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Module 7 > Oral Medicine > Flashcards

Oral Medicine Flashcards

1
Q

What is the name of the scale used to assess oral dryness?

A

The challacombe scale of oral dryness: This does not need special equipment and can be done by a clinician easily

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2
Q

What scores can you give for oral dryness? and how is it assessed?

A

Each one of these scores one:
Mirror sticks to buccal mucosa
Mirror sticks to tongue
Saliva frothy
No saliva pooling FOM
Tongue shows generalised shortened papillae
Altered gingival architecture (smooth)
Glossy appearance of oral mucosa especially palate
Tongue lobulated/fissured
Cervical caries (more than two teeth)
Debris on palate or sticking to teeth

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3
Q

What are the classifications of oral dryness and how would you treat each?

A

Score 1-3: Mild dryness. Routine check up monitoring
Score 4-6: Moderate dryness. Further investigations if
cause not clear.
Score 7-10: Severe dryness. Cause needs to be
determined need to exclude Sjogren’s, refer

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4
Q

How do we manage each case of dryness?

A

Score 1-3: May not need treatment, sugar free
chewing gum, attention to hydration
Score 4-6: Sugar free gum or sialogogues. Consider saliva
substitutes and topical fluoride
Score 7-10: Saliva substitutes and topical fluoride

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5
Q

What other signs of Dry mouth could we see in the mouth?

A

Evidence of candidosis
* angular cheilitis
* erythematous mucosa
* thrush
* denture stomatitis
* Traumatic ulceration
* Poor denture retention
* Bacterial sialadenitis: a bad taste in the mouth and swelling of the salivary glands

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6
Q

What investigations are needed to diagnose the severity of dry mouth?

A

Objective evidence of a reduced unstimulated salivary flow rate: as the patient to sit with head forward and ask saliva to pool in the FOM, no talking and spitting.
* Whole saliva
* 15mins
* Normal = >0.2 ml/min
* Significantly reduced rate ≤ 0.1ml/min

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7
Q

What investigations could assist in the therapeutic management of dry mouth but not in diagnosis?

A
  • Stimulated whole salivary flow rate
  • not of diagnostic significance
    But
  • of therapeutic significance: help us decide if the pt salivary gland respond to stimulation
  • whole saliva
  • 15mins
  • sugar free gum or SST (Saliva Stimulating Tablet)
  • no normal value as such, approximately x10 unstimulated (more than 0.4 ml/min)
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8
Q

What is the aetiology of Dry Mouth?

A
  • Age related: medications
  • Stress
  • Mouth breathing: waking with oral dryness/ ask patients if they snore
  • Diabetes: undiagnosed or poorly controlled
  • Side effect of medication (drug induced): 154 medications effects salivary gland function. examples are: urological medication and for anxiety and depression
  • Head and neck radiation treatment: salivary glands within the radiotherapy feild, 63-93% of patients, expected 6-12 months post therapy
  • Chemotherapy: some pts but only for 2-8 weeks post therapy
  • Sjögren’s syndrome
  • HIV infection: Hypofunction similar to sjogrens syndrome
  • Hepatitis C: Hypofunction similar to sjogrens syndrome
  • Sarcoidosis: a chronic granulomatous condition which can cause changes in the oral mucosa similar to Crohns disease such as lip swelling and lymphadenopathy in the head and neck region and it can cause shortness of breath
  • Graft versus host disease: its oral presentation mimics lichen planus
  • Renal failure
  • Salivary gland aplasia: salivary gland failing to develop
  • Cystic fibrosis: damage to salivary gland causing hypofunction
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9
Q

what is sjogrens syndrome and what is it divided into?

A

3-4% of the population, it is second to only rheumatoid arthritis. females more than males and onset is 50 years

Pathology
* autoimmune chronic inflammatory condition polyclonal B cell proliferation
* acinar atrophy secondary to infiltration by lymphocytes
* exocrine glands

Primary Sjogren’s
* Dry mouth
* Dry eyes

Secondary Sjogren’s
* Dry mouth
* Dry eyes
* Connective tissue disorder e.g. rheumatoid arthritis, lupus erythematosus

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10
Q

what are the possible causes of sjogrens syndrome?

