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Finals > Oral Medicine > Flashcards

Oral Medicine Flashcards

1
Q

How is oral ulceration managed?

A

Nutritional deficiencies
Avoid sharp or spicy foods
Prevention of superinfection
Symptomatic relieve

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2
Q

What are Bohn’s Nodules?

A

Gingival cysts filled with keratin in the alveolar ridge

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3
Q

What are fibro-epithelial polyps?

A

Localised hyperplastic lesion

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4
Q

What is the aetiology of fibro-epithelial polyps?

A

Overproduction of granulation and fibrous tissue in response to damage or trauma

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5
Q

What are the clinical features of fibro-epithelial polyps?

A

Pedunculated or sessile
Firm or soft
Pink appearance
Painless
Can be ulcerated and easily traumatic
May have associated frictional keratosis
Usually an isolated lesion

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6
Q

Where do fibro-epithelial polyps present?

A

Buccal mucosa
Areas of trauma

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7
Q

Describe the histology of a fibre-epithelial polyp:

A

Fibrous core
Thick interlacing collagen
Adjacent normal tissue
Covered with squamous epithelium
May have hyperkeratosis
Little inflammatory infiltrate

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8
Q

What are the clinical considerations in regard to fibro-epithelial polyps?

A

Does it bother the patient?
Do they have risk factors for oral cancer?

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9
Q

What is the name for a fibro-epithelial polyp on the gingiva?

A

Fibrous epulis

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10
Q

What is the management of a fibro-epithelial polyp?

A

Photos
Identify and if appropriate, correct the traumatic cause
Consider excision biopsy

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11
Q

What are the benefits of excision biopsy for fibro-epithelial polyps?

A

Can confirm diagnoses
Can remove the lesion

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12
Q

What are the risks of excision for fibro-epithelial polyps?

A

Surgical risks
Altered sensation- can be permanent
Recurrence or incomplete excision

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13
Q

What are examples of hyperplasticity tissue conditions related to dentures?

A

Leaf fibroma
Denture hyperplasia
Papillary hyperplasia

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14
Q

What is papillary hyperplasia?

A

Granular inflammation of denture bearing surface- more common on palate

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15
Q

What is papillary hyperplasia associated with?

A

Candida

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16
Q

What is the management for denture associated lesions?

A

Consider excision of lesion
Denture hygiene
Candida management
Consider making a new prosthesis

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17
Q

What is an epulis?

A

A reactive hyperplastic lesion on the gingiva

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18
Q

What are the features of fibrous epulis?

A

Fibro-epithelial polyp on the gingiva
Same colour as gingiva
May be ulcerated

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19
Q

What is giant cell epulis also known as?

A

Peripheral giant cell granuloma

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20
Q

Describe the presentation of giant cell epulis:

A

Red/purple appearance
Sessile or pedunculated
Often interdental
Most common in children

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21
Q

What does giant cell epulis have identical histopathological features as?

A

Central giant cell lesion
Hyperparathyroidism (Brown’s Tumour)

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22
Q

What is the histopathological presentation of giant cell epulis?

A

Multi-nucleated osteoclast giant cells
Vascular stroma
Fibrous tissue

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23
Q

What is the pathogenesis of giant cell epulis?

A

Unknown
Reactive to trauma or irritation

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24
Q

What is the management of giant cell epulis?

A

Excisional biopsy
OPT +/- CBCT
Bone profile
Parathyroid hormone assay
Photos and investigation from paeds clinic

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25
Q

What is a vascular epulis the same as?

A

Pyogenic granuloma

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26
Q

What is the name of a vascular epulis that presents in pregnancy?

A

Pregnancy epulis

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27
Q

Why do pregnancy epulis present/increase in size?

A

Hormonal changes- may resolve following birth and result in a fibrous epulis
May recur if removed during pregnancy

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28
Q

What is the presentation of a vascular epulis?

