Oral Medicine

Question 1

What soft tissue infections may occur?

Answer 1

Viral
- primary herpes
- herpangina
- hand foot and mouth

Bacterial
- Strep
- staph

Fungal
- candida

Question 2

What is primary herpetic gingivostomatitis?

Signs and symptoms?

Treatment?

Answer 2

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

Question 3

What may cause outbursts of primary hermetic gingivostomatitis?

How manage?

Answer 3

Light, stress, other systemic conditions

Topical acyclovir cream

Question 4

What is herpangina?

Answer 4

Cocksackie A virus

Vesicles in tonsillar / posterior oropharynx region lasting 7-10 days

Often children under 10 in summer / autumn time

Fever too

Question 5

What is hand foot and mouth?

Answer 5

Ulceration on gingiva, tongue and cheeks along with rash on hands and feet

Lasts 7-10 days

Question 6

Define an oral ulceration

Answer 6

Local defect where covering epithelium is destroyed leaving inflamed area of exposed connective tissue

Question 7

What 10 questions would you ask about an ulcer?

Answer 7

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?

Question 8

What are some main causes for ulceration?

Answer 8

• 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

Question 9

What is RAU? What do the ulcers look like?

Answer 9

Recurrent apthous ulceration

• most common cause in children
• round or ovoid with grey or yellow base

Unclear aetiology

• mainly hereditary or iron deficiency

Question 10

Main role of GDP in management of ulceration?

Answer 10

Prevent superinfection
- 0.2% corsodyl

Protect healing ulcers
- gengigel topical gel
- gelclair mouthwash

Symptomatic relief
- difflam
- LA spray

Question 11

What is OFG? Cause? When seen?

Answer 11

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.

Question 12

Clinical features of OFG?

Answer 12

Swelling of soft tissues inc gingiva and lips

Angular chelitis

Lip or tongue fissures

Cobblestone buccal mucosa

Question 13

What is geographic tongue? Cause? Symptoms and management?

Answer 13

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

Question 14

What may be some causes of some solid swellings?

Answer 14

Fibroepithelial polyp

Epulides

Congenital epulis

HPV associated mucosal swellings

Question 15

What is a fibroepithelial polyp? Where are they often found? and how can it be treated?

Answer 15

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

Question 16

What is an epulide? What types?

Answer 16

Solid swelling of mucosa often found at the interdental region

Swellings due to inflammation where calculus or plaque is present

Question 17

What is congenital epulis?

Answer 17

Large lesion of granular cells covered with epithelium

Benign tumour in newborn infant

Question 18

What musical swellings can HPV cause? What are their typical signs?

Answer 18

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

Question 19

What may cause a fluid filled swelling?

Answer 19

• 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

Question 20

What is a mucocele? What causes them? When and where typically found?

Answer 20

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

Question 21

What is a ranula? What is needed for this?

Answer 21

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

Question 22

What are bohns nodules? Where are they most commonly found and when?

Answer 22

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

Question 23

What are espteins pearls? Where found and when?

Answer 23

Small cysts along the palatal mid line

Found again in neonates

Usually disappear in first few weeks

Question 24

If someone has pain, masticatory spasm and limited opening in the jaw, what might they have?

Answer 24

Temporomandibular joint dysfunction syndrome

Question 25

What should your examination consist of when suspecting TMJDS?

Answer 25

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

Question 26

How may one treat TMJDS?

Answer 26

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

Question 27

Why do those with CLP have higher incidence of caries?

Answer 27

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