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BDS Exam style questions > Oral Medicine > Flashcards

Oral Medicine Flashcards

1
Q

Give 5 signs and symptoms of TMD?

A
  • 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)
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2
Q

What are examples of conservative advice to give to patients?

A
  • 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
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3
Q

What information from a clinical examination would suggest a patient had TMD?

A

E/O:
Muscle hypertrophy
Muscle tenderness
Deviation

I/O:
Scalloped tongue
Linea alba
Wear on teeth
Fractured restorations

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4
Q

What factors can predispose a patient to TMD?

A

Stress

Trauma

Chewing gum

Parafunctional habits

Female sex

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5
Q

What other conditions may present like TMD, how could you exclude these?

A

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

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6
Q

How should a splint be made for TMD?

A

Must cover all teeth

Block out any deep undercuts

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7
Q

If denture induced stomatitis (erythematous candiasis) persisted what would you do to manage it?

A

Use anti fungal medication- Fluconazole

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8
Q

What instructions would you give to a technician regarding construction of an upper special try for master impression?

A

Please provide light cured acrylic resin custom trays with the appropriate spacing and an extra-oral handle

Spacing- 3mm alginate, 2mm silicone or polyether

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9
Q

What makes the brown pigmented part of lesions?

A

Melanin

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10
Q

What are the changes which occur suggesting a lesion is potentially malignant?

A

Cellular atypia

Hyperchromatism

Pleomorphism

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11
Q

What are the aetiological factors involved in development of white lesion with some areas of brown and grey?

A

Smoking

Drugs- hydroxychloroquine, tetracycline

Melanoma

HIV

Amalgam tattoo

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12
Q

What features make you highly suspicious that the lesion is potentially malignant?

A

Hardened

Raised rolled margins

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13
Q

What is the likely cause of a lesion that is white and Lacey in appearance in the buccal muscosa?

A

Reticular Lichen planus

Lichenoid tissue reaction- if next to restoration

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14
Q

What type of reaction is Lichenoid tissue reaction?

A

Type 4 hypersensitivity

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15
Q

Name 2 types of biopsy to investigate a lichenoid reaction?

A

Incisional

Excisional

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16
Q

What are the histological features of lichenoid reaction?

A

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

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17
Q

What is the disease caused by candida that presents as redness at the corners of the mouth?

A

Angular Cheilitis

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18
Q

What micorganisms are involved in angular cheilitis?

A

Staphylococcus Aureus

Candida Albicans

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19
Q

What microbiological sampling method is used for angular cheilitis?

A

Swab

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20
Q

What immune deficiency disease is associated with angular cheilitis?

A

HIV

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21
Q

What gastro-intestinal bleeding disease is associated with angular cheilitis?

A

Crohn’s

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22
Q

What intra-oral disease is associated with angular cheitliis?

A

OFG

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23
Q

Why is miconazole used for angular cheilitis when sampling is not available ?

A

As miconazole is effective against fungi and staphylococcal bacteria

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24
Q

What is a diagnosis of inflamed gingiva extending beyond mucogingival margin?

A

Atrophic Lichen planus

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25
Q

What is the descriptive term used to describe appearance of inflamed gingivae extending beyond mucogingival margin?

A

Desquamitive gingivitis

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26
Q

What oral mucosal conditions can cause desquamative gingivitis?

A

Pemphigoid

Pemphigus

Lichen Planus

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27
Q

What local factors can makes desquamative gingivitis worse?

A

Plaque

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28
Q

What treatments can be used for desquamative gingivitis?

A

Betamethasone mouthwash

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29
Q

What methods are used to diagnose Pemphigus Vulgaris?

A

Incisional peri-leisonal biopsy
-> Direct immunofluorescence- basket weave
-> Histoplatholgy assessment
-> Indirect immunofluorescence

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30
Q

What causes pemphigus vulgaris?

