Oral Medicine Flashcards
Give 5 signs and symptoms of TMD?
- Limited opening
- Clicking
- Crepitus
- Headache
- Earache
- Locking of jaw- fixed or patient may be able to manipulate back in (subluxation)
- Wear facets/micro-cracks
- Lost fillings
- Linea Alba on buccal surface- keratin layer (protective)
- Radiographically Flattening of bones in joint, Widened PDLs (also seen in high fillings)
What are examples of conservative advice to give to patients?
- Stick to softer, less chewy diet- cut food into small pieces
Takes pressure off muscles and jaw- scrambled eggs, pasta, soft meat
Avoid biting edge to edge- pulls mandible out of alignment (apples etc) - Reduce use of chewing gum
- Nail biting- can put pressure on joints (nail polish)
- Mouth guard (splint)- protects joint and teeth
- Chew bilaterally/equally (look for teeth missing)
- Analgesia- paracetamol/ibuprofen tablets or gel (have they been doing this already)
- Massage can help in uncomfortable areas
- Use of hot and cold packs
Heat is good for muscle relaxation
Icepack reduces inflammation - Physiotherapy- controversial- may add extra pressure to jaw, training a patient how to open properly
- Acupuncture
- Botox
- Supported yawning and reduced mouth opening
What information from a clinical examination would suggest a patient had TMD?
E/O:
Muscle hypertrophy
Muscle tenderness
Deviation
I/O:
Scalloped tongue
Linea alba
Wear on teeth
Fractured restorations
What factors can predispose a patient to TMD?
Stress
Trauma
Chewing gum
Parafunctional habits
Female sex
What other conditions may present like TMD, how could you exclude these?
Dental pain
Sinusitis
Ear pathology
Salivary gland pathology
Referred neck pain
Headache
Atypical facial pain
Trigeminal neuralgia
Angina
Condylar fracture
Temporal arteritis
-> would not get clicking of jaw
How should a splint be made for TMD?
Must cover all teeth
Block out any deep undercuts
If denture induced stomatitis (erythematous candiasis) persisted what would you do to manage it?
Use anti fungal medication- Fluconazole
What instructions would you give to a technician regarding construction of an upper special try for master impression?
Please provide light cured acrylic resin custom trays with the appropriate spacing and an extra-oral handle
Spacing- 3mm alginate, 2mm silicone or polyether
What makes the brown pigmented part of lesions?
Melanin
What are the changes which occur suggesting a lesion is potentially malignant?
Cellular atypia
Hyperchromatism
Pleomorphism
What are the aetiological factors involved in development of white lesion with some areas of brown and grey?
Smoking
Drugs- hydroxychloroquine, tetracycline
Melanoma
HIV
Amalgam tattoo
What features make you highly suspicious that the lesion is potentially malignant?
Hardened
Raised rolled margins
What is the likely cause of a lesion that is white and Lacey in appearance in the buccal muscosa?
Reticular Lichen planus
Lichenoid tissue reaction- if next to restoration
What type of reaction is Lichenoid tissue reaction?
Type 4 hypersensitivity
Name 2 types of biopsy to investigate a lichenoid reaction?
Incisional
Excisional
What are the histological features of lichenoid reaction?
T cell infiltrate into the basement membrane of connective tissue
-> Appears as lymphocytic band hugging BM (key diagnostic feature)
Civette bodies
Dead keratinocytes
Saw tooth rete ridges
Basal cell damage
Patchy acanthosis
Parakeratosis/orthokeratosis
What is the disease caused by candida that presents as redness at the corners of the mouth?
Angular Cheilitis
What micorganisms are involved in angular cheilitis?
Staphylococcus Aureus
Candida Albicans
What microbiological sampling method is used for angular cheilitis?
Swab
What immune deficiency disease is associated with angular cheilitis?
HIV
What gastro-intestinal bleeding disease is associated with angular cheilitis?
Crohn’s
What intra-oral disease is associated with angular cheitliis?
