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Dentistry Module 6 > Oral Medicine > Flashcards

Oral Medicine Flashcards

1
Q

What term describes orofacial pain attributed to lesion or disease of the cranial nerves?

A

Trigeminal neuralgia

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2
Q

What is the term given to small, very slightly raised yellow/white sebaceous glands which become prominent on the mucosa with age?

A

Fordyce spots

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3
Q

What papillae is hyperplastic and affected in black hairy tongue?

A

Filiform papillae

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4
Q

What type of mouthwash can induce black hairy tongue?

A

Chlorohexidine mouthwash

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5
Q

Define, a group of conditions affecting the TMJ and/or the muscles of mastication.

A

TMD

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6
Q

At what age range is TMD at peak incidence?

A

18 to 44 years of age

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7
Q

What are the common sites for pain associated with TMD?

A

Jaw
Ear
In front of ear
temple

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8
Q

What brings about TMD pain?

A
  1. Jaw movement
  2. Function
  3. Parafunctional habits
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9
Q

What muscles should be examined upon TMJ examination?

A

Masseter and temporalis

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10
Q

How would you palpate the temporalis muscle?

A

Ask patient to clench
Palpate along muscle

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11
Q

How would you palpate the masseter muscle?

A

Bimanual palpation

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12
Q

What are three common co-morbidities of TMD?

A
  1. Fibromyalgia
  2. Chronic pain
  3. Psychological factors (e.g. stress, anxiety)
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13
Q

What are three common intra-oral signs of bruxism/ clenching associated with TMD?

A
  1. Ridging buccal mucosa at level of occlusal plane
  2. Scalloping of borders of tongue
  3. Tooth wear
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14
Q

What are the two types of pain related TMD’s?

A
  1. Myalgia
  2. Arthralgia
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15
Q

What are the 6 types of intra-articular TMD’s?

A
  1. Disc displacement with reduction
  2. Disc displacement with reduction with intermittent locking
  3. Disc displacement without reduction with limited opening
  4. Disc displacement without reduction without limited opening
  5. Degenerative joint disease
  6. Subluxation
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16
Q

Which type of intra-articular TMD only allows very limited Jaw opening and why?

A

Disc displacement without reduction, as disc does not reduce into glenoid fossa upon opening

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17
Q

Define, a degenerative disorder involving the joint characterised by deterioration of the articular tissue with concomitant osseous changes in the condyle and/or articular eminence.

A

Degenerative joint disease

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18
Q

What sound is often associated with palpation if the patient has degenerative joint disease?

A

Crepitus

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19
Q

Define, where a patient is able to manoeuvre locked anterior displaced disc back into its position within the condyle.

A

Subluxation

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20
Q

Define, where assistance of a clinician is required to be able to manoeuvre locked anterior displaced disc back into its position within the condyle.

A

Luxation

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21
Q

What medication can be prescribed for conservative management of TMD accompanied by muscle spasm or disc displacement without reduction with limited opening?

A

Diazepam 5 day course

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22
Q

If a patient has a white patch on their buccal sulcus that can not be wiped off, what is your provisional diagnosis?

A

Epithelial hyperkeratosis

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23
Q

Define, pain attributed to a lesion or disease of the trigeminal nerve.

A

Trigeminal neuralgia OR Painful trigeminal neuropathies

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24
Q

Define, pain attributed to a lesion or disease of the Glossopharyngeal nerve.

A

Glossopharyngeal neuralgia OR painful Glossopharyngeal neuropathies

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25
Q

What is trigeminal neuralgia?

A

A disease characterised by recurrent unilateral brief electric shock-like pains limited to the distribution of one or more divisions of the trigeminal nerve.

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26
Q

What is the diagnostic pain criteria for trigeminal neuralgia?

A

Pain with all following characteristics:
1. Lasting from a fraction of a second to 2 minutes
2. Severe intensity
3. Electric shock-like, shooting, stabbing or sharp in quality.

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27
Q

What is the common age group to experience trigeminal neuralgia?

A

50-60 years old

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28
Q

What are the three types of trigeminal neuralgia?

A
  1. Classical TN
  2. Secondary TN
  3. Idiopathic TN
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29
Q

What causes classical trigeminal neuralgia?

A

Neurovascular compression (causes morphological changes in trigeminal nerve)

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30
Q

What is the cause of secondary trigeminal neuralgia?