A

Type 2 hypersensitivity reaction against desmoglian 3 antibody in desmosomes

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31
Q

What condition could represent the same as pemphigus vulgaris clinically but would be different histopathologically?

A

Bullous Pemphigoid

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32
Q

What are the risk factors for oral squamous cell carcinoma?

A

Sunlight

HPV

Smoking

Alcohol

Poor diet

Poor OH

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33
Q

Patient has SCC that is 5cm in width, bilateral LN involvement <2mm and no sign of spread. Stage the tumour using TMN?

A
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34
Q

How do you grade dysplasia histopathologically?

A

Hyperplasia

Dysplasia- mild, moderate, severe

Carcinoma in situ

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35
Q

What are the interventions that can be used to treat oral SCC?

A

Excision

Chemotherapy

Radiotherapy

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36
Q

How can you restore function of tongue after removing OSCC?

A

Soft tissue graft

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37
Q

What organism is associated with denture stomatitis?

A

Candida albicans

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38
Q

What local factors can cause DI stomatitis?

A

Poor OH

Wearing denture at night

Smoking

Xerostomia

Inhaler

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39
Q

What are the management options for DI stomatitis?

A

CHX mouthwash

Denture hygiene- stepping in milton

Tissue conditioner

Antifungals
-> nystatin
-> fluconazole

Removing denture at night

Smoking cessation

Rinsing after inhaler use

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40
Q

What can be seen on occlusal surfaces due to inhaler use? What can be done to treat?

A

Erosion
-> rinse mouth after use and apply F varnish

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41
Q

What are the types of RAS?

A

Major

Minor

Herpetiform

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42
Q

What are the differences between major and minor RAS?

A

Minor- <10mm, Major >10mm

Minor <2 weeks, Major>2 weeks

Major may scar

Minor only affects NK tissue

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43
Q

What are the causes of RAS?

A

Systemic diseases

Stress

Viral/bacterial infections

Genetic Predisposition

Hormone level fluctuations (menstrual)

Microelement deficiency
-> malabsorption
-> GI blood loss

SLS toothpaste

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44
Q

How are RAS ulcers treated?

A

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)

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45
Q

What potential issues can occur alongside RAS?

A
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46
Q

What is the nature of the pain seen in Trigeminal Neuralgia?

A

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)

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47
Q

What are the common causes of TN?

A

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

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48
Q

If MS caused TN what other symptoms may the patient be experiencing?

A

Muscle weakness
Intention tremor
Visual disturbance
Paraesthesia
Autonomic dysfunction
Dysarthria
Pain
Balance/hearing loss

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49
Q

If brain tumour caused TN what other symptoms may the patient be experiencing?

A

Headache

Diploplia

Seizures

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50
Q

How can you manage the patients pain from TN surgically?

A

Microvascular Decompression

Gamma knife radiosurgery

Neurectomy

Balloon compression

Glycerol injection

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51
Q

How can you manage the patients pain from TN medically?

A

Carbamazepine

Oxcarbazepine

Lamotrigine

Gabapentin

Phenytoin

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52
Q

What tests would you do before before prescribing carbamazepine?

A

FBC- can cause neutropenia, thrombocytopenia, pancytopenia

LFT- can cause liver toxicity

Electrolyte testing (U+E)- can cause hyponatraemia

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53
Q

What are the side effects of carbamazepine?

A

Skin reactions

Headache

Drowsiness

Dry mouth

Weight gain

Ataxia

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54
Q

What is the intra-oral manifestation of herpes?

A

Primary Herpetic gingivostomatitis

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55
Q

What are 3 causes of vesicle formation?

A

Erythema Multiforme

Pemphigoid

Pemphigus

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56
Q

What viral conditions can cause ulceration?

A

HSV

VZV

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57
Q

What oral lesions are caused by Coxsackie virus?

A

Hand foot and mouth

Herpangina

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58
Q

What disorders can be caused by EBV?

A

Glandular fever

Hairy leikoplakia

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59
Q

How does herpes labials form?

