Oral Medicine Flashcards
Patient presents with dental pain without detected pathology which follows a distinct pattern - diagnose and what may you do?
Atypical odontalgia
- referral from primary care to OM Specialist
- aim to reduce chronic pain and reduce outbursts of pain
- high intensity short duration opioid analgesic
- tooth extraction if necessary
Alcohol and oral cancer
- give alcohol and oral cancer risk advice
- give alcohol cessation advice
Oral cancer foundation
- found that alcohol abuse is the 2nd largest risk factor for development of oral cancer
- found that alcohol increases cell permeability allowing further carcinogens such as cigarette smoke to take effect
- nutritional deficiency from drinking also a risk factor
Alcohol and your health
- increased risk of many cancers
- causes increased tooth decay and tooth wear due to acidity
Limits of alcohol
- 14 units per week is the maximum recommended limit, spread over at least 3 days
- at least 2 alcohol free days per week
Intervention
- ask how much they drink
- advise that they are over the limit, and of the heath risks associated with this
- assess their willingness to quit
- appropriate referral / document referral
Patient presents with this, what is advice and management? Diagnosis?
Diagnosis - chronic hyperplastic candidiasis - fungal infection
- often found on inside of cheek or on the tongue
Inform
- potentially malignant, requires referral to OM for biopsy
Risk factors
- steroid inhaler use - rinse after or use spacer
- poor OH
- uncontrolled diabetes
- nutritional deficiency
- immunosuppression
Management
- referral for biopsy and investigations
- OHI
- systemic antifungal - fluconazole 50mg, 7 days, 1 a day
Patient presents with lichen planus - explain what it is and treatment options
Oral lichen planus (OLP) is a chronic inflammatory condition that affects the mucous membranes inside the mouth.
- It is considered an autoimmune disorder where the immune system mistakenly attacks the lining of the mouth
- The cause is not fully understood, but it is believed that genetic, immune, and environmental factors may contribute to the condition.
- sometimes there cna be reactions to silver fillings or certain medications - when this is the case it is called an oral lichenoid lesion
Management
- LP can be pre-malignant, so it is important we monitor this along with your symptoms
- start by avoiding SLS containing toothpaste
- symptoms can be managed by difflam spray
- more persisting lesions may require steroid treatment from the oral medicine department
- i will refer you to OM for some diagnostic testing and likely a biopsy
- any questions?
27-year old patient presents with ulcers. The patient’s ulcers are no more than 10mm in size. Using this information and the available lab results (Patient has low iron and folate).
Discuss the lab findings, the diagnosis and management options for this condition with the patient. You do not need to gain any more information from the patient.
Diagnosis - recurrent aphthous stomatitis - minor ulcers
- you previously were in complaining of the ulcers
- would you like me to go through your lab work?
- follwoing tests, you are low in iron and folate, these can typically result in ulcers forming in the mouth
- reassure nothing sinister
Anaemia
- reduction in iron resulting in fewer number of red blood cells
- multiple aetiology such as low iron in diet or stomach ulcers resulting in loss of blood / poor absorption
Management
- increase in iron in diet and take iron supplements
- gp can provide these and monitor your iron
Diet advice
- meat and fish - iron rich
- dark leafy greens - iron rich
- Vit C - help absorb iron
Summary
- reassure pt this is common
- ulcers should go away within 2 weeks
- we know cause and can manage them
- any questions?
Pt diabetic and taking Warfarin - Give findings and explain Tx (6 mins).
A patient has a sore denture and sore palate, test done previously to confirm condition and you have received the results.
Medical history includes diabetes type 2 and on warfarin for atrial fibrillation. Explain findings to the patient, recognise the multifactorial condition and provide oral hygiene advice.
Diagnosis - denture stomatitis
Inform what it is
- fungal infection of the palate - multifactorial
Risk factors
- leaving denture in at night
- poor oral hygiene or denture hygiene
- steroid inhaler
- immunocompromised
Advice
- brush your palate
- brush and clean your denture after meals with non abrasive denture cleaner and soft brush
- take denture out at night, and clean your denture with denture cleaner, and store in water overnight
- if using steroid inhaler, rinse afterwards or use a spacer device
- limit smoking
Antimicrobial prescription
- pt on warfarin so avoid azole
- use nystatin oral suspension or CHX
Take a history of a patient suffering from dry mouth
What are the usual presentations
- what management options can i provide?
History
- how long had dry mouth
- how is it affecting them and in what way?
- what medications are they on? - amitriptyline???
Usual features / symptoms
- swallowing difficulty, speech issues, discomfort, altered taste, cervical caries, bad breathe
Management
- small frequent sips of water
- chew on sugar free chewing gum
- write to gp to change medication regime
- stop smoking / alcohol
- manage cervical caries with high fluoride toothpaste and fluoride varnish
Prescription
- biotene saliva replacement
- salivix pastilles
- saliva gel
- all on SDCEP
Biopsy results = dysplasia - give results and advice
Inform patient that from biopsy indicates that there is potential for the tissue to be cancerous, but it is not cancerous YET
- ensure they understand the risk of it becoming cancerous
- cancer risk can be reduced by lowering risk factors for cancer
- provide alcohol and smoking cessation advice
- provide oral hygiene instruction