A

Underlying disease

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31
Q

Name two underlying diseases likely to be associated with trigeminal neuralgia?

A
  1. Multiple sclerosis
  2. Space occupying lesion
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32
Q

What patients typically present with secondary TN and what characteristics are usually present?

A

Patients tend to be younger (<30 years), have trigeminal sensory deficits (e.g. tingling or complete numbness), have bilateral TN.

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33
Q

Describe, idiopathic trigeminal neuralgia.

A

Trigeminal neuralgia with neither electro physiological tests nor MRI showing significant abnormalities.

34
Q

What is the first line radiographic investigation for trigeminal neuralgia?

35
Q

If MRI is not available, what radiographic imaging is appropriate for investigating trigeminal neuralgia?

36
Q

What are red flags (7) in a TN assessment that may necessitate more urgent referral to specialist services?

A
  1. Sensory or motor deficits
  2. Deafness or other ear problems
  3. Optic neuritis
  4. History of malignancy
  5. Bilateral TN pain
  6. Systemic symptoms
  7. Presentation of TN in young age.
37
Q

If a patient presents with TN and associated optic neuritis, what underlying condition might this be suggestive of?

A

Multiple sclerosis (MS)

38
Q

Define pain, with unknown aetiology, which is usually persistent, of moderate intensity, poorly localised and described as dull, pressing or of burning character in the orofacial region.

A

Idiopathic orofacial pain

39
Q

What are the three categories of idiopathic orofacial pain?

A
  1. Persistent idiopathic facial pain
  2. Persistent idiopathic dentoalveolar pain
  3. Burning mouth syndrome
40
Q

What are basic features of idiopathic orofacial pain?

A
  1. Daily pain (>2 hours per day)
  2. Pain lasts >3 months
  3. No apparent abnormality to account for symptoms
41
Q

What is chronic pain?

A

Pain lasting for >3 months

42
Q

What medical conditions are related with idiopathic orofacial pain?

A
  1. Chronic pain elsewhere in the body
  2. Current/past contact with pain services
  3. Depression/anxiety
43
Q

Define, an intra-oral burning or dysaesthetic sensation, recurring daily for more than 2 hours per day for more than 3 months, without evident causative lesions on clinical examination and investigation.

A

Burning mouth syndrome

44
Q

Accompanying taste disturbances can occur with burning mouth syndrome. True or false?

45
Q

What sites in the mouth are most commonly affected by burning mouth syndrome?

A
  1. Tongue
  2. Palate
  3. Lips
46
Q

What medical conditions can cause a burning sensation in the mouth?

A
  1. Anaemia
  2. Haematinic deficiency
  3. Diabetes (poorly controlled)
  4. Thyroid dysfunction
47
Q

What medication can casue sensation of burning mouth?

A

ACE inhibitors

48
Q

Name three orofacial pains resembling presentations of primary headaches.

A
  1. Orofacial migraine (migraine)
  2. Tension type of orofacial pain (tension headache)
  3. Trigeminal autonomic orofacial pain (trigeminal autonomic cephalalgias)
49
Q

Define, a recurrent headache disorder manifesting in attacks lasting 4-72 hours. Typical characteristics of the headache are unilateral location, pulsating quality, moderate or severe intensity, aggravation by routine physical activity and association with nausea and/or photophobia and phonphobia.

A

Migraine without aura

50
Q

Define, recurrent headache attacks, lasting minutes, of unilateral fully reversible visual, sensory or other CNS symptoms that usually develop gradually and are usually followed by headache and associated migraine symptoms.

A

Migraine with aura

51
Q

Define genodermatoses.

A

A broad term that refers to a wide range of genetic skin disorders

52
Q

What is white sponge naevus?

A

“An autosomal dominant benign skin disorder characterised by white, irregular, diffuse plaques mainly affecting the oral mucosa.”

53
Q

What does this clinical feature suggest?

Buccal and labial mucosa filmy white/grey appearance, soft on palpation, asymptomatic.

A

Leukoedema

54
Q

What does this clinical feature suggest?

Strands of gelatinous milky white material removable by wiping, no significant abnormality of underlying tissue.

A

Epitheliolysis (oral mucosal peeling)

55
Q

What causes epitheliolysis?