A
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60
Q

What medical conditions are associated with acute pseudomembranous candidiasis?

A

HIV

Poorly controlled diabetes

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61
Q

What are the advantages/disadvantages of oral swab?

A
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62
Q

What are the advantages/disadvantages of oral rinse?

A
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63
Q

What should we as the pathologist for when sending a sample?

A
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64
Q

Which drugs does fluconazole interact with?

A

Warfarin

Statins

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65
Q

What are the causes of microcytic anaemia?

A

Iron Deficiency

Thalassemia

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66
Q

What topical treatments are available for RAS?

A

Betamethasone mouthwash

Beclomethasone MDI

Benzydamine spray

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67
Q

What is the likely cause of a middle aged female complaining of burning mouth and diffuse erythema?

A
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68
Q

What is the likely cause of dull throbbing pain in maxillary region made worse by bending over?

A
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69
Q

What is the likely cause of episodic pain lasting up to 20 mins with nose dripping which is worse when shaking head?

A
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70
Q

What is the likely cause of sharp shooting pain in right cheek when biting with tears forming in elderly patient?

A

Trigeminal neuralgia

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71
Q

What is the likely cause of temporal pain and weakness of shoulder muscle?

A

Temporal arteritis

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72
Q

What are the local causes of a pigmented tongue?

A

Smoking

CHX

Bacterial overgrowth- black hairy tongue

Melanoma

Melanotic macule

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73
Q

What are the systemic causes of a pigmented tongue?

A

Addisons

Race

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74
Q

What are the histological characteristics of Lichen Planus?

A

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

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75
Q

What are the causes of Lichen Planus?

A

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

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76
Q

What investigations are required for LP?

A

FBC

Haematinic deficiency screen

Autoantibody screen

Biopsy- smoker, symptomatic, high risk area

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77
Q

How is LP treated?

A

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

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78
Q

What are the histological features of pemphigus?

A

 Loss of epithelium and shedding of epithelial layer

 Supra-basal (split occurs above basement membrane as desmosomes are attacked)

 Tzank cells

 Acantholysis

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79
Q

What are the causes of pemphigus?

A

Autoimmune- T2 hypersensitivity

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80
Q

What special investigations are used for pemphigus?

A

Biopsy- peri-lesional
-> Histopatholgy assessment
-> Direct immunofluorescence (indirect too)

ELISA

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81
Q

How is pemphigus/pemphigoid treated?

A

Steroids

Immune modifying drugs- azathioprine, mycophenolate, dapsone, biologics

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82
Q

What is the distribution of salivary gland cancers among the different glands?

A

Parotid- 80%
Submandibular- 10%
Minor- 10%
Sublingual- 0.5%

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83
Q

Incidence of salivary gland tumours in order:

A

Pleomorphic adenoma- 75%
Warthins- 15%
Adenoid cystic carcinoma- 5%
Mucoempidemroid carcinoma- 3%
Acinic cell carcinoma- <1%

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84
Q

What are the histological features of pleomorphic adenoma?

A

Myoepithelial cells

Fibrous capsule- often incomplete

Myxoid tissue

Chondorid areas

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85
Q

What feature leads to recurrence of pleomorphic adenoma?

A

During removal myxomatous tissue parts can easily fall off and continue growing

86
Q

What are the histological characteristics of Warthin’s tumour?

A

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

87
Q

What are the histological features of adenoid cystic carcinoma?

A

Cribiform appearance

Tubular

Solid

No capsule

88
Q

What feature of parotid swelling would make you suspicious of malignancy?

A
89
Q

What is desquamative gingivitis?

A

Descriptive term rather than diagnostic
-> Full thickness erythema of the gingivae

90
Q

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?

A

Trauma

Lichenoid reaction

Lichen Planus

Oral cancer- SCC

91
Q

What are the reasons for dentures no longer fitting in Paget’s disease?