A

Soft-bright red appearance
Gradual increase in size

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29
Q

What is the histological appearance of a vascular epulis?

A

Vascular appearance
Variable amounts of inflammatory infiltrate

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30
Q

What are the management options for a vascular epulis?

A

Keep under observation
Refer to oral surgery in GDP
Excisional biopsy
Excise after birth (pregancy epulis)

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31
Q

What drugs are associated with generalised gingival overgrowth?

A

Calcium channel blockers
Ciclosporin
Phenytoin

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32
Q

What is the management of gingival overgrowth?

A

Gingivoplasty
Ask GP to consider alternative medications
Plaque control
Are there risk factors for other disease
Consider referral to Oral Medicine to exclude other causes

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33
Q

What is chronic hyperplastic gingivitis associated with?

A

Mouth breathing
Pregnancy

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34
Q

How does hereditary gingival fibromatosis present?

A

Enlarged gingiva
Little inflammation
Expansion of the tuberosities

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35
Q

What is a sign of haematological malignancy associated with gingival overgrowth?

A

Rapid progression in presence of good OH

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36
Q

What is squamous cell papilloma also referred to as?

A

Benign growth (tumpur)
Wart

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37
Q

How does squamous cell papilloma present?

A

Pedunculated or sessile
Cauliflower appearance
Often keratinised surface
Single or multiple lesions

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38
Q

What is the aetiology of squamous cell papilloma?

A

Viral- HPV infection (HPV: 2,4,6,11 and 40)
May present in immunocompromised

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39
Q

What is the management of squamous cell papilloma?

A

Excisional biopsy
Observation: if no red flag signs, symptoms or OSCC risk factors

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40
Q

What is the histological presentation of squamous cell papilloma?

A

Finger like processes of hyperplastic squamous epithelium
Thin cores of vascular connective tissue

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41
Q

What is a pyogenic granuloma?

A

Reactive vascular lesion

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42
Q

Where do pyogenic granulomas present?

A

Gingiva usually

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43
Q

What is the cause of pyogenic granulomas?

A

Response to local irritation/trauma

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44
Q

What is the histological presentation of a pyogenic granuloma?

A

Vascular proliferation
Oedematous fibrous stroma
Variable inflammatory infiltrate

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45
Q

What is the management of pyogenic granulomas?

A

Remove irritant- plaque/overhangs/denture/trauma
Excisional biopsy
Photos

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46
Q

What is the pathophysiology of black hairy tongue?

A

Hyperplasia of filiform papillae
Build up of commensal bacteria, food debris
Pigment inducing fungi and bacteria

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47
Q

What are factors associated with the development of black hairy tongue?

A

Smoking
Antibiotics
Chlorhexidine mouthwash
Poor oral hygiene

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48
Q

What is the management of black hairy tongue?

A

Re-assure
Stop smoking
Stay hydrated
Lightly brush the tongue
Gently exfoliate tongue surfaces- peach stones
Eating fresh pineapple

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49
Q

What are fordyce spots?

A

Sebaceous glands

50
Q

What do fordyce spots present as:

A

Yellowish bumps on the buccal mucosa and lips
Symmetrical distribution
Greater prominence later in life

51
Q

What % of adults have fordyce spots?

A

60-75%

52
Q

What is geographic tongue also called?

A

Benign migratory glossitis
Erythema migrans

53
Q

What % of adults have geographic tongue?

A

1-3%

54
Q

What is geographic tongue associated with?

A

Psoriasis

55
Q

What is geographic tongue?

A

Loss of filiform papillae- areas of tongue atrophy and hyper keratinisation

56
Q

What are the symptoms of geographic tongue?

A

Asymptomatic
Sensitivity to hot and spicy foods and toothpaste

57
Q

What is the management of geographic tongue?

A

Reassurance
Biopsy not indicated
If symptomatic- consider difflam mouthwash
Ask about skin changes (psoriasis)
Consider avoiding trigger foods if painful

58
Q

What are mucoceles?

