Oral Medicine Flashcards
What do we need to know
- History taking
- Red patches
- Ulcers
- White patches
- managing suspicious lesion
- when to refer your patient
Pain history ? SOCRATES
Site- where is pain?
Onset- when/how did pain start ( sudden/gradual)
Character- describe the pain? Dull/sharpe
Radiation- Does pain move anywhere?
Associations- Any symtoms/ signs associated with pain?
Timing- How has pain changed over time?
Exacerbating/Relieving factors- does anything worsen/ relieve the pain?
Severity- How bad is the pain in scale 1-10 ?
History of lesion?
- when did you notice it?
- were they any predisposing events?
- has it changed?
- does it bother you?
- are there any other lumps?
Past medical history ?
- Current and previous illness
- Previous operation
- Previous investigation
- Allergies
- other
Drug History
- Current and previous medication
- Dosage and durations
- Any allergies
Family history
- Note any relevant conditions in immediate family members
- Systemic illnesses, neoplasms etc
Social History
- Smoking no. Per day and how long for
- vaping
- Alcohol intake in unit / single spirit 1 unit
- Occupation
Red patches/ Erythema
- Red patches appear red due to thinning/ ulceration / erosion of oral mucosa and increased
- Most will cause a degree of discomfort (occasionally painless)
- Some are pre- malignant
- can be widespread in oral cavity.
Erythema
- Trauma
- Infection e.g Candida
- Immune related disease
- Idiopathic tongue - swelling of tongue
- Neoplasia - uncontrolled , abnormal growth of cells or tissue in body
Type of Erythema
1- Painful and May ulceration-
Post radiotherapy mucositis
Hypersensitivity reaction
Erosive lichen planus
2- painful with no ulceration.
Acute candidosis
Geographic Tongue
Anemia ( iron , folate)
3- Painless with no ulceration
Erythroplakia
Chronic Candidosis
4- Painless with ulceration
Squamous cell carcinoma
Infectious mononucleosis
Contact hypersensitivity reaction
Cause by dental material/chemical I.e
Nickel , orthodontic wires
Acute Erythematous Candiosis
-May be painful
- steroid inhaler
- immunosuppression / HIV
Median Rhomboid glossitis
Caused by CANDIDA
Chronic Erythematous Candidosis
- Seen under fitting surface of URA and nance buttons
- caused by Candida albicas
- management- OHI , appliance cleaning adv, soaking and leaving out at night
- some cases - Tropical anti fungal paste-Miconazole 6hrs for 4 Weeks
Geographic tongue ( Erythema migrants)
- Idiopathic condition
- Typically involves tongue
- increased sensitivity to certain foodstuffs
- management- reassurance and symptomatic relief
Erythroplakia
- Aetiology Tobacco, Alcohol, deficiency, Candida infection, chronic Trauma
- Malignant 5-10 %
- Require biopsy
Squamous cell Carcinoma
- Variable clinical features
- Present floor of mouth , tongue , retromolar region
- 5yr survival rate ,40%
Oral ulceration
- Breach of Oral mucosa ( breaking into tissue) suqmous epithelium.
Oral Ulceration - Erosion
- Superficial break in epithelial continuity with underlying Lamina propria being intact
Aetiology of Oral Ulceration
- Trauma - ortho wires, sharp restoration
- Immunological
- Infection . HSV, TB
-Immune related disease - Neoplatic lesions
Trauma
Physical- Orthodontic appliance ,
Chemical - aspirin burn
Recurrent Aphthous Stomatitis / Ulceration
- often recurring
- child / adult
- Round / oval shape
- painful
- White/ yellow
- can present in number of ways
- 15-20 % population
- someone smoke stop smoking experience RAS
- idiopathic ( unknown)
- Predisposing factor - Stress anxiety / Hypersensitivity (allergy), Deficiency, Hormonal
RAS - types 1 . Minor RAS
- unusually mobile
- 2-6 per episode
- last 7-14 days
- heals with no scaring
Type 2 - Major RAS
- large >1 cm diameter
- involve both keratinised and non keratinised mucosa
- Month or longer
- scar by healing
Type 3 - HYPETIFORM RAS
- Apthae grow and fuse
- 7-14 days
- heal without scarring
Management of RAS/ RAU
Investigation :-
-Full blood count (B12, folate,Ferritin)
- clinical findings: coeliac disease screen, antibody, HIV
MANAGEMENT:
Beclometasone dipropionate: 2 puff directed onto ulcers 3x days
Betnesol Mouthwash: : 3 x day
Chlorhexidine M/W may help prevent secondary infection of RAU
Ulcers - infective causes
- Recurrent herpetic gingivostomatitis caused by Herpes simplex virus (HSV-1)
- Herpes zoster virus (HHV- 3)
-HIV
White patches / Lesions
When commonly developed?
- Trauma
- Infection
- Immune related disease
- Neoplasia
Pattern of white patches with pain
- often associated with pain
- Chemical burn
- lichen Planus
- Lichenoid reaction
- Lupus Erythmatosus
White patches
- usually painless, although discomfort can appear due to erosion and ulceration
- Premalingnant - biopsy
- may be localised or wide spread
Trauma - Chemical burn
- Painful injury to soft tissues
- White sloughing due to necrosis
Immune related - Hypersensitivity lichenoid reactions.
- unilateral often adjacent to amalgam
Acute Pseudomembranous candidosis
- creamy path can be removed
- caused by steroid inhalers use and broad spectrum AB’s
What caused by orthodontic wire?
- Frictional Keratosis
Frictional keratosis
- Thickening of mucosa due to persistent irritation eg smoking, heat, cheek biting, orthodontic wire.
Leukoplakia
- white thick patch in oral cavity
- middle age or above
- tongue
-Retromolar region - lower lip
- floor of mouth
Smoking and smokeless tobacco
- White keratosis , buccal tissue and on alveolar ridge
- inflammed minor salivary glands
- Nicotinic Stomatitis
Alcohol
- Oral cancer - high alcohol consumption
- 38 times risk increase for drink and smoke heavily together
- tooth erosion
- accidental dental trauma
Management of suspicious lesion
- record in notes - visual exam
- sign and symptoms - use open questions
- Notes include MH, Social history, smoking and alcohol habit.
DCP MANAGEMENT
- Take a thorough history -
-Take infra oral photos and measurement of suspicious lesions - Consult with orthodontist
- Refer if in doubt
- Review
