Oral Medicine Flashcards
how to diagnose oral candidiasis
pt hx
clinical findings
what to note from pt exam when considering oral candidiasis
- appearance i.e. colour / site / distribution / symptoms / duration
- medical hx taking note of immunosuppression / diabetes / radiotherapy / chemotherapy
- medications i.e. antibiotics / steroid inhalers
- ask about denture hygiene if applicable i.e. night time wear / cleaning / denture fit i.e. is there trauma / food trap
acute pseudomembranous candidiasis i.e. oral thrush
appearance & tx
a - white patches (milk curds) that can be wiped off to reveal bleeding bases; cheeks, palate, oropharynx
t - identify & address underlying cause - diabetes / HIV / antibiotic use / smoker, improve OH, CHX MW, antifungals - miconazole (2.5ml QDS continue at least 7 days after lesion healed), nystatin rinse (100,000 units QDS 7 days continue 48hrs after lesions healed), fluconazole is most effective
chronic hyperplastic candidiasis i.e. candidal leukoplakia
appearance & tx
a - white patch on commissures, buccal mucosa, dorsum of tongue
t - associated with heavy smokers, iron, B12, folate deficiency; biopsy, check vitamin levels, stop smoking advice, 2-4wks oral fluconazole (chance of malignancy)
acute erythematous / atrophic candidiasis (antibiotic sore mouth)
appearance & tx
a - red shiny atrophic mucosa
c - chronic use of antibiotics / steroid inhalers, immunosuppression (HIV), xerostomia
t - spacer device, rinse after inhaler, tx as oral thrush
chronic erythematous stomatitis (denture stomatitis) appearance & tx
a - diffuse redness in denture bearing area, asymptomatic
t - remove dentures at night, clean & brush with warm soapy water, soak in NaOCl / CHX, miconazole gel 5-10ml to affected area or inside of denture QDS until 48hrs after lesions have resolved, refer to GMP if suspect systemic cause (vitamin levels / medications i.e. steroids / endocrine)
angular cheilitis appearance & tx
a - red cracked corners of mouth
c - trauma / immunosuppression / malabsorption (crohn’s / coeliac) / iron or B12 deficiency / broad spectrum antibiotics / candida infection / incorrect OVD dentures
t - correct cause i.e. FBC for vitamins, dentures, topical miconazole to continue for 10 days after lesions resolve
what to ask in exam when pt has ulceration
- MH
- onset - is it due to trauma i.e. # tooth / ill fitting dentures or is it spontaneous
- recurrence - 1st episode or multiple ?
- duration i.e. >3wks
- site - keratinised v non keratinised, is it a high risk area such as lateral border of tongue, FoM, soft palate & oropharynx
- size
- shape
- number
- outcome - healing with or without scarring
management advice for pt to do at home for ulcer to speed up healing & reduce pain
soft diet
avoid spicy / citrus food
cool drinks through a straw and try to avoid hot drinks
use soft toothbrush with SLS free toothpaste
warm salty water rinses
ice cubes over sores
OTC numbing gels e.g. oragel, iglu, anbesol
antiseptic MW i.e. CHX or peroxide based, benzydamine MW or spray
process when reviewing ulcer 3wks later
if still present after 3wks refer to hospital for assessment & tx
if present after 3wks and you suspect oral cancer then refer a urgent 2wk referral for biopsy investigation
medications with oral ulceration listed as common side effect
NSAIDs
beta blockers
methotrexate
penicillin
nicorandil
allopurinol
sulphonamides
sulfasalazine
gold
anti convulsants i.e. phenytoin, carbamazepine, phenobarbital
systemic conditions with oral ulceration listed as a manifestation
herpetic gingivostomatitis HSV-1
lichen planus
vesiculobullous disease i.e. MMP
HFM disease (coxsackie virus)
haematological malignancy (leukaemia)
squamous cell carcinoma
erythema multiforme
haematinic deficiency i.e. vit b12 / iron / folate
inflammatory bowel disease i.e. crohn’s / ulcerative colitis
causes of dry mouth
- meds i.e. anticholinergic
- dehydration
- drinking & smoking
- mouth breathing
- anxiety
- cancer tx
- MH i.e. diabetes, HIV, sjogren’s
home management advice for pt with dry mouth
drink water
suck ice cubes
suck sugar free sweets
reduce caffeine / alcohol / foods that cause irritation (spicy/citrus)
use SLS free toothpaste
what is SLS free toothpaste
sodium lauryl sulfate free toothpaste
this is the main foaming agent
e.g. sensodyne
good for those with sensitivities