OFG
Why is miconazole used for angular cheilitis when sampling is not available ?
As miconazole is effective against fungi and staphylococcal bacteria
What is a diagnosis of inflamed gingiva extending beyond mucogingival margin?
Atrophic Lichen planus
What is the descriptive term used to describe appearance of inflamed gingivae extending beyond mucogingival margin?
Desquamitive gingivitis
What oral mucosal conditions can cause desquamative gingivitis?
Pemphigoid
Pemphigus
Lichen Planus
What local factors can makes desquamative gingivitis worse?
Plaque
What treatments can be used for desquamative gingivitis?
Betamethasone mouthwash
What methods are used to diagnose Pemphigus Vulgaris?
Incisional peri-leisonal biopsy
-> Direct immunofluorescence- basket weave
-> Histoplatholgy assessment
-> Indirect immunofluorescence
What causes pemphigus vulgaris?
Type 2 hypersensitivity reaction against desmoglian 3 antibody in desmosomes
What condition could represent the same as pemphigus vulgaris clinically but would be different histopathologically?
Bullous Pemphigoid
What are the risk factors for oral squamous cell carcinoma?
Sunlight
HPV
Smoking
Alcohol
Poor diet
Poor OH
Patient has SCC that is 5cm in width, bilateral LN involvement <2mm and no sign of spread. Stage the tumour using TMN?
How do you grade dysplasia histopathologically?
Hyperplasia
Dysplasia- mild, moderate, severe
Carcinoma in situ
What are the interventions that can be used to treat oral SCC?
Excision
Chemotherapy
Radiotherapy
How can you restore function of tongue after removing OSCC?
Soft tissue graft
What organism is associated with denture stomatitis?
Candida albicans
What local factors can cause DI stomatitis?
Poor OH
Wearing denture at night
Smoking
Xerostomia
Inhaler
What are the management options for DI stomatitis?
CHX mouthwash
Denture hygiene- stepping in milton
Tissue conditioner
Antifungals
-> nystatin
-> fluconazole
Removing denture at night
Smoking cessation
Rinsing after inhaler use
What can be seen on occlusal surfaces due to inhaler use? What can be done to treat?
Erosion
-> rinse mouth after use and apply F varnish
What are the types of RAS?
Major
Minor
Herpetiform
What are the differences between major and minor RAS?
Minor- <10mm, Major >10mm
Minor <2 weeks, Major>2 weeks
Major may scar
Minor only affects NK tissue
What are the causes of RAS?
Systemic diseases
Stress
Viral/bacterial infections
Genetic Predisposition
Hormone level fluctuations (menstrual)
Microelement deficiency
-> malabsorption
-> GI blood loss
SLS toothpaste
How are RAS ulcers treated?
Betamethasone mouthwash- 1mg in 10ml
Correct blood deficiencies- Ferritin (iron), Folic Acid, Vit B12
Refer for investigation if Coeliac positive
-> endoscopy and jejunal biopsy
Avoid dietary triggers (identified through testing)- Empirical dietary avoidance – use FOOD MAESTRO
Avoid SLS containing toothpaste – (Sensodyne Pronamel and Kingfisher are SLS free)
What potential issues can occur alongside RAS?
What is the nature of the pain seen in Trigeminal Neuralgia?
Intense stabbing pain- tends to be brief but severe
-> Goes along course of affected cranial nerve
-> Can be caused by irritation or damage (not always)
What are the common causes of TN?
Vascular compression of CN5
-> can be investigated through use of MRI
Demyelination of CNV causing ischaemia
-> MS
Brain tumour
Idiopathic
Deformity of skull base
AV malformations
If MS caused TN what other symptoms may the patient be experiencing?
Muscle weakness
Intention tremor
Visual disturbance
Paraesthesia
Autonomic dysfunction
Dysarthria
Pain
Balance/hearing loss
If brain tumour caused TN what other symptoms may the patient be experiencing?