A

History of presenting complaint
* dryness of other mucosae, eyes in particular.
* Medical history: connective tissue disease
* Family history: connective tissue disease

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11
Q

what are the extra glandular manifestations of sjogrens syndrome?

A

arthralgia
arthritis
myalgia
neuropathy
lymphadenopathy
anaemia
leukopenia
renal tubular acidosis
pulmonary disease
gastro-intestinal tract disease
vasculitis
lymphoma

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12
Q

what investigations are needed to diagnose sjogrens syndrome?

A

Unstimulated whole salivary flow rate less than 0.1mil/min
Lacrimal flow rate – Schirmer test: tear production
Ocular staining score: discontinuity of the tear film and damage to the surface to the conjunctiva covering the eye

Serology for connective tissue diseases: identify rheumatoid arthritis and lupus erythematosus leading to secondary sjogrens
Minor labial salivary gland biopsy – focal lymphocytic sialadenitis

Ultrasound of salivary glands

Other investigations which may be carried out:
FBC: anaemia
Inflammatory markers
IgG: raised usually
Sialography: often replaced by ultrasound

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13
Q

what is the classification criteria for sjogren’s syndrome?

A

American College of Rheumatology (ACR)/European League Against Rheumatism (EUALR)
2016

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14
Q

what testing is used for sjogrens syndrome and what are the scorings?

A

. anti-SSA/Ro antibody prsent (score = 3)

  • positivity and focal lymphocytic
    sialadenitis with a focus score of ‡1 foci/4 mm2 (score = 3) ( the biopsy)
  • abnormal ocular staining score of ‡5 (or van Bijsterveld score of ‡4) (score = 1)
  • Schirmer’s test result of ≤ 5 mm/5 minutes (score = 1)
  • unstimulated salivary flow rate of ≤ 0.1 ml/minute (score = 1)

Total score of 4 for meets the criteria for primary

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15
Q

What salivary stimulation could a GDP prescribe under the NHS?

A

If stimulated salivary flow rate is significant
* Artificial saliva pastilles DPF (Salivix)
* SST (Saliva-stimulating tablets)*

  • only for patients with impaired salivary gland function and patent salivary duct
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15
Q

Why is a diagnosis of Sjogren’s important?

A
  • Management of systemic involvement in Primary Sjogren’s by
    rheumatologist: hydroxychloroquine will not reverse the damage to the salivary glands
  • Increased risk of lymphoma in Primary Sjogren’s: with the use of ultrasound. if they get persistent inflammation of salivary glands
  • May lead to diagnosis of an associated connective tissue disease in
    Secondary Sjogren’s
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15
Q

What other treatment Can a GDP prescribe privately for stimulating saliva?

A

Local
* sugar free chewing gum/sweets
* Salivix plus pastilles: have flouride in them
* Xerostom pastilles

Systemic Therapy
*** Pilocarpine: acetylcholine esterase inhibitor, 5mg then increased to avoid side effect, face sweating and GO irritation

*** Xerostomia following irradiation for head and neck cancer; dry mouth and dry eyes in Sjögren’s syndrome

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15
Q

What saliva replacement therapy can a GDP prescribe under NHS?

A
  • Artificial Saliva Oral Spray DPF (Xerotin)
  • Artificial Saliva Protective Spray DPF (Aequasyal) – glycerol trimester based
  • Artificial Saliva Gel, DPF (Biotene Oralbalance saliva replacement gel) - carboxymethyl cellulose based
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16
Q

What other treatment Can a GDP prescribe privately for replacing saliva?