A

Disturbed turnover of bone- deposition and resorption can occur simultaneously
-> results in swelling and enlargement causing dentures not to fit

92
Q

What is the reason for radio-opacity formation in relation to roots of teeth in Paget’s?

A

Hypercementosis (characteristic of disease)

93
Q

What precautions would you take when extracting a tooth in a patient taking bisphosphonates?

A

Atraumatic extraction technique

94
Q

What are the signs and symptoms of Primary herpetic gingivostomatitis?

A

Ulceration

Fever

Dry mouth- dehydration

Inflamed/swollen gingivae

95
Q

What is the cause of a generalised white plaque that can be scraped off easily and leave an erythematous base?

A

Pseduomembranous Candidiasis????

96
Q

Which conditions can cause this? What would you ask pathologist for?

A
97
Q

What are the different forms of haemangioma?

A

Cavernous- large blood filled spaces

Capillary- groups of smaller vessels, mostly capillaries

98
Q

What investigations can be done for Trigeminal Neuralgia?

A

MRI

CN5 reflex testing

99
Q

What neurological conditions can cause Trigeminal neuralgia?

A

MS

Brain tumours

100
Q

What are the indications for surgery in trigeminal neuralgia?

A

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

101
Q

What muscles are examined in patients with TMD?

A

Temporalis

Masseter

*Medial/lateral pterygoid are not reliably examined

102
Q

What are the common causes of TMD?

A

Parafunction

Trauma

Occlusal discrepancy

OA/RA

Ankylosis of joint

Anxiety/stress

103
Q

What nerve supplies the TMJ?

A

CN5- mandibular division via auriculotemporal nerve

104
Q

What are the signs and symptoms of TMD?

A

Pain

Clicking

Crepitus

Limited opening

Headache

Earache

Lost fillings

Linea alba

105
Q

What advice is given for conservative management of TMD?

A

Soft diet

Cut food into small pieces

Analgesia- paracetamol

Stop chewing gum

Avoid nail biting

Support when yawning

Wear BRA

106
Q

What is the mechanism of action in a bite splint?

A

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

107
Q

What is athrocentesis?

A

jaw joint is washed out with sterile fluid. It aims to return the disc of cartilage to its normal position within the joint.

108
Q

What other surgeries are available for TMD?

A

Disc plication
Eminectomy
High condylar shave
Condylotomy
Meniscectomy
Condylectomy
Reconstructive procedures

109
Q

What are the types of LP?

A
  • Erosive- has potential to become malignant and is most painful (biopsy)
  • Reticular
  • Papular
  • Atrophic
  • Bullous
  • Plaque like
110
Q

What are some examples of Human Herpes Viruses?

A

HHV3- Varicella Zoster

HHV4- Epstein Barr

HHV5- cytomegalovirus

HHV8- associated with Kaposi Sarcoma

111
Q

What cranial nerve is Herpes associated with?

A

Trigeminal

112
Q

What are triggers for reactivation of Herpes virus?

A

If patient immunocomprimised/systemically unwell

If patient immunosuppressed

Stress

Sunlight

113
Q

What is Anaemia?

A

Reduced Hb present in blood

114
Q

What are the signs and symptoms of Anaemia?

A

Palpitations

Fatigue

Palor

SOB

Weakness

Dizziness

Brittle nails

115
Q

What are the oral signs of anaemia?

A

Pale mucosa

Smooth tongue- iron deficient

Beefy tongue- B12 deficient

Oral dysaesthesia

ROU

Candidiasis

116
Q

What are the causes of macrocytic Anaemia?

A

B12/folate deficiency

Presence of reticulocytes

117
Q

Wear are the causes of normocytic anaemia?

A

Bleeding

Pregnancy

Renal disease

118
Q

What are the causes of Xerostomia?

A

Polypharmacy- TCAs, diuretics, anti-histamine, antipsychotics

Salivary gland obstruction

Sjogren’s

Anxiety and somatoform disorders

Dehydration

Sarcoidosis

HIV

CF

119
Q

How can you assess xerostomia intra-orally?