Headache
Diploplia
Seizures
How can you manage the patients pain from TN surgically?
Microvascular Decompression
Gamma knife radiosurgery
Neurectomy
Balloon compression
Glycerol injection
How can you manage the patients pain from TN medically?
Carbamazepine
Oxcarbazepine
Lamotrigine
Gabapentin
Phenytoin
What tests would you do before before prescribing carbamazepine?
FBC- can cause neutropenia, thrombocytopenia, pancytopenia
LFT- can cause liver toxicity
Electrolyte testing (U+E)- can cause hyponatraemia
What are the side effects of carbamazepine?
Skin reactions
Headache
Drowsiness
Dry mouth
Weight gain
Ataxia
What is the intra-oral manifestation of herpes?
Primary Herpetic gingivostomatitis
What are 3 causes of vesicle formation?
Erythema Multiforme
Pemphigoid
Pemphigus
What viral conditions can cause ulceration?
HSV
VZV
What oral lesions are caused by Coxsackie virus?
Hand foot and mouth
Herpangina
What disorders can be caused by EBV?
Glandular fever
Hairy leikoplakia
How does herpes labials form?
What medical conditions are associated with acute pseudomembranous candidiasis?
HIV
Poorly controlled diabetes
What are the advantages/disadvantages of oral swab?
What are the advantages/disadvantages of oral rinse?
What should we as the pathologist for when sending a sample?
Which drugs does fluconazole interact with?
Warfarin
Statins
What are the causes of microcytic anaemia?
Iron Deficiency
Thalassemia
What topical treatments are available for RAS?
Betamethasone mouthwash
Beclomethasone MDI
Benzydamine spray
What is the likely cause of a middle aged female complaining of burning mouth and diffuse erythema?
What is the likely cause of dull throbbing pain in maxillary region made worse by bending over?
What is the likely cause of episodic pain lasting up to 20 mins with nose dripping which is worse when shaking head?
What is the likely cause of sharp shooting pain in right cheek when biting with tears forming in elderly patient?
Trigeminal neuralgia
What is the likely cause of temporal pain and weakness of shoulder muscle?
Temporal arteritis
What are the local causes of a pigmented tongue?
Smoking
CHX
Bacterial overgrowth- black hairy tongue
Melanoma
Melanotic macule
What are the systemic causes of a pigmented tongue?
Addisons
Race
What are the histological characteristics of Lichen Planus?
T cell infiltrate into the basement membrane of connective tissue
-> Appears as lymphocytic band hugging BM (key diagnostic feature)
Civette bodies
Dead keratinocytes
Saw tooth rete ridges
Basal cell damage
Patchy acanthosis
Parakeratosis/orthokeratosis
What are the causes of Lichen Planus?
Genetic predisposition- not HLA linked
Physical and emotional stress
Injury to the skin- scratches or after surgery
-> isomorphic response (koebnerisation)
Localised skin disease such as herpes zoster—isotopic response
Systemic viral infection- hepatitis C
Contact allergy- metal fillings
Drugs-gold, quinine, b-blockers, ace inhibitors
-> lichenoid rash
What investigations are required for LP?
FBC
Haematinic deficiency screen
Autoantibody screen
Biopsy- smoker, symptomatic, high risk area
How is LP treated?
Remove cause- amalgam restoration, medication
CHX
Benzdamine mouthwash
If symptomatic
-> Beclomethasone MDI 0.5mg/puff – 2 puffs x 2-3 daily
-> Betamethasone rinse – 1mg/10ml/2mins/twice daily
What are the histological features of pemphigus?
Loss of epithelium and shedding of epithelial layer
Supra-basal (split occurs above basement membrane as desmosomes are attacked)
Tzank cells
Acantholysis
What are the causes of pemphigus?
Autoimmune- T2 hypersensitivity
What special investigations are used for pemphigus?
