Oral Medicine Flashcards

1
Q

Patient presents with dental pain without detected pathology which follows a distinct pattern - diagnose and what may you do?

A

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

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2
Q

Alcohol and oral cancer
- give alcohol and oral cancer risk advice
- give alcohol cessation advice

A

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

The lancet publication 2018
- describing alcohol use and its relation to 4 types of oral cancer, and even 1 drink per day raises relative risk of developing these
- alcohol damages cells repairing themselves resulting in DNA changes which may result in oral cancer

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
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3
Q

Patient presents with this, what is advice and management? Diagnosis?

A

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

The lancet publication 2018
- describing alcohol use and its relation to 4 types of oral cancer, and even 1 drink per day raises relative risk of developing these
- alcohol damages cells repairing themselves resulting in DNA changes which may result in oral cancer

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
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4
Q

Patient presents with lichen planus - explain what it is and treatment options

A

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?
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5
Q

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.

A

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?

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6
Q

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.

A

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

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7
Q

Take a history of a patient suffering from dry mouth

What are the usual presentations

  • what management options can i provide?
A

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

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8
Q

Biopsy results = dysplasia - give results and advice

A

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
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9
Q

Facial palsy after IDB, how manage

A

Causes
- injection in parotid sheath, prolonged anaesthesia of facial nerve

How to test
- test branches of facial nerve

Symptoms
- generalised weakness ipsilateral face drooping mout, unable to blink

Inform patient what has occurred, reassure them
- cover eye with eyepatch until blink reflex returns

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10
Q

OFG (6 mins). History of patient given - swollen lips all his life. Chat through history, ask and ascertain local and systemic signs. Chat about how you would manage it going forward.Asked patient about any bowel problems he said yes, informed of potential Crohn’s.
● OF

A

OFG = orofacial granulomatosis
- blockage of lymphatic drainage causing swelling of the face

Autoimmune disease
- type 4 hypersensitive to additives in food
- benzoates, chocolate, SLS

Symptoms
- swelling lips, cobblestone mucosa, angular chelitis, ulceration

History
- weight loss / bowel issues?

Diagnosis
- refer for patch testing

Management
- dietary avoidance, steroids, azathioprine

Patient mentions yes to bowel problems
- possible crohns - inflammatory disease of GI tract
- refer to GP

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11
Q

Pt with suspected cancer in high risk site, Name the different H+N lymph nodes you would feel in an E/O exam, history I may take and how to inform them.

A

Pre-auricular
Posterior auricular
Parotid
Submental
Submandibular
Deep cervical - by sternocleidomastoid

History
- how long lesion been there
- is it symptomatic
- hoarse voice, limited mouth opening, tooth mobility /occlusal derangement
- smoker, alcohol

Urgent 2 week cancer referral for
- biopsy

Explain to pt that
- they will give la, take small sample of tissue from the lesion, or take it all.

Risk factor management
- smoking cessation and alcohol consumption advice

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12
Q

What are the urgent cancer referral guidelines?

A

Persistent unexplained head and neck bumps for >3 weeks

Ulceration or oral mucosa lesion unexplained for >3 weeks

Persistent hoarseness for >3 weeks

Dysphagia for >3 weeks

Persistent throat pain >3 weeks

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