A

Challacombe scale

120
Q

What are the signs and symptoms suggesting that a patient has a dry mouth?

A

Increased caries rate- especially cervical

Frothy saliva

Shortening of tongue papillae

Smoothed gingival architecture

Issues eating, speaking, swallowing

Halitosis

Candida infection

121
Q

How can xerostomia be managed?

A

Salivary stimulants- pilocarpine

Salivary substitutes- orthana, glandosane, oral balance

Frequent sips of water

Chewing gum

Using drugs that don’t cause dry mouth

122
Q

What are examples of sugar substitutes?

A

Xylitol

Aspartame

Sorbitol

123
Q

What are examples of salivary proteins?

A

Histatins

S-IgA

Mucins

Lactoferrin

124
Q

What are examples of salivary enzymes?

A

Amylase

Lipase

Lysozyme

125
Q

When are antibiotics indicated for dental treatment?

A

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

126
Q

What are the ways in which antibiotics work?

A

Protein synthesis inhibition

Inhibition of cell wall synthesis

Nucelic acid inhibition- replication inhibition

Inhibition of plasma membranes

Inhibition of essential metabolites

127
Q

What are some of the disadvantages of antibiotics?

A

Resistance

Allergy

Drug interactions

128
Q

What are examples of antibiotics used in dentistry and their treatment regime?

A

Phenoxymethylpencillin- 500 4 x per day for 5 days

Amoxicillin- 500mg TID for 5 days

Metronidazole- 400mg TID for 5 days

129
Q

What are the mechanisms of antibiotic resistance?

A

Biofilm formation

Efflux

Alteration of target molecule

Blocking entry of antibiotic

Production of inactivation enzymes

130
Q

How is desquamative gingivitis managed?

A

Blood tests

DI

Control local factors- plaque, restorations, medication

Aid OH if patient cannot manage normal brushing
-> CHX
-> F supplements

131
Q

How do you differentiate between upper and lower motor neurone disease? What causes this difference?

A

Upper spares upper- everything above the eye brow still functions

132
Q

What are the causes of Lower MND?

A
133
Q

What is geographic tongue?

A

Benign migratory glossitis- Denuded erythematous patches on tongue surface that vary daily (filiform depappilation)

134
Q

How is Geographic tongue managed?

A

Avoid spicy/acidic foods

FBC- check haematinic which may cause

Reassure- mostly assymptomatic and not worrisome

135
Q

What is Coxsackie virus?

A

RNA enterovirus

136
Q

What diseases are associated with Coxsackie Virus?

A

Hand, foot, mouth disease

Herpangina

Meningitis

137
Q

What diseases are caused by EBV?

A

Glandular fever

Hairy leukoplakia

NHL

138
Q

If your patient takes two inhalers for asthma what are they likely to be?

A

Short Acting B2 Agonist (blue)- salbutamol

Corticosteroid (brown)- Beclamethasone

139
Q

What is Asthma?

A

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

140
Q

What are the signs and symptoms of asthma?

A

Wheeze

Cough

SOB

Rash

141
Q

What are the dental implications of inhaler use and what advice should be given?

A

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

142
Q

What is the percentage of people being treated for asthma in Scotland?

A

7%

143
Q

What are the signs of epithelial dysplasia?

A

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

144
Q

How is dysplasia graded?

A

Basal cell hyperplasia

Mild- lower third

Moderate- mid third

Severe- upper third

Carcinoma in situ- full thickness

145
Q

What is another name for Oral Dysaethesia?

A

Burning mouth syndrome

146
Q

Who is most commonly affected by Oral dysaesthesia?

A

Females >50 yo (post menopausal)

147
Q

What are the differential diagnoses for Oral dysaesthesia?

A

Candiasis

Xerostomia

Anaemia

LP

Anxiety

Allergy

148
Q

What investigations are used for Oral Dysaesthesia?