A

Cysts

59
Q

What are mucoceles caused by?

A

Damage to salivary ducts or minor salivary glands

60
Q

What is a ranula?

A

Mucocele on floor of mouth

61
Q

Where do mucoceles present?

A

Lower lip mainly
If upper lip- treat as malignancy until proven otherwise

62
Q

How do mucoceles present?

A

Blue/translucent lump
Sessile

63
Q

How are mucoceles classified?

A

Mucous retentive
Mucous extravasation

64
Q

What age group are mucoceles most common in?

A

Under 30

65
Q

What is the management of mucoceles?

A

Excision- blunt dissection to remove full capsule of cyst and damaged minor salivary gland
Paeds- watchful wait

66
Q

What happens if a mucocele is incompletely excised?

A

Increased chance of reoccurrence

67
Q

What is a lingual tonsil?

A

Lymphoid tissue

68
Q

Where is a lingual tonsil found?

A

Postero-lateral aspect of tongue

69
Q

What is a varice?

A

Blood vessel

70
Q

When are varices more prominent?

A

Increasing age
Smokers
CVD patients

71
Q

What is a hamartoma?

A

Disorganised vascular tissue

72
Q

Where do hamartomas present?

A

Head and neck

73
Q

What is a haemangioma?

A

Common, benign growth made of a collection of small blood vessels that form a lump under the skin

74
Q

What are the histological subtypes of haemangioma?

A

Capillary- smaller capillary vessels
Cavernous- large thin walled vessels

75
Q

What groups are haemangiomas most common in?

A

Children
Females

76
Q

What is a vascular malformation?

A

Congenital lesion due to abnormal blood vessel development

77
Q

What are vascular malformations associated with?

A

Larger arteries and veins
Stuge-weber syndrome

78
Q

When do vascular malformations present?

A

Birth
Different times of life

79
Q

What is the management of vascular malformations?

A

No treatment
Ultrasound
Cryotherapy
Cauterisation
MRI +/- Angiogram (large lesions)
May require extensive excision and free-flap reconstruction

80
Q

What is the histological presentation of tori and exostoses?

A

Thicker epithelium
Broad rete process

81
Q

What is linea alba?

A

Horizontal, asymptomatic white lesion along the occlusal

82
Q

What is the histological appearance of linea alba?

A

Parakeratosis
Prominent or reduced granular layer
Acanthuses

83
Q

What is fissured tongue?

A

Variation of normal anatomy
Occurs later in life
No treatment needed
Associated with geographic tongue

84
Q

What is the management of fissured tongue?

A

Encourage good oral hygiene
Consider lightly brushing tongue

85
Q

What is a bony exostosis?

A

Usually benign overgrowth of calcified bone
Associated with parafunction

86
Q

What % of the population have bony exostosis?

A

30-40%

87
Q

Where do bony exostosis present?

A

Palate: torus palatinus
Mandible: torus mandibularis (typically lingual)

88
Q

What is the management of bony exostosis?

A

Monitoring: photos, study models, x-rays

89
Q

What should be considered with patients with physiological pigmentation?

A

Addisons disease
Smokers melanosis
Drug-related pigmentation

90
Q

What are the systemic risk factors for oral candida infection?

A

Immunocompromised: medication, medical conditions
Deficiency states: anaemia
Extremes of age

91
Q

What are the local factor that influence oral immunity or ecology and are associated with increased oral candida infection risk?

A

Hyposalivation
Smoking
Broad-spectrum antimicrobials
Corticosteroids
Dental appliances
Irradiation involving the mouth or salivary glands

92
Q

What is candida infection also known as?

A

Thrush/Yeast/Fungal infection

93
Q

What is the management of oral candidiasis?

A

Antifungal therapy
Local measures
Investigations to exclude systemic disease

94
Q

What anti fungal therapy can be provided to patients with oral candida?