Biopsy- peri-lesional
-> Histopatholgy assessment
-> Direct immunofluorescence (indirect too)
ELISA
How is pemphigus/pemphigoid treated?
Steroids
Immune modifying drugs- azathioprine, mycophenolate, dapsone, biologics
What is the distribution of salivary gland cancers among the different glands?
Parotid- 80%
Submandibular- 10%
Minor- 10%
Sublingual- 0.5%
Incidence of salivary gland tumours in order:
Pleomorphic adenoma- 75%
Warthins- 15%
Adenoid cystic carcinoma- 5%
Mucoempidemroid carcinoma- 3%
Acinic cell carcinoma- <1%
What are the histological features of pleomorphic adenoma?
Myoepithelial cells
Fibrous capsule- often incomplete
Myxoid tissue
Chondorid areas
What feature leads to recurrence of pleomorphic adenoma?
During removal myxomatous tissue parts can easily fall off and continue growing
What are the histological characteristics of Warthin’s tumour?
Completely encapsulated (easy to remove, recurrence is rare, malignant transformation is rare)
Cystic spaces between epithelium with lymphoid tissue in between
Oncocytic epithelium- appears pink
What are the histological features of adenoid cystic carcinoma?
Cribiform appearance
Tubular
Solid
No capsule
What feature of parotid swelling would make you suspicious of malignancy?
What is desquamative gingivitis?
Descriptive term rather than diagnostic
-> Full thickness erythema of the gingivae
What are your differential diagnoses for a patient with reddened area in buccal mucosa with a white Lacey edge adjacent to tooth restored with amalgam?
Trauma
Lichenoid reaction
Lichen Planus
Oral cancer- SCC
What are the reasons for dentures no longer fitting in Paget’s disease?
Disturbed turnover of bone- deposition and resorption can occur simultaneously
-> results in swelling and enlargement causing dentures not to fit
What is the reason for radio-opacity formation in relation to roots of teeth in Paget’s?
Hypercementosis (characteristic of disease)
What precautions would you take when extracting a tooth in a patient taking bisphosphonates?
Atraumatic extraction technique
What are the signs and symptoms of Primary herpetic gingivostomatitis?
Ulceration
Fever
Dry mouth- dehydration
Inflamed/swollen gingivae
What is the cause of a generalised white plaque that can be scraped off easily and leave an erythematous base?
Pseduomembranous Candidiasis????
Which conditions can cause this? What would you ask pathologist for?
What are the different forms of haemangioma?
Cavernous- large blood filled spaces
Capillary- groups of smaller vessels, mostly capillaries
What investigations can be done for Trigeminal Neuralgia?
MRI
CN5 reflex testing
What neurological conditions can cause Trigeminal neuralgia?
MS
Brain tumours
What are the indications for surgery in trigeminal neuralgia?
If maximum medication doses are being taken
Patients in their 50s using significant amount of drugs as treatment
If side effects of medicine is intolerable
What muscles are examined in patients with TMD?
Temporalis
Masseter
*Medial/lateral pterygoid are not reliably examined
What are the common causes of TMD?
Parafunction
Trauma
Occlusal discrepancy
OA/RA
Ankylosis of joint
Anxiety/stress
What nerve supplies the TMJ?
CN5- mandibular division via auriculotemporal nerve
What are the signs and symptoms of TMD?
Pain
Clicking
Crepitus
Limited opening
Headache
Earache
Lost fillings
Linea alba
What advice is given for conservative management of TMD?
Soft diet
Cut food into small pieces
Analgesia- paracetamol
Stop chewing gum
Avoid nail biting
Support when yawning
Wear BRA
What is the mechanism of action in a bite splint?
Eliminates occlusal interference
Works as habit breaker against grinding
Opens mouth slightly- prevents condyle moving up and back at area of bilaminar zone which is usually most inflamed
-> reduced loading on TMJ
What is athrocentesis?
jaw joint is washed out with sterile fluid. It aims to return the disc of cartilage to its normal position within the joint.