A

Secondary to mucosal irritation by toothpaste, mouthwashes. Usually the sodium lauryl sulphate (SLS) in these products, so cease use.

56
Q

What causes traumatic keratosis?

A

Parafunctional habits (e.g. clenching,grinding)

57
Q

What does this clinical feature suggest?

White plaque not removed by rubbing/scraping, may have a shaggy surface, appear macerated or be associated with ridging.

A

Traumatic keratosis

58
Q

What does this clinical feature suggest?

Generalised white/greyish appearance of the hard palate extending onto the soft palate. Small red dots visible on hard palate representing inflamed opening of minor salivary glands. Usually a cause of smoking.

A

Stomatitis nicotina

59
Q

What two conditions can sometimes mimic oral lichen planus?

A

Lupus erythematosus and graft versus host disease

60
Q

What areas of the mouth are most commonly affected by lichen planus?

A

Tongue, cheeks and gingivae

61
Q

Is oral lichen planus usually unilateral or bilateral?

62
Q

Other than the oral cavity, what are 4 other common sites of involvement of lichen planus.

A
  1. Skin
  2. Scalp
  3. Nails
  4. Genital (vulvovaginal gingival lichen planus)
63
Q

What are the 4 investigations for oral lichen planus/lichenoid reaction?

A
  1. Diagnosis can be made on clinical grounds
  2. Biopsy
  3. Swab if suspect super-added candida
  4. Blood tests if associated disease suspected
64
Q

Is lichen planus/lichenoid reaction potentially malignant?

65
Q

What medications commonly cause lichenoid reactions in the oral cavity?

A
  1. Antihypertensives (ACE inhibitors, beta blockers etc.)
  2. Oral hypoglycaemics
  3. Non-steroidal anti-inflammatory drugs (e.g. ibuprofen, naproxen etc.)
66
Q

What metal in fillings can cause a type 4 contact dermatitis reaction leading to a lichenoid reaction?

67
Q

What are the risk factors from malignant transformation in lichen planus/lichenoid reactions?

A

Smoking and alcohol consumption

68
Q

In simple terms what mechanism underlies lichenoid reactions to restorative materials?

A

Type 4 sensitivity reaction - contact dermatitis

69
Q

What is graft versus host disease?

A

A systemic disorder that occurs when the grafts immune cells recognise the host as foreign and attack the body’s cells.

70
Q

What other disease seems to be associated with lichen planus other than graft versus host disease?

A

Hepatitis C

71
Q

What do these clinical features suggest?

Firmly adherent, corrugated surface of white patches. Often found on lateral border of tongue.

A

Hairy leukoplakia

72
Q

What 2 infectious diseases is hairy leukoplakia strongly associated with?

A

Epstein Barr Virus (human herpes virus 4)
HIV

73
Q

What individuals are most prone to hairy leukoplakia developing on the lateral border of the tongue?

A

Individuals who:
1. Have Epstein Barr virus
2. Have HIV (diagnosed or undiagnosed)
3. Are Immunosupressed/immunocompromised
4. Take inhaled and topical corticosteroids

74
Q

What is the managment for hairy leukoplakia?

A

Biopsy and offer of HIV test

75
Q

What do these clinical features suggest?

White patches removed by scraping leaving an erythematous/bleeding base.

A

Acute pseudomembranous candidosis

76
Q

Name 7 underlying local and/or systemic predisposing factors for acute pseudomembranous candidosis.

A
  1. Dry mouth
  2. Steroid inhaler use
  3. Anaemia
  4. Nutritional deficiency
  5. Diabetes
  6. Immunosuppressed/immunocompromised
  7. Extremes of age
77
Q

What is the gold standard test for investigating suspected candidosis?

A

Oral rinse test

78
Q

What investigations should you do to investigate a possible underlying cause for candidosis?

A
  1. FBC
  2. Serum B12, folate, ferritin
  3. HbA1c (glycosylated haemoglobin)
  4. TSH
79
Q

What do these clinical features suggest?

Firmly adherent white plaques that do not scrape away. There may be inter-mingles erythema and nodularity. Commiserate/anterior region of buccal mucosa most commonly affected (often bilateral).

A

Chronic hyperplastic candidosis

80
Q

What is a significant aetiological factor for chronic hyperplastic candidosis?

A

Cigarette smoking

Dentistry Module 6 (15 decks)

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