Oral Medicine Flashcards
What soft tissue infections may occur?
Viral
- primary herpes
- herpangina
- hand foot and mouth
Bacterial
- Strep
- staph
Fungal
- candida
What is primary herpetic gingivostomatitis?
Signs and symptoms?
Treatment?
Acute disease caused by HSV1 droplets
- fluid filled vesicles that rupture into ulcers
- severe gingivitis
- fever, malaise and headache
- swollen cervical lymph nodes
- dehydration most common
Treatment
- bed rest
- proper fluid intake
- paracetamol
- antimicrobial gel / mouthwash
What may cause outbursts of primary hermetic gingivostomatitis?
How manage?
Light, stress, other systemic conditions
Topical acyclovir cream
What is herpangina?
Cocksackie A virus
Vesicles in tonsillar / posterior oropharynx region lasting 7-10 days
Often children under 10 in summer / autumn time
Fever too
What is hand foot and mouth?
Ulceration on gingiva, tongue and cheeks along with rash on hands and feet
Lasts 7-10 days
Define an oral ulceration
Local defect where covering epithelium is destroyed leaving inflamed area of exposed connective tissue
What 10 questions would you ask about an ulcer?
Onset
Frequency of ulcers
Number of ulcers
Size of ulcers
Site and size of ulcers
How long they last
Exacerbating dietary factors
Any lesions in other areas
Associated medical issues
Any treatment os far?
What are some main causes for ulceration?
- most common = no underlying cause
Infection - Herpes, hand foot mouth, herpangina
Immune medicated - coeliac or crohns
Trauma
Vitamin deficiency - iron, b12, folate
Neoplastic / haematological - anaemia, leukaemia
What is RAU? What do the ulcers look like?
Recurrent apthous ulceration
- most common cause in children
- round or ovoid with grey or yellow base
Unclear aetiology
- mainly hereditary or iron deficiency
Main role of GDP in management of ulceration?
Prevent superinfection
- 0.2% corsodyl
Protect healing ulcers
- gengigel topical gel
- gelclair mouthwash
Symptomatic relief
- difflam
- LA spray
What is OFG? Cause? When seen?
Type 4 hypersensitivity reaction (T-cell mediated) where mutlinucleated giant cell macrophages formed
Immune reaction causes swelling of the peri-oral area and oral tissues as lymphatic drainage is blocked due to inflammation.
Clinical features of OFG?
Swelling of soft tissues inc gingiva and lips
Angular chelitis
Lip or tongue fissures
Cobblestone buccal mucosa
What is geographic tongue? Cause? Symptoms and management?
Shiny red areas on tongue with loss of filliform papillae
- surrounded by white margins
Cause is idiopathic and is non contagious
Associated with intense discomfort in children, or discomfort with spicy food or juices
Gets better with age
Manage by reducing diet to a bland mix of foods until flare up has disappeared
What may be some causes of some solid swellings?
Fibroepithelial polyp
Epulides
Congenital epulis
HPV associated mucosal swellings
What is a fibroepithelial polyp? Where are they often found? and how can it be treated?
Firm pink lump either pedunculated or sessile caused from minor trauma such as biting
Often found in cheeks along smile line, or on the lips or tongue
Surgical excision is curative
What is an epulide? What types?
Solid swelling of mucosa often found at the interdental region
Swellings due to inflammation where calculus or plaque is present
What is congenital epulis?
Large lesion of granular cells covered with epithelium
Benign tumour in newborn infant
What musical swellings can HPV cause? What are their typical signs?
Verruca vulgaris and squamous cell papilloma
- small pedunculated Cauliflower like growths
VV can be solitary or multiple lesions
- often associated with skin warts too
SCP is most usually solitary
What may cause a fluid filled swelling?
- mucoceles
- ranula - swelling under tongue filled with saliva from damaged salivary gland
- bohn’s nodules - soft white cysts in newborn oral cavity
- Epstein pearls - same as bohns nodules but seen closer to mid palatine raphe and also vibrating line
What is a mucocele? What causes them? When and where typically found?
Fluid filled swelling caused by either salivary gland secretions rupturing into adjacent tissue, or by secretions being retained in an expanded duct
Typically found on minor salivary glands in the lower lip in the 2nd decade of life
What is a ranula? What is needed for this?
Mucocele but in the floor of the mouth
Caused by ducts of the submandibular or sublingual gland most often
Need an MRI or ultrasound to see if it extends into the submental or submandibular space
What are bohns nodules? Where are they most commonly found and when?
Gingival cysts found on the alveolar ridge in the first 28 days of life (neonates)
They are remnants of the dental lamina filled with keratin and usually disappear in the first few months
What are espteins pearls? Where found and when?
Small cysts along the palatal mid line
Found again in neonates
Usually disappear in first few weeks
If someone has pain, masticatory spasm and limited opening in the jaw, what might they have?
Temporomandibular joint dysfunction syndrome
What should your examination consist of when suspecting TMJDS?
Extra oral feeling of tmj and MOM, check opening of the mouth too (normal 40-50mm)
Check for any intra oral wear or signs of clenching or grinding
How may one treat TMJDS?
Explain condition
Reduce exacerbating factors
- manage stress
- avoid clenching, grinding or nail biting
Allow over worked muscles to rest by stifling yawns or eating soft diet for a while
Pain management with OTC medication
Why do those with CLP have higher incidence of caries?
Difficulty carrying out oral hygiene in cleft area
Hypoplastic enamel
Supernumerary teeth in the cleft area
Delayed oral clearance
Reduced salivary flow
Fistula with nasal cavity
Extended bottle feeding