A

Carboxmethylcellulose based:
* Glandosane aerosol spray *: lemon PH
* Saliveze oral spray *

Olive and other fruit/plant oils:
* Xerostom oral spray

Mucin (pig) based:
* Artificial Saliva Substitute Spray (AS Saliva Orthana)
* AS Saliva Orthana lozenges*

  • use restricted to post radiotherapy or sicca syndrome by Advisory Committee on Borderline Substances (ACBS
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17
Q

How can we prevent dry mouth Syndrome?

A

Dietary advice
Improve and maintain OH
Fluoride:
* Sodium Fluoride Mouthwash 0.05% (alcohol free)
* Sodium Fluoride Toothpaste 0.619% or 1.1% (2800 or 5000 ppm)

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18
Q

describe Sialadenosis (sialosis)?

A
  • Classical presentation: bilateral, symmetrical, diffuse parotid salivary gland
    enlargement
  • Diabetes; liver disease; bulimia; malnutrition; pregnancy; idiopathic
  • Clinical diagnosis
  • No treatment required
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19
Q

how are orofacial classified?

A
  1. Orofacial pain attributed to disorders of dentoalveolar and anatomically
    related structures: pain attributed to teeth and the periodontium
  2. Myofascial orofacial pain: temporomandibular disorders
  3. Temporomandibular joint (TMJ) pain: temporomandibular disorders
  4. Orofacial pain attributed to lesion or disease of the cranial nerves
  5. Orofacial pains resembling presentations of primary headaches: orofacial migraines
  6. Idiopathic orofacial pain: persistent idiopathic orofacial pain
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20
Q

How are orofacial pain attributed to lesion or disease of the cranial nerve divided?

A

Pain attributed to lesion or disease of the trigeminal nerve:
Trigeminal neuralgia
Painful trigeminal neuropathies

Pain attributed to lesion or disease of the glossopharyngeal nerve:
Glossopharyngeal neuralgia
Painful glossopharyngeal neuropathies

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21
Q

How are Orofacial pains resembling presentations of Primary
Headaches divided?

A

Migraine
Tension type headache (TTH)
Trigeminal autonomic cephalalgias (TACs)
Other primary headache disorders

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22
Q

How are Idiopathic orofacial pains divided?

A

Burning mouth syndrome (BMS)
Persistent idiopathic facial pain (PIFP)
Persistent idiopathic dentoalveolar pain

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23
Q

What is trigeminal neuralgia?

A

1- A disorder characterized by recurrent unilateral brief electric shock-like pains, 2- abrupt in onset and termination,
3-limited to the distribution of one or more divisions of the trigeminal
nerve and
4- triggered by innocuous stimuli.
5- It may develop without apparent cause or be a result of another diagnosed disorder.
6-Additionally, there may be concomitant continuous pain of moderate intensity within the distribution(s) of the affected nerve division(s

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24
Q

What is the aetiology of Trigeminal neuralgia?

A

Incidence:
4-13 per 100,000
Age:
50-60y
Females > Males
risk factors include hypertension and stroke

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25
Q

What are the more common characteristics of trigeminal neuralgia?

A

maxillary and mandibular divisions, the ophthalmic division is rarely affected,
50% of the cases patients can identify a trigger, 65% of patients have no relieving factors, may cause anxiety and depression

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26
Q

What are the three classifications of trigeminal neuralgia?

A
  • Classical trigeminal neuralgia
  • Secondary trigeminal neuralgia
  • Idiopathic trigeminal neuralgia
27
Q

What is classical trigeminal neuralgia?

A

Description:
* Trigeminal neuralgia because of neurovascular compression.
In some cases there would be a constant background pain in between the bursts of sharp pain

28
Q

how can we diagnose trigeminal neuralgia?

A

Diagnostic criteria:
* Recurrent paroxysms of unilateral facial pain fulfilling criteria for Trigeminal neuralgia

  • Demonstration on MRI or during surgery of neurovascular compression (not simply contact), with morphological changes in the trigeminal nerve root.

Root entry zone:
point where the peripheral & central myelins of Schwann cells & astrocytes meet
Abnormal firing of the nerve : Ignition hypothesis

29
Q

What is the cause of Secondary trigeminal neuralgia?

