaw opening
What questions should be asked in a history for TMJDS?
A description of the presenting symptoms
When did the discomfort begin?
Is the pain worse at any time during the day?
Exacerbating factors
Habits
Stress
What should an extra oral examination for TMJDS include?
Palpation of the MoM both at rest and when teeth are clenched to assess tenderness and/or hypertrophy
Palpation of the TMJ at rest and when opening and closing to assess tenderness and click/crepitus
Assessment of opening - check for any deviation of the jaw and assess extent of opening
What should an intra oral examination for TMJDS include?
Assessment of any dental wear facets
Signs of clenching/grinding - scalloped lateral tongue surface, buccal mucosa ridges
How is TMJDS managed?
Explain the condition
Reduction of exacerbating factors
Allow the overworked muscles to rest
Symptomatic relief
If these measures are unsuccessful then refer for specialist care