What other surgeries are available for TMD?
Disc plication
Eminectomy
High condylar shave
Condylotomy
Meniscectomy
Condylectomy
Reconstructive procedures
What are the types of LP?
- Erosive- has potential to become malignant and is most painful (biopsy)
- Reticular
- Papular
- Atrophic
- Bullous
- Plaque like
What are some examples of Human Herpes Viruses?
HHV3- Varicella Zoster
HHV4- Epstein Barr
HHV5- cytomegalovirus
HHV8- associated with Kaposi Sarcoma
What cranial nerve is Herpes associated with?
Trigeminal
What are triggers for reactivation of Herpes virus?
If patient immunocomprimised/systemically unwell
If patient immunosuppressed
Stress
Sunlight
What is Anaemia?
Reduced Hb present in blood
What are the signs and symptoms of Anaemia?
Palpitations
Fatigue
Palor
SOB
Weakness
Dizziness
Brittle nails
What are the oral signs of anaemia?
Pale mucosa
Smooth tongue- iron deficient
Beefy tongue- B12 deficient
Oral dysaesthesia
ROU
Candidiasis
What are the causes of macrocytic Anaemia?
B12/folate deficiency
Presence of reticulocytes
Wear are the causes of normocytic anaemia?
Bleeding
Pregnancy
Renal disease
What are the causes of Xerostomia?
Polypharmacy- TCAs, diuretics, anti-histamine, antipsychotics
Salivary gland obstruction
Sjogren’s
Anxiety and somatoform disorders
Dehydration
Sarcoidosis
HIV
CF
How can you assess xerostomia intra-orally?
Challacombe scale
What are the signs and symptoms suggesting that a patient has a dry mouth?
Increased caries rate- especially cervical
Frothy saliva
Shortening of tongue papillae
Smoothed gingival architecture
Issues eating, speaking, swallowing
Halitosis
Candida infection
How can xerostomia be managed?
Salivary stimulants- pilocarpine
Salivary substitutes- orthana, glandosane, oral balance
Frequent sips of water
Chewing gum
Using drugs that don’t cause dry mouth
What are examples of sugar substitutes?
Xylitol
Aspartame
Sorbitol
What are examples of salivary proteins?
Histatins
S-IgA
Mucins
Lactoferrin
What are examples of salivary enzymes?
Amylase
Lipase
Lysozyme
When are antibiotics indicated for dental treatment?
Adjunct to surgical treatment in Periodontal disease
For treatment of necrotising periodontal disease
For treatment of acute infection when drainage or XLA is not possible
If signs of spreading dental infection or sepsis
What are the ways in which antibiotics work?
Protein synthesis inhibition
Inhibition of cell wall synthesis
Nucelic acid inhibition- replication inhibition
Inhibition of plasma membranes
Inhibition of essential metabolites
What are some of the disadvantages of antibiotics?
Resistance
Allergy
Drug interactions
What are examples of antibiotics used in dentistry and their treatment regime?
Phenoxymethylpencillin- 500 4 x per day for 5 days
Amoxicillin- 500mg TID for 5 days
Metronidazole- 400mg TID for 5 days
What are the mechanisms of antibiotic resistance?
Biofilm formation
Efflux
Alteration of target molecule
Blocking entry of antibiotic
Production of inactivation enzymes
How is desquamative gingivitis managed?
Blood tests
DI
Control local factors- plaque, restorations, medication
Aid OH if patient cannot manage normal brushing
-> CHX
-> F supplements
How do you differentiate between upper and lower motor neurone disease? What causes this difference?
Upper spares upper- everything above the eye brow still functions
What are the causes of Lower MND?
What is geographic tongue?
Benign migratory glossitis- Denuded erythematous patches on tongue surface that vary daily (filiform depappilation)
How is Geographic tongue managed?
Avoid spicy/acidic foods
FBC- check haematinic which may cause
Reassure- mostly assymptomatic and not worrisome
What is Coxsackie virus?