A

Trigeminal neuralgia caused by an underlying disease. Clinical examination
shows sensory changes in a significant proportion of these patients.

30
Q

How can we diagnose Secondary trigeminal neuralgia?

A
  • An underlying disease has been demonstrated that is known to be able to
    cause, and explaining, the neuralgia.

Underlying diseases:
Trigeminal neuralgia attributed to multiple sclerosis
Trigeminal neuralgia attributed to space occupying lesion: cyst or tumour
Trigeminal neuralgia attributed to other cause

31
Q

What are the clinical features of Patients with secondary trigeminal neuralgia?

A

tend to be younger (<30 years of age)
to have trigeminal sensory deficits
to have bilateral TN
but low sensitivity therefore imaging mandatory, if this is not available trigeminal
reflexes may be useful

32
Q

What is Idopathic trigeminal neuralgia?

A

Neither Classical trigeminal neuralgia nor Secondary trigeminal neuralgia has been
confirmed by adequate investigation including electrophysiological tests and MRI
* Recurrent paroxysms of unilateral facial pain fulfilling criteria for Trigeminal neuralgia,
either purely paroxysmal or associated with concomitant continuous or near-continuous
pain

33
Q

How can Idiopathic trigeminal neuralgia be diagnosed?

A

1-History
2- Examination: to exclude of other causes, by testing trigeminal nerve disturbance in sensation
3-High resolution magnetic resonance imaging

34
Q

What is the main mode of treatment for Trigeminal neuralgia?

A

Carmazepine Which can be prescribed by a GDP under the NHS, the next line of treatment is Oxcarbazepine with cannot be prescribed by a dentist in the NHS

a GDP is able to manage TGN with collaboration with a general dental surgeon to initiate treatment under primary care and refer to secondary care

35
Q

What is carmazepine?

A
  • Proprietary name - Tegretol
  • Anti-convulsant: management of epilepsy and bipolar disorder.
  • Binds to voltage dependent sodium channels: this inhibits action potential generation
  • Metabolized in the liver: there is an interaction with other medications that are metabolised in the liver by the same enzymes and sometimes we see reduction in the efficacy after a couple weeks
  • Predominantly excreted in urine
36
Q

What should we avoid when prescribing carbamazepine?

A

Do not prescribe for patients of Han Chinese or Thai origin –increased likelihood of Stevens -Johnson syndrome

Pregnancy – congenital malformations
Hepatic and renal impairment – caution and monitoring
Cross sensitivity with other anticonvulsants
Interactions – numerous includes herbal medicines e.g. St John’s Wort, alcohol and grapefruit

37
Q

What is the regimen for carbamazepine?

A

Baseline blood tests FBC, LFTs, C&Es

Dosing regime::
* 100 mg twice daily for 1-3 days
* review
* if necessary increase by 100 mg every 2 days, introducing lunchtime and
afternoon doses if needed
* Therapeutic range 800 to 1200 mg per day
* Once pain free for 4 weeks trial dose reduction

Monitoring:
No set regimen suggest FBC, LFTs, C&Es weekly for first 4 weeks, 3
monthly after this

38
Q

What medications can GDP prescribe other than carbamazepine?

A

Lidocaine10mg per dose nasal spray for maxillary pain
Lidocaine 5% ointment to be applied to trigger point as requires
Lidocaine 2% 1:80 000 adrenaline as infiltration/block to trigger point

The latter can be a useful diagnostic tool and, if a long-acting local anaesthetic
agent is used e.g. bupivacaine, provide more prolonged relief

39
Q

What is Glossopharyngeal neuralgia?

A

. Recurring paroxysmal attacks of unilateral pain in the distribution of the
glossopharyngeal nerve1 and fulfilling criterion B
B. Pain has all of the following characteristics:
1. lasting from a few seconds to 2 minutes
2. severe intensity
3. electric shock-like, shooting, stabbing or sharp in quality
4. precipitated by swallowing, coughing, talking or yawning
Pain is experienced in
the ear, base of the tongue, tonsillar fossa and/or beneath the angle of the jaw.

