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Dentistry Module 7 > Oral Medicine > Flashcards

Oral Medicine Flashcards

1
Q

What is Behçet’s disease?

A

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

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2
Q

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

A

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

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3
Q

What is pathergy?

A

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

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4
Q

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

A
  1. Pathergy
  2. Erythema nodosum
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5
Q

What is the management of recurrent aphthous stomatitis?

A
  • SLS free toothpaste
  • topical analgesic
  • topical steroid
  • diet modification- consider benzoate and cinnamon avoidance
  • consider oral disease severity score
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6
Q

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

A
  1. Analgesic mouthwashes
  2. Anti-microbial mouthwashes
  3. Topical steroids
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7
Q

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

A
  1. Benzydamine mouthwash or oromucosal spray
  2. Lidocaine ointment
  3. Lidocaine spray
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8
Q

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

A
  1. Chlorohexidine glauconate mouthwash
  2. Dispersible doxycycline tablet as mouthwash
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9
Q

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

A
  1. Betamethasone soluble tablets (as mouthwash)
  2. Clenil modulie inhalation
  3. Hydrocortisone oromucosal tablets
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10
Q

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

A

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

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11
Q

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

A
  1. Topical steroids (varying potencies)
  2. Triple mouthwash (Betamethasone, doxycycline and nystatin suspension)
  3. Systemic medication (e.g. short course of prednisolone)
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12
Q

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

A
  • skin
  • scalp
  • oesophagus
  • nails
  • genitals
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13
Q

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

A
  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)
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14
Q

Does classical reticular lichen planus need referral?

A

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

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15
Q

After diagnosis of lichen planus, what is the management?

A
  • diet modification
  • SLS free toothpaste
  • topical analgesic
  • topical steroid
  • regular reviews, 6 monthly, potentially malignant mucosal disorder
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16
Q

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

A

Doxycycline tablet mouthwash

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17
Q

What is the management of oral lichenoid reactions?

A
  • 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)
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18
Q

Define, a blister >1cm in diameter that contains clear, serous, or haemorrhagic fluid.

A

Bulla

19
Q

Define, a small blister <1cm in diameter that contains clear, serous, or haemorrhagic fluid.

A

Vesicle

20
Q

What does rupture of a bulla/vesicle result in?

A

Development of an erosion/ulcer.

21
Q

What two broad groups can vesiculobullous conditions be classified into depending on the level at which separation occurs?

A
  1. Intra-epithelial/epidermal (within epithelium/epidermis)
  2. Sub-epithelial/epidermal (below the basement membrane)
22
Q

What are many of the vesiculobullous conditions a result of?

A

Production of antibodies against components of the epithelium or basement membrane zone

23
Q

What two subgroups can intra-epithelial vesiculobullous conditions be further divided into?

A
  1. Acantholytic
  2. Non-acantholytic
24
Q

Define, the separation of keratinocytes within the epidermis due to the loss of adhesion between keratinocytes (failure of the integrity of the intracellular/intraepidermal cell junctions).

A

Acantholysis

25
Q

Name 4 acantholytic intraepithelial vesiculobullous conditions.

A
  1. Pemphigus vulgaris
  2. Pemphigus foliaceous
  3. Paraneoplastic Pemphigus
  4. Drug induced Pemphigus
26
Q

Name 3 non-acantholytic intraepithelial vesiculobullous conditions (viral infections).

A
  1. Herpes simplex
  2. Herpes zoster
  3. Coxsackie infections
27
Q

What intra-epithelial vesiculobullous condition is suggested from these clinical findings?

Flaccid (floppy) bullae/vesicles which rupture easily to leave areas of erosion and ulceration. A positive Nikolskys sign is an indicator.

A

Pemphigus vulgaris

28
Q

Define a positive Nikolsky’s sign.

A

Where top layer of skin/mucosa can be removed with lateral rubbing leaving a moist base

29
Q

In investigation of Pemphigus vulgaris, what two autoantibodies likely to be detected?

A

Desmoglein 3
Desmoglein 1

30
Q

What is the gold standard investigation for detecting autoantibodies when investigating Pemphigus vulgaris?

A

Direct immunofluorescence (DIF)

31
Q

What quantitative investigations provide a means of monitoring response to therapy and may be used for diagnostic purposes if:
- Patient does not wish to undergo biopsy
- biopsy is contra-indicated
- biopsy is non-diagnostic

A

IDIF and ELISA

32
Q

What is the correct management of Pemphigus vulgaris?

A
  1. Recognition of signs and symptoms
  2. Prompt referral to secondary care
33
Q

What local management can be implicated for Pemphigus vulgaris?

A
  1. Topical analgesic mouthwash (e.g. Gelclair)
  2. Topical steroids
34
Q

What is the most commonly administered drug for systemic management of Pemphigus vulgaris?

A

Rituximab

35
Q

The condition Pemphigus vulgaris is so rare, so why is it important to us as dentists?

A
  • can be exacerbated by dental treatments or x-rays
  • it is a life-threatening disease which we can hopefully detect early before complications arise
36
Q

What Subepithelial vesiculobullous condition is suggested by these clinical features?

  • Turgid (tense) bullae/vesicles which rupture to leave areas of erosion and ulceration. May be present as Desquamative gingivitis, confined to the gingiva.
  • may have conjunctival involvement
A

Mucous membrane pemphigoid

37
Q

Why is conjunctival involvement of mucous membrane pemphigoid particularly significant?

A

May result in scarring and loss of sight

38
Q

What are the two investigations required for mucous membrane pemphigoid?

A
  1. Biopsy
  2. DIF
39
Q

What is the local management of mucous membrane pemphigoid?

A
  • topical analgesic mouthwash
  • topical steroids
  • good OHI
40
Q

What systemic management is used for mild mucous membrane pemphigoid?

A

Doxycycline

41
Q

What systemic management is used for severe mucous membrane pemphigoid?

A
  • dapsone/prednisolone/ DMARD’s (e.g. Rituximab)
42
Q

What is the main trigger for erythema multiforme (in 70% if cases)?

A

HSV

43
Q

How can erythema multiforme be prevented in a patient with HSV?

A

Long term prophylactic herpes medication (aciclovir)

Dentistry Module 7 (14 decks)

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