RNA enterovirus
What diseases are associated with Coxsackie Virus?
Hand, foot, mouth disease
Herpangina
Meningitis
What diseases are caused by EBV?
Glandular fever
Hairy leukoplakia
NHL
If your patient takes two inhalers for asthma what are they likely to be?
Short Acting B2 Agonist (blue)- salbutamol
Corticosteroid (brown)- Beclamethasone
What is Asthma?
Over-reaction of the immune system to innocuous stimuli causing mast cell degranulation resulting in reversible airflow obstruction:
-> Smooth muscle contraction
-> inflammation and swelling of mucosa
-> increased mucus secretion
What are the signs and symptoms of asthma?
Wheeze
Cough
SOB
Rash
What are the dental implications of inhaler use and what advice should be given?
Xerostomia
Increased chance of candida infections due to steroids
Incresed erosion due to acidic nature of medication
-> rinse mouth with water after use
-> use of a spacer
-> regular preventive advice
What is the percentage of people being treated for asthma in Scotland?
7%
What are the signs of epithelial dysplasia?
Nuclear Hyperchromatism
Increased number and size of nuclei
Atypical mitoses
Abnormal nucleus shape or size
Abnormal cell shape or size
Increased or altered nucleus:cytoplasm ratio
Drop shaped rete ridges
Abnormal keratinisation
Abnormal stratification
Loss of epithelial cell adhesion
Lost polarity of basal cells
How is dysplasia graded?
Basal cell hyperplasia
Mild- lower third
Moderate- mid third
Severe- upper third
Carcinoma in situ- full thickness
What is another name for Oral Dysaethesia?
Burning mouth syndrome
Who is most commonly affected by Oral dysaesthesia?
Females >50 yo (post menopausal)
What are the differential diagnoses for Oral dysaesthesia?
Candiasis
Xerostomia
Anaemia
LP
Anxiety
Allergy
What investigations are used for Oral Dysaesthesia?
Oral swab- to check fungal or viral cause
FBC- for haematinic deficiency
Salivary flow rate test
Psychiatric assessment
How is oral dysaesthesia managed?
Correct deficiencies
Correct parafunction
Benzydamine mouthwash
Anxiolytics
nortyptiline
Gabapentin/pregablin
Clonazepam
What are the symptoms of oral dysaesthesia?
Pain
Paraesthesia
Dry mouth
What is OFG?
Oedema in the oral and facial soft tissues by blockage of lymphatic drainage due to T4 hypersensitivity reaction
What condition is OFG associated with?
Crohn’s
What are the aetiological factors for OFG?
Autoimmune
Benzoic acid
Sorbic acid
Cinnamon
Chocolate
SLS
What are the histological features of OFG?
Giant cell- multi-nucleated
Oedema
Th1 cells
Mononuclear IL-1 producing cells
large, active, dendritic B cells
What are the signs and symptoms of OFG?
Swelling
Cobble stoned mucosa
Angular cheilitis
Tags of mucosa
Linear ulceration in depth of sulcus
Erythema of peri-oral tissues
Stag horning
Full thickness gingivitis
How is OFG managed?
Strict exclusion diet- 3 months
Miconazole for angular cheilitis
Tacrolimus ointment 0.03%-
Intra-lesional steroids/pulses of prednisolone
Immune supressants- azathioprine, mycophenolate, adalimumab
What is meant by dentally fit?
Patient is free of dental disease and potential sources of infection
What is a multidisciplinary team?
When healthcare professionals who specialise in different subjects work together to provide holistic care for a patient
Who is in the MDT for patient with Oral Cancer?
Oncologist
Special care dentist
OMFS
Radiologist
Nutritionist
SLT
What are the risks for a patient following radiotherapy?
Xerostomia
ORN
Increased infection
Poor wound healing
Trismus
Mucositis
What are the grades of mucositis?
Grade 0 = No oral mucositis.
Grade 1 = Erythema and soreness.