40
Q

How would you diagnose Glossopharyngeal neuralgia?

A

High resolution MRI of head and neck

41
Q

What is painful trigeminal neuropathies classified into?

A

1-Painful trigeminal neuropathy attributed to the Herpes zoster virus
2-Trigeminal post-herpetic neuralgia (post-herpetic neuralgia)
3-Painful post-traumatic trigeminal neuropathy

42
Q

What are the main characteristics of Painful trigeminal neuropathies?

A

1- Allodynia: Pain in response to a stimulus which would not normally cause pain e.g. light touch in mechanical allodynia
2- Hyperalgesia: Increased response to a stimulus which would normally cause pain e,g, cold in cold hyperalgesia
3-Hypoalgesia: Reduction in response to a stimulus which would normally cause pain
4- Hyperesthesia: Increased cutaneous/mucosal sensitivity to a stimulus e.g. touch, temperature changes
5- Dysesthesia: An unpleasant abnormal sensation affecting the skin or mucosa e.g. burning, tingling, crawling, stinging, pain

43
Q

What is painful trigeminal neuropathy in its three classifications?

A

. Facial pain in the distribution(s) of one or more branches of the trigeminal nerve caused by another disorder and indicative of neural damage.

  • The primary pain is usually continuous or near-continuous, and commonly described as burning or squeezing or likened to pins and needles.
  • Superimposed brief pain paroxysms may occur, but these are not the predominant pain type, the continuous pain is the main one.
  • There are clinically detectable sensory deficits within the trigeminal distribution, and mechanical allodynia and cold hyperalgesia are common, fulfilling IASP criteria for neuropathic pain.
  • As a rule, allodynic areas are much larger than the punctate trigger zones present in trigeminal neuralgia
44
Q

What is Painful trigeminal neuropathy attributed to the Herpes zoster virus?

A

Unilateral facial pain of less than 3 months’ duration in the distribution(s) of one or more branches of the trigeminal nerve, caused by and associated with other symptoms and/or clinical signs of acute herpes zoster(Shingles).

45
Q

What is Trigeminal post-herpetic neuralgia?

A
  • Unilateral facial pain persisting and recurring for at least 3 months in the distribution(s) of one or
    more branches of the trigeminal nerve with variable sensory changes, caused by herpes zoster.
46
Q

What can be done to avoid Trigeminal post-herpetic neuralgia and Painful trigeminal neuropathy attributed to the Herpes zoster virus?

A

1- Prevention of Shingles: Immunisation against Herpes zoster for 70-79 year olds

2-Prevention of trigeminal post-herpetic neuralgia: Antivirals (Acyclovir) up to 72h following appearance of lesions of shingles (Herpes zoster)

3-Immediate management:
Paracetamol and codeine may give partial relief

47
Q

How would we mange Painful trigeminal neuropathy attributed to the Herpes zoster virus and Trigeminal post-herpetic neuralgia?

A

Management:
* Explanation and reassurance
* Self management:
* Relaxation
* Distraction
* Exercise
* Mindfulness

  • Topical:
    Capsaicin cream/patches
    Lidocaine patches: left up to 12 hours
  • Systemic:
    Duloxetine (SSNRI)
    Amitriptyline (Tricyclic)
    Amantadine (dopamine agonist)
48
Q

What is Painful post-traumatic trigeminal neuropathy?

A

Unilateral or bilateral facial or oral pain following and caused by trauma to the trigeminal nerve(s),
with other symptoms and/or clinical signs of trigeminal nerve dysfunction this could be due to dental treatment

49
Q

How can we diagnose Painful post-traumatic trigeminal neuropathy?