A

Fluconazole
Miconazole
Nystatin

95
Q

What local measures of management can be provided to patients with oral candida?

A

Rinse after inhalers
Use a spacer
Denture hygiene
Smoking cessation

96
Q

What is traumatic keratosis?

A

Increased keratin deposition at a site of trauma
Protective response

97
Q

What is the management of traumatic keratosis?

A

Encourage smoking cessation
Take photographs

98
Q

What are the six types of oral lichen planus and oral lichenoid reactions?

A

Reticular
Atrophic
Papular
Erosive
Plaque like
Bullous

99
Q

What is oral lichen planus?

A

CD8+ T Cell mediated destruction of basal keratinocytes
Chronic inflammatory condition

100
Q

How does oral lichen planus present?

A

Asymptomatic or burning/stinging sensation

101
Q

What is the difference between oral lichen planus and oral lichenoid tissue reactions?

A

Oral lichen planus is generalised and idiopathic
Oral lichenoid tissue reactions are localised and may be a response to medicines/allergens

102
Q

What is the malignant potential of oral lichenoid reactions?

A

1% over 10 years

103
Q

What should you ask a patient with oral lichen planus/oral lichenoid reactions about?

A

Systemic symptoms or recent cancer therapy

104
Q

What drugs can cause oral lichenoid reactions?

A

Antihypertensives
Antimalarials
NSAIDs
Allopurinol
Lithium

105
Q

What materials can cause oral lichenoid reactions?

A

Metals (gold, nickel)
Composite resin

106
Q

What is the management of oral lichen planus/ oral lichenoid reactions?

A
  1. Simple mouthwash (HSMW)
  2. Local anaesthetic (Benzydamine or lidocaine)
  3. Avoid trigger factors (spicy foods, fizzy drinks)
  4. Steroid mouthwash (Betamethasone MW, Beclometasone inhaler or hydrocortisone oromucosal tablets
  5. Change restorations (composite causative?)
  6. Onward referral- biopsy, inform of increased cancer risk, stop the cause
107
Q

What is hairy leukoplakia?

A

Non-removable white patch
Acanthotic and para-keratinised tissue
Finger-like projections of para keratin

108
Q

Where is hairy leukoplakia usually?

A

Lateral borders of tongue

109
Q

What are the risk factors for hairy leukoplakia?

A

Triggered by EBV
Immunocompromised

110
Q

What % of HIV patients have hairy leukoplakia?

A

20-25%

111
Q

What is leukoplakia?

A

Diagnosis of exclusion
No obvious cause for white patch
Has malignant potential
Can be dysplastic: group of abnormal cellular changes associated with malignancy

112
Q

What is a red patch with no clear cause associated with?

A

A high likelihood of being dysplastic or malignant

113
Q

What is granulomatosis with polyangitis also known as?

A

Wegner’s granulomatosis

114
Q

What is granulomatosis with polyangitis?

A

Systemic vasculitis
May present with fever and weight loss

115
Q

How is granulomatosis with polyangitis managed?

A

Immunosuppressants

116
Q

What % of patients with granulomatosis with polyangitis have ear, nose or throat manifestations?

A

92%

117
Q

What is erythroplakia?

A

Velvety, fiery, red patch
High malignant transformation

118
Q

How is erythroplakia diagnosed?

A

Diagnosis of exclusion

119
Q

What is the management of erythroplakia?

A

Urgent referral (high malignant transformation)
Consider urgent biopsy for histopathology

120
Q

What is OFG and Oral Crohn’s?

A

Non-necrotising granuloma formation

121
Q

What is the management of OFG and Oral Crohn’s?

A

Topical steroids
Avoidance diets
Intralesional steroid
Biologics for crohns disease
Infliximab, adalimumab (anti TNF), ustekinumab (Anti IL21/23), Vedolizumab (Anti-a4b7)

122
Q
A

Finals (20 decks)

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