A

Oral swab- to check fungal or viral cause

FBC- for haematinic deficiency

Salivary flow rate test

Psychiatric assessment

149
Q

How is oral dysaesthesia managed?

A

Correct deficiencies

Correct parafunction

Benzydamine mouthwash

Anxiolytics
nortyptiline
Gabapentin/pregablin
Clonazepam

150
Q

What are the symptoms of oral dysaesthesia?

A

Pain

Paraesthesia

Dry mouth

151
Q

What is OFG?

A

Oedema in the oral and facial soft tissues by blockage of lymphatic drainage due to T4 hypersensitivity reaction

152
Q

What condition is OFG associated with?

A

Crohn’s

153
Q

What are the aetiological factors for OFG?

A

Autoimmune

Benzoic acid

Sorbic acid

Cinnamon

Chocolate

SLS

154
Q

What are the histological features of OFG?

A

Giant cell- multi-nucleated

Oedema

Th1 cells
Mononuclear IL-1 producing cells

large, active, dendritic B cells

155
Q

What are the signs and symptoms of OFG?

A

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

156
Q

How is OFG managed?

A

Strict exclusion diet- 3 months

Miconazole for angular cheilitis

Tacrolimus ointment 0.03%-

Intra-lesional steroids/pulses of prednisolone

Immune supressants- azathioprine, mycophenolate, adalimumab

157
Q

What is meant by dentally fit?

A

Patient is free of dental disease and potential sources of infection

158
Q

What is a multidisciplinary team?

A

When healthcare professionals who specialise in different subjects work together to provide holistic care for a patient

159
Q

Who is in the MDT for patient with Oral Cancer?

A

Oncologist

Special care dentist

OMFS

Radiologist

Nutritionist

SLT

160
Q

What are the risks for a patient following radiotherapy?

A

Xerostomia

ORN

Increased infection

Poor wound healing

Trismus

Mucositis

161
Q

What are the grades of mucositis?

A

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)

162
Q

How can mucositis be managed?

A

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

163
Q

What is the histological differences between pemphigoid and pemphigus?

A

Pemphigoid - Sub-basal split, autoantibodies attack hemidesmosomes

Pemphigus - Supra-basal split, autoantibodies attack desmosomes, Tzank cells, acantholysis

164
Q

How do pemphigoid and pemphigus differ clinically?

A

Pemphigoid has thick, full epidermis blood blisters that may persist to be seen clinically

Pemphigus has clear, superficial fluid filled blisters that often burst

165
Q

What are the risk factors for Oral cancer?

A

Sunlight

Smoking

Alcohol

HPV- 16 and 18

Betel use

Poor diet

Low socio-economic status

166
Q

What are the signs of oral cancer?

A

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

167
Q

How does oral cancer tend to spread?

A
168
Q

What are the steps in the metastatic cascade?

A
169
Q

What is necrotising sialometaplasia, its aetiology, histology and management?

A
170
Q

What are causes of swollen lip?

A

Trauma

Mucocele

OFG

SSC

171
Q

What is a mucocele?

A

Swelling in mucosa filled with saliva from minor glands
-> mucous extravasation cyst

172
Q

How does a mucoele appear histologically?

A
  • 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
173
Q

How is a mucocele managed?

A

Excision of extravasated mucous, mucous in duct and gland itself

174
Q

What is the name of a mucocele if it is in floor of the mouth?

A

Ranula

175
Q

What are the different types of oral candiasis?

A

Pseudomembraneous

Atrophic erythematous- HIV

DI stomatitis

Chronic hyperplastic

Angular Cheilitis

176
Q

What are the histological features of Median rhomboid glossitis?

A
177
Q

Where does median rhomboid glossitis occur?

A
178
Q

What are 3 testing methods for Candida?

A

Swab

Oral rinse

Biopsy

179
Q

What are the virulence factors of Candida?

A

Proteinase

Phospholipase

Haemolysin

Hyphae

Biofilm formation

Adhesins

180
Q

What are examples of antifungal agents?