Grade 2 = Ulcers, able to eat solids.
Grade 3 = Ulcers, requires a liquid diet (due to mucositis)
Grade 4 = Ulcers, alimentation not possible (due to mucositis)
How can mucositis be managed?
Caphosol
Gelclair
Mugard
Difflam- benzydamine (contains alcohol- so can be sore initially)
Soluble aspirin
Aloe vera (with tea tree oil)
Zinc supplements
Crytho-therapy
Ice chips/lollies
Manuka honey
Lidocaine mouthwash 2%
Low level laser therapy (only for radiotherapy induced)
Strong analgesics
Saline/bicarbonate mouth rinse
To prevent- OH, check no ill fitting dentures, IV keratinocyte growth factor
What is the histological differences between pemphigoid and pemphigus?
Pemphigoid - Sub-basal split, autoantibodies attack hemidesmosomes
Pemphigus - Supra-basal split, autoantibodies attack desmosomes, Tzank cells, acantholysis
How do pemphigoid and pemphigus differ clinically?
Pemphigoid has thick, full epidermis blood blisters that may persist to be seen clinically
Pemphigus has clear, superficial fluid filled blisters that often burst
What are the risk factors for Oral cancer?
Sunlight
Smoking
Alcohol
HPV- 16 and 18
Betel use
Poor diet
Low socio-economic status
What are the signs of oral cancer?
1) Ulcer perists (t > 2 weeks) despite removal of any obvious causation
2) Rolled margins, central necrosis
3) Speckled erythroleukoplakia- red and white patches
4) Cervical lymphadenopathy (enlarged (size > 1cm), firm, fixed, tethered, non-tender, unilateral)
5) Worsening pain (neuropathic, dysaethesia, paraesthesia)
6) Referred pain (ear, throat, mandible)
7) Weight loss (local / systemic effects)- cachexia
8) Dysphagia
How does oral cancer tend to spread?
What are the steps in the metastatic cascade?
What is necrotising sialometaplasia, its aetiology, histology and management?
What are causes of swollen lip?
Trauma
Mucocele
OFG
SSC
What is a mucocele?
Swelling in mucosa filled with saliva from minor glands
-> mucous extravasation cyst
How does a mucoele appear histologically?
- Cavity- filled with saliva, may have some neutrophils
- Wall- granulation tissue
- Lining- made of macrophages
- On outer surface- epithelium
- Macrophages- remove debris, phagocytosis of necrotic tissue or pathogens, they will try to engulf saliva as well (become big and pale- collections of foam cells)
- Plasma cells
- BVs- many capillaries
- Lymphocytes
- Fibroblasts- form collagen (appears pink/brown)
Over time tissue becomes more fibrous and less cellular and BVs reduce
How is a mucocele managed?
Excision of extravasated mucous, mucous in duct and gland itself
What is the name of a mucocele if it is in floor of the mouth?
Ranula
What are the different types of oral candiasis?
Pseudomembraneous
Atrophic erythematous- HIV
DI stomatitis
Chronic hyperplastic
Angular Cheilitis
What are the histological features of Median rhomboid glossitis?
Where does median rhomboid glossitis occur?
What are 3 testing methods for Candida?
Swab
Oral rinse
Biopsy
What are the virulence factors of Candida?
Proteinase
Phospholipase
Haemolysin
Hyphae
Biofilm formation
Adhesins
What are examples of antifungal agents?
Fluconazole
Nystatin
Itaconazole
Liposomal AmB
Caspofungin
Micafungin
What are the signs of adrenal insufficiency? (Addisons)
Vitiligo
Weight loss
Lethargy
Postural hypotension
Hyperpigmentation at areas of skin trauma
Loss of body hair
What emergency is associated with adrenal insufficiency?
Addisonian Crisis
What information should be included in a prescription?
