oral medicine

Question 1

what are common viral oro-facial soft tissue infections?

Answer 1

primary herpes
hand foot and mouth disease
mumps
measles
rubella

Question 2

what are common bacterial oro-facial soft tissue infections?

Answer 2

staphlyococcal
streptococcal
syphillis
TB

Question 3

name a common fungal oro-facial soft tissue infection

Answer 3

candida

Question 4

describe primary herpetic gingivostomatitis (exclude signs and symptoms)

Answer 4

herpes simplex virus 1
transmission by droplet formation with 7 day incubation period

Question 5

what are the signs and symptoms of primary herpetic gingivostomatitis?

Answer 5

fuild filled vesicles on gingivae, tongue, lips, buccal and palatal mucosa
severe oedematous marginal gingivitis
fever
headache
malaise
cervical lymphadenopathy

Question 6

what is the treatment of primary herpetic gingivostomatitis?

Answer 6

bed rest
soft diet/hydration
paracetamol
antimicrobial gel/mouthwash
aciclovir for immunocompromised children

Question 7

what is the most common complication of primary herpetic gingivostomaitis?

Answer 7

dehydration

Question 8

how long does primary herpetic gingivostomatitis usually last?

Answer 8

14 days

Question 9

which two diseases can coxsackie A virus cause?

Answer 9

herpangina
hand foot and mouth disease

Question 10

describe herpangina

Answer 10

vesicles in the tonsillar/pharyngeal region that last 7-10 days

Question 11

describe hand foot and mouth disease

Answer 11

ulceration on the gingivae/tongue/cheeks/palate
maculopapular rash on the hands and feet
lasts 7-10 days

Question 12

define oral ulceration

Answer 12

a localised defect in the surface oral mucosa where the covering epithelium is destroyed leaving an inflamed area of exposed connective tissue

Question 13

name 3 causes of oral ulceration

Answer 13

inherited or acquired immunodeficiency disorders
traume
vitamin deficiencies e.g. iron, B12, folate

Question 14

what is the most common cause of ulceration in children?

Answer 14

recurrent apthous stomatitis

Question 15

describe the appearance of recurrent aphthous stomatitis

Answer 15

round/ovoid in shape with a grey/yellow base

Question 16

what are the 3 patterns of recurrent aphthous stomatitis?

Answer 16

minor- <10mm
major- >10mm
herpetiform- 1-2mm

Question 17

what are the aetiological factors of Recurrent aphthous stomatitis?

Answer 17

hereditary predisposition
haematological and deficiency disorders
gastrointestinal disease
minor trauma in a susceptible individual
stress
allergic disorders
hormonal disturbance

Question 18

what initial investigations shoul you carry out for an individual with Recurrent aphthous stomatitis?

Answer 18

diet diary
full blood count
haematinics
coeliac screen

Question 19

name some management techniques of Recurrent aphthous stomatitis

Answer 19

iron supplementation if low ferritin
avoid sharp/spicy food
dietary exclusion if allergy present
corsodyl 0.2% mouthwash for prevention of superinfection
gengigel topical gel/gelclair mouthwash to protect healing ulcers
0.15% benzydamine hydrochloride for symptomatic relief
local anaesthetic spray

Question 20

what is the average age onset of orofacial granulomatosis?

Answer 20

11 years old

Question 21

what conditions are associated with orofacial granulomatosis?

Answer 21

granulomatous conditions (chrohn’s disease or sarcoidosis)

Question 22

what are the clinical features of orofacial granulomatosis?

Answer 22

identical to oral crohns
lip swelling
full thickness gingival swelling
peri-oral erythema
cobblestone appearance of buccal mucosa
linear oral ulceration
mucosal tags
lip/tongue fissuring
angular cheilitis

Question 23

what investigations can be carried out to diagnose oro-facial granulomatosis?

Answer 23

measure growth
full blood count
haematinics
patch testing
diet diary

Question 24

describe the management of orofacial granulomatosis

Answer 24

oral hygiene support
symptomatic relief
dietary exclusion to reduce inflammation
topical steroids
topical tacrolimus
short courses of oral setoids
surgical intervention (unresponsive long standing disfigurement)

Question 25

describe geographic tongue

Answer 25

idiopathic and non contagious
shiny red areas surrounded by white margins
red areas have loss of filiform papillae
discomfort with spicy food/tomato/citrus

Question 26

what is the management of geographic tongue?

Answer 26

bland diet during flare ups
likely to become less troublesome with age

Question 27

describe fibroepithelial polyps

Answer 27

firm pink lump

Question 27

describe fibroepithelial polyps

Answer 27

firm pink lump mainly on cheeks, lip or tongue
remains a constant size
thought to be initiated by minor trauma
surgical extraction is curative

Question 28

what is a epulide?

Answer 28

benign hyperplastic lesion
common solid swelling of the oral mucosa

Question 29

what are the 3 main types of epulides?

Answer 29

fibrous epulis
pyogenic granuloma
peripheral giant cell granuloma

Question 30

describe fibrous epulis

Answer 30

pedunculated or sessile mass
firm consistency
similar colour to surrounding gingivae
inflammatory cell infiltrate and fibrous tissue

Question 31

pyogenic granuloma is also sometimes referred to as what?

Answer 31

pregnancy epulis

Question 32

describe pyogenic granuloma

Answer 32

soft, deep red/purple swelling
often ulcerated
haemorrhage spontaneously or with mild trauma
thought to be a reaction to chronic trauma e.g. calculus
tend to recur after removal

Question 33

describe a peripheral giant cell granuloma

Answer 33

pendunculated or sessile swelling
typically dark red and ulcerated
arises interproximally
hour-glass shape
radiograph may reveal superficial erosion of the interdental bone
may recur after surgical excision

Question 34

describe congenital epulis

Answer 34

rare lesions that occur in neonates
most commonly affect anterior maxilla
granular cells covered with epithelium
benign

Question 35

name 2 types of HPV associated swellings

Answer 35

verruca vulgaris
squamous cell papilloma