A

Fluconazole
Nystatin
Itaconazole
Liposomal AmB
Caspofungin
Micafungin

181
Q

What are the signs of adrenal insufficiency? (Addisons)

A

Vitiligo

Weight loss

Lethargy

Postural hypotension

Hyperpigmentation at areas of skin trauma

Loss of body hair

182
Q

What emergency is associated with adrenal insufficiency?

A

Addisonian Crisis

183
Q

What information should be included in a prescription?

A

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

184
Q

What is the rate of infection for HIV on exposure?

A

1 in 300

185
Q

What is the rate of infection for Hep C on exposure?

A

1 in 30

186
Q

What is the rate of infection for Hep B on exposure?

A

1 in 3

187
Q

What are 6 oral lesions associated with HIV?

A

Oral candidiasis- atrophic

Kaposi Sarcoma

NHL

Necrotising periodontal diseases

Hairy leukoplakia

Ulcers

Angular chelitis

188
Q

How is HIV diagnosed and treated?

A

Diagnosed using ELISA of blood sample

Treated with HAART

189
Q

What is a fibrous epulis?

A

Soft tissue swelling on gingivae containing fibrous tissue
-> peripheral lesion

190
Q

What is the aetiology of a fibrous epulis?

A

Reaction to low grade irritation

191
Q

How does a fibrous epulis appear histologically?

A

Ulceration

Granulation tissue

Metaplastic bone formation

Presence of plasma cells

Fibrin

192
Q

What is a fibrous epulis called if it is not found on the gingivae?

A

Fibro-epithelial polyp

193
Q

What is a pyogenic granuloma?

A

Formation of granulation tissue as a result of trauma at any mucosal site

194
Q

How does a pyogenic granuloma appear histologically?

A

Granulation tissue

Blood vessels

Connective tissue- collagen, fibroblasts

Ulceration

195
Q

What GI diseases may cause iron deficient anaemia?

A

Crohn’s

Ulcerative Colitis

Coeliac

196
Q

What are the mean cell volumes for different types of anaemia?

A

Microcytic- <80fL

Normocytic- 80-100fL

Macrocytic- >100fL

197
Q

What is the cause of a generalised white patch that rubs off to give underlying erythematous tissue?

A

Psuedomembranous Candiosis

198
Q

What medical conditions can result in PC?

A

HIV

Diabetes

199
Q

What information should be provided on a lab sheet for sampling?

A

Clinical contact details

Diagnosis (presumptive)

Investigation required- culture and susceptibility testing

Patient identifiets- CHI/DOB

Clinical details

Date/time taken

Specimen details

Site

200
Q

What is Sjögren’s syndrome?

A

Autoimmune disease affecting exocrine glands- primarily salivary and lacrimal

201
Q

What other conditions can Sjogren’s be associated with?

A

SLE

Scleroderma

RA

202
Q

What investigations can be used to help diagnose Sjogrens?

A

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

203
Q

What are the oral complications of Sjogren’s?

A

Sialosis

Lymphoma risk

Xerostomia
-> Issues with speech/eating
-> Caries risk
-> Issues with denture retention
-> infection risk

204
Q

What are the histological features of Sjogren’s (major/minor)?

A
205
Q

What systemic drug is used to manage Sjogren’s?

A

Pilocarpine

206
Q

What is a hereditary white patch that can occur in oral cavity?

A

White sponge naevus

207
Q

How does WSN appear histologically?

A
208
Q

How does smokers Keratosis appear histologically?

A

 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)

209
Q

What are the differential diagnoses for Dental hyperplasia?

A

SCC

Leaf fibroma

Pyogenic Granuloma

210
Q

What causes denture hyperplasia?

A

Chronic trauma due to ill fitting or old dentures
-> reaction by tissues

211
Q

How is denture hyperplasia?

A

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

212
Q

What are the histological features of denture hyperplasia?

A

BDS Exam style questions (15 decks)

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