A

History of an identifiable traumatic event to the trigeminal nerve(s), with clinically evident positive
(hyperalgesia, allodynia) and/or negative (hypoesthesia, hypoalgesia) signs of trigeminal nerve
dysfunction
B. Evidence of causation demonstrated by both of the following:

  1. pain is localized to the distribution(s) of the trigeminal nerve(s) affected by the traumatic event
  2. pain has developed <6 months after the traumatic event
49
Q

What is Idiopathic orofacial pain?

A

Unilateral or bilateral intraoral or facial pain in the distribution(s) of one or
more branches of the trigeminal nerve(s) for which the aetiology is unknown.

How it differs from Trigeminal neuralgia:
The pain is usually persistent( neuralgia has periods of relief),
of moderate intensity( neuralgia is intense),
poorly localized ( you can localise it in neuralgia easily) and
described as dull, pressing or of burning character.( Neuralgia has Sharp shooting pain)

50
Q

What are the three members of the idiopathic orofacial pain?

A
  • Persistent Idiopathic Facial Pain
  • Persistent Idiopathic Dentoalveolar Pain
  • Burning Mouth Syndrome
51
Q

What are the basic common features of Idiopathic orofacial pain?

A

Basic features common to members of this group:
daily pain
>2 hours duration per day
for >3 months
no apparent abnormality to account for symptoms

Each member of this group has some typical characteristics in addition to the
above.

Conventional analgesics e.g. paracetamol, NSAIDs, opioids usually ineffective

52
Q

What would we find on a medical history of a patient that has idiopathic orofacial pain?

A

Medical history:
related conditions:
>chronic pain elsewhere in the body
>current/past contact with Pain Services
depression/ anxiety

medication:
>may already be taking analgesics/neuromodulators e.g.
amitriptyline

> May be overusing over the counter analgesics, abusing tobacco, alcohol or drugs to escape from pain

53
Q

What is persistent Idiopathic orofacial pain? and what are the characteristics

A

It has the same features of the other classifications of orofacial pain with a dull constant pain that is poorly localised.

  • F>M
  • 14-19% bilateral
  • Constant daily pain (57-90%)
  • Characteristics - deep poorly localised, nagging, burning, gripping, throbbing, pressure
  • 17-35% pain free months
  • Provoking factor – stress, cold weather, chewing, head movements, life events
  • Relieving factors – warmth, pressure, medication
  • Associated factors – dental treatment, psychiatric conditions, altered sensations.
  • May be preceded by a minor injury, operation or dental treatment and persist after healing has
    occurred
54
Q

What investigations could be carried out for Persistent idiopathic facial pain and Persistent Idiopathic Dentoalveolar Pain?

A

MRI/CT/CBCT may be considered if appropriate

55
Q

What treatment can be prescribed for Persistent Idiopathic orofacial pain and Persistent Idiopathic Dentoalveolar Pain?

A

lidocaine ointment 5%
lidocaine patches
capsaicin cream
levomenthol cream

Systemic treatments:
amitriptyline/nortriptyline
duloxetine

56
Q

What is Persistent Idiopathic Dentoalveolar Pain?

A

A. Intraoral dentoalveolar pain fulfilling criteria B and C
B. Recurring daily for >2 hours/day for >3 months
C. Pain has both of the following characteristics:
1. localized to a dentoalveolar site (tooth or alveolar bone)
2. deep, dull, pressure-like quality
D. Clinical and radiographic examinations are normal and local causes have been excluded

57
Q

What is burning mouth syndrome?

A

Diagnostic criteria:
A. Oral pain fulfilling criteria B and C
B. Recurring daily for >2 hours per day for >3 months
C. Pain has both of the following characteristics:
1. burning quality
2. felt superficially in the oral mucosa: may be accompanying oral dystopia
D. Oral mucosa is of normal appearance, and local or systemic causes have been excluded

58
Q

What is the epidemiology of Burning mouth syndrome?

A

Incidence:
* 1-15% general population
* 18-33% post menopausal women
* F>M 3:1

Sites:
* Tongue
* Palate
* Lips

59
Q

How do we dignose BMS?