Patient’s name, Address, Age (under 18)
Patient identifier – DoB, CHI Number
Number of Days treatment
Drug to be prescribed
Drug formulation and Dosage
Instructions on quantity to be dispensed
Instructions to be given to the patient
Signed – identifier of Prescriber
What is the rate of infection for HIV on exposure?
1 in 300
What is the rate of infection for Hep C on exposure?
1 in 30
What is the rate of infection for Hep B on exposure?
1 in 3
What are 6 oral lesions associated with HIV?
Oral candidiasis- atrophic
Kaposi Sarcoma
NHL
Necrotising periodontal diseases
Hairy leukoplakia
Ulcers
Angular chelitis
How is HIV diagnosed and treated?
Diagnosed using ELISA of blood sample
Treated with HAART
What is a fibrous epulis?
Soft tissue swelling on gingivae containing fibrous tissue
-> peripheral lesion
What is the aetiology of a fibrous epulis?
Reaction to low grade irritation
How does a fibrous epulis appear histologically?
Ulceration
Granulation tissue
Metaplastic bone formation
Presence of plasma cells
Fibrin
What is a fibrous epulis called if it is not found on the gingivae?
Fibro-epithelial polyp
What is a pyogenic granuloma?
Formation of granulation tissue as a result of trauma at any mucosal site
How does a pyogenic granuloma appear histologically?
Granulation tissue
Blood vessels
Connective tissue- collagen, fibroblasts
Ulceration
What GI diseases may cause iron deficient anaemia?
Crohn’s
Ulcerative Colitis
Coeliac
What are the mean cell volumes for different types of anaemia?
Microcytic- <80fL
Normocytic- 80-100fL
Macrocytic- >100fL
What is the cause of a generalised white patch that rubs off to give underlying erythematous tissue?
Psuedomembranous Candiosis
What medical conditions can result in PC?
HIV
Diabetes
What information should be provided on a lab sheet for sampling?
Clinical contact details
Diagnosis (presumptive)
Investigation required- culture and susceptibility testing
Patient identifiets- CHI/DOB
Clinical details
Date/time taken
Specimen details
Site
What is Sjögren’s syndrome?
Autoimmune disease affecting exocrine glands- primarily salivary and lacrimal
What other conditions can Sjogren’s be associated with?
SLE
Scleroderma
RA
What investigations can be used to help diagnose Sjogrens?
Unstimulated salivary flow test
Schirmer test
Autoantibody testing- anti ro/la
Labial gland biopsy- histopathology testing
Fluorescing tear film assessment
MRI
Asking about dry eyes and dry mouth- subjective
What are the oral complications of Sjogren’s?
Sialosis
Lymphoma risk
Xerostomia
-> Issues with speech/eating
-> Caries risk
-> Issues with denture retention
-> infection risk
What are the histological features of Sjogren’s (major/minor)?
What systemic drug is used to manage Sjogren’s?
Pilocarpine
What is a hereditary white patch that can occur in oral cavity?
White sponge naevus
How does WSN appear histologically?
How does smokers Keratosis appear histologically?
Cells have empty spaces- contain glycogen
Cells are not tightly bound-as muscles move a lot so needs to be flexible
Thick pink layer- keratin (Orthokeratinisation- no nuclei present)- would not usually be present here
Thin epithelium- lower third displays cellular atypia (cells with darker nuclei, more crowded, has mitotic figures, increased basal cells and altered shape/size of cells)
Grade (microscope): MILD epithelial dysplasia- not all cells affected, only a third
Melanin- brown spots (produced by melanocytes- generally found in basal layer)
What are the differential diagnoses for Dental hyperplasia?
SCC
Leaf fibroma
Pyogenic Granuloma
What causes denture hyperplasia?
Chronic trauma due to ill fitting or old dentures
-> reaction by tissues
How is denture hyperplasia?
Major ease of denture or remove denture for a week
Use of tissue conditioner- COE comfort
Review and repeat
Consider replacement denture
LA and excision of hyperplasia
What are the histological features of denture hyperplasia?