Oral Medicine

Question 1

What is Behçet’s disease?

Answer 1

“A rare disorder that causes blood vessel inflammation throughout your body.”

Question 2

How is Behçet’s disease diagnosed from clinical intra-oral exam?

Answer 2

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

Question 3

What is pathergy?

Answer 3

“ an exaggerated skin injury occurring after minor trauma such as a bump or bruise.”

Question 4

What are the two key features of Behçet’s disease?

Answer 4

1. Pathergy
2. Erythema nodosum

Question 5

What is the management of recurrent aphthous stomatitis?

Answer 5

• SLS free toothpaste
• topical analgesic
• topical steroid
• diet modification- consider benzoate and cinnamon avoidance
• consider oral disease severity score

Question 6

What types of topical therapy can dental practitioners working under the NHS prescribe to patients to help with aphthous ulceration?

Answer 6

1. Analgesic mouthwashes
2. Anti-microbial mouthwashes
3. Topical steroids

Question 7

Give three examples of analgesic mouthwashes that can be prescribed to treat aphthous ulcers on NHS?

Answer 7

1. Benzydamine mouthwash or oromucosal spray
2. Lidocaine ointment
3. Lidocaine spray

Question 8

Give two examples of antimicrobial mouthwashes that can be prescribed to treat aphthous ulcers on NHS?

Answer 8

1. Chlorohexidine glauconate mouthwash
2. Dispersible doxycycline tablet as mouthwash

Question 9

Give three examples of topical steroids that can be prescribed to treat aphthous ulcers on NHS?

Answer 9

1. Betamethasone soluble tablets (as mouthwash)
2. Clenil modulie inhalation
3. Hydrocortisone oromucosal tablets

Question 10

What extremely important to establish before prescribing Betamethasone mouthwash to a patient suffering with recurrent aphthous stomatitis?

Answer 10

That the patient can spit it out and not swallow it. (If too much swallowed this can cause adrenal suppression)

Question 11

What types of topical therapy can secondary care professionals prescribe to patients to help with aphthous ulceration?

Answer 11

1. Topical steroids (varying potencies)
2. Triple mouthwash (Betamethasone, doxycycline and nystatin suspension)
3. Systemic medication (e.g. short course of prednisolone)

Question 12

Where are common sites other than the mouth for lichen planus to occur?

Answer 12

• skin
• scalp
• oesophagus
• nails
• genitals

Question 13

What are the 6 steps to initial management of lichen planus in primary care?

Answer 13

1. Explanation of diagnosis
2. Ask about other site involvement and refer if necessary
3. Counsel re smoking cessation and alcohol moderation
4. Advise of risk of oral cancer
5. Baseline photographs
6. Consider use of symptom severity measure (ODSS)

Question 14

Does classical reticular lichen planus need referral?

Answer 14

No, this can be managed and monitored in dental practice every 6 months.

Question 15

After diagnosis of lichen planus, what is the management?

Answer 15

• diet modification
• SLS free toothpaste
• topical analgesic
• topical steroid
• regular reviews, 6 monthly, potentially malignant mucosal disorder

Question 16

Lichen planus has the same topical therapy treatment as recurrent aphthous ulceration, apart from one type of topical antimicrobial, which is this?

Answer 16

Doxycycline tablet mouthwash

Question 17

What is the management of oral lichenoid reactions?

Answer 17

• liaise with GMP re medication
• consider placement of culpable restorative material (e.g. amalgam) with an alternative
• review 3 months (potential for malignant change higher than oral lichen planus)