A

Examination:
NAD – no mucosal abnormality to account for symptoms

Exclusion of local causes:
parafunctional habits
dry mouth
GORD – particularly if posterior part of mouth affected
candidosis – less likely if no mucosal abnormality

Exclusion of systemic causes:
anaemia
haematinic deficiency
diabetes – undiagnosed or poorly controlled
thyroid dysfunction
medication e.g. ACE inhibitors

60
Q

What investigations can be carried out for Diagnosing BMS?

A

Full Blood Count
Haematinics (Vitamin B12, serum/red blood cell folate, ferritin)
Glycosylated haemoglobin (HbA1c)
Thyroid stimulating hormone
Serum Zinc (particularly if taste disturbance)
Sialometry (if examination suggests dry mouth)
Exclude candidal infection (swab/oral rinse)

61
Q

What can be prescribed to manage BMS?

A

Topical treatments:
Primary Care:
benzydamine as mouthwash or oromucosal spray (Difflam)

Secondary Care:
capsaicin mouthwash – made up by patient using Tabasco sauce in water
clonazepam – oral rinse/tablet sucked & then spat out, not swallowed

Systemic treatments:
amitriptyline/nortriptyline
duloxetine

62
Q

What primary management can be preformed for Oral lichen planus?

A
  • Diet modification
  • SLS free toothpaste
  • Topical analgesic
  • Topical steroid: this is to reduce the inflammation, it is a cumulative affect it will not relief pain straight away
  • Regular reviews, 6 monthly, potentially malignant mucosal disorder
63
Q

what topical Therapy can be provided by dental practitioners working under
the NHS?

A

Topical Analgesics/Anaesthetics:
* benzydamine mouthwash or oromucosal spray
* Lidocaine ointment 5%
* Lidocaine spray 10%

Topical antimicrobial:
* Chlorhexidine mouthwash

Topical steroids:
* betamethasone soluble tablets 500 micrograms (as a mouthwash)
* Clenil modulate 50 micrograms/metered inhalation (beclometasone
diproprionate)
* hydrocortisone oromucosal tablets

64
Q

What Oral lichen planus and recurrent aphthous Management is offered in Secondary Care?

A

Topical steroids:
* varying potencies e.g. betamethasone, clobetasol, fluticasone, fluociniolone
* different preparations e.g. mouthwash, sprays, ointments mixed with adhesive base.

Triple mouthwash:
* Betamethasone 500microg soluble tablet, doxycycline 100mg dispersible tablet, nystatin suspension
1ml in 10 to 15ml water

Calcneurin inhibitors as mouthwash or ointment e.g. tacrolimus

Systemic medication:
* short course of prednisolone
* disease-modifying antirheumatic drugs (DMARDs) e.g. hydroxychloroquine, azathioprine, mycophenolate mofetil

65
Q

What is Behcet’s disease?

A

Multisystem
Vasculitis
Uncertain aetiology
At least 3 episodes of aphthous ulceration in past 12 months
Plus at least two of:
* Recurrent genital ulceration
* Eye involvement
* Skin lesions
* Positive pathergy test: you would injure the pt with a needle, if the get a large area of ulceration it is Bechet’s

66
Q

what are the Candidiasis Classifications?

A

Acute pseudomembranous (Thrush)
Acute erythematous
Chronic erythematous
Chronic hyperplastic
Candida Associated Lesions (secondary
candidiasis):
Angular cheilitis (angular stomatitis)
Denture stomatitis
Median rhomboid glossitis

67
Q

what are Candidosis Treatments?

A

intra-oral:
miconazole oromucosal gel 20 mg/g(Daktarin)
nystatin suspension 100,000 units/ml(Nystan)

extra-oral:
miconazole cream 2% (Daktarin)
miconazole 2% + hydrocortisone cream/ointment 1% (Daktacort)

Systemic:
fluconazole capsules 50 mg
fluconazole oral suspension 50mg/5ml

Other:
chlorhexidine gluconate mouthwash
hypochlorite (to soak acrylic dentures

Module 7 (9 decks)

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