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SAQs for dentistry > Oral Medicine > Flashcards

Oral Medicine Flashcards

1
Q

A 50 year old patient presents with a brown lesion on the palatal mucosa. What characteristics would make you think it was a malignant melanoma?

A

Position- most common on the palate
Colour- usually dark brown or black
Age- commonest between 40-60 years
Often asymptomatic
The lesions are often firm and rubbery to touch. They are macular or nodular and may ulcerate
They may cause an enlarged node, may bleed or become sore- although these are often late presentations

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2
Q

Apart from a malignant melanoma what else could the lesion be if it is a single brown lesion in the palate? (4)

A
  • amalgam tattoo
  • racial pigmentation
  • idiopathic melanotic macule
  • melanotic naevus
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3
Q

If the patient had presented with multiple small brown lesions in the mucosa what could have been the cause? (4)

A
  • oral melanotic naevi
  • peutz jeghers syndrome
  • oral melanotic macule associated with human immunodeficiency virus infection
  • addisons disease
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4
Q

What are the common causes of a dry mouth?

A

Developmental- aplasia
Salivary gland disease- sjogrens syndrome
Psychogenic- burning mouth syndrome, anxiety and depression
Dehydration- diarrhoea
Alcohol
Mouth breathing
Iatrogenic drugs- diuretics

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5
Q

What are the dental concerns for a patient with dry mouth? (3)

A
  • development of new carious lesions. Try to discourage these patients from using sugar containing chewing gum or acidic sweets to help encourage saliva production
  • consider fluoride mouthwash
  • candidal infection may be present and require treatment
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6
Q

List 4 possible etiological factors for recurrent aphthae

A
  • genetic predisposition
  • immunological abnormalities
  • haematological deficiencies
  • stress
  • hormonal changes
  • gastrointestinal disorders
  • infections
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7
Q

What types of recurrent apthae are there? How do you differentiate between the different types?

A

Minor apthea may occur singly or in crops and they affect the non keratinised and mobile mucosa. They are usually less than 4mm diameter
Major apthae usually occur as single ulcers, which may be greater than 1cm in diameter. the masticatory mucosa and dorsum of the tongue are usually affected
Herpetiform aphthae usually occur in crops of ulcers which are 1-2mm in diameter although they may coalesce to form larger ulcers. They occur on non keratinised mucosa

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8
Q

How may recurrent aphthae be treated? (5)

A
  • treat underlying systemic disease
  • benztdamine mouthwash
  • corticosteroids
  • tetracycline mouthwashes
  • chlorohexidine mouthwash
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9
Q

List three predisposing factors for angular cheilitis

A
  • wearing dentures and having denture related stomatitis
  • nutritional deficiencies e.g. iron deficiencies
  • immunocompromised
  • decreased vertical dimension resulting in inflolding of tissues at the corner of the mouth allowing the skin to become macerated
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10
Q

Which organisms commonly cause angular cheilitis?

A

Staphylococcus aureus and candida albicans

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11
Q

What medicaments could be used to treat angular cheilitis?

A

Fusidic acid cream and miconazole gel

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12
Q

Acute pseudomembranous candidiasis or thrush is presentation of candidal infection in the mouth. List 4 other ways in which candidal infections may present to a dentist

A
  • acute atrophic candidiasis
  • chronic atrophic candidiasis
  • chronic erythematous candidiasis
  • chronic hyperplastic candidiasis
  • chronic mucocutaneous candidiasis
  • angular stomatitis
  • median rhomboid glossitis
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13
Q

What does acute pseudomembranous candidiasis look like in the mouth?

A

Whitish yellow plaques or flecks cover the mucosa, but they can be wiped off leaving erythematous mucosa underneath

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14
Q

Smears are often taken from acute pseudomembranous candidiasis. How are these smears treated and what do they show?

A

Smears are gram stained and show a tangled mass of gram positive fungal hyphae as well as leukocytes and epithelial cells

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15
Q

Name two azalea type drugs and two other drugs which are not azoles that are used to treat candidal infections

A

Azores- ketoconazole, miconazole, fluconazole, itraconazole

Others- nystatin, amphotericin

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16
Q

Name common white patches and what causes them

A

Frictional keratosis- friction
Leukoedema- a variation of normal
Candidal infection- candida albicans infection
Cheek biting- trauma from cheek biting
Fordyce spots/granules- developmental (sebaceous glands in the mucosa)
Lichen planus- unknown
Lichenoid reactions- gold/antimalarials/dental amalgam
Skin grafts- previous free flap to transfer tissue to cover an intramural defect

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17
Q

What are the three types of leukoplakia?

A
  • homogenous leukoplakia,
  • nodular leukoplakia,
  • speckled leukoplakia
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18
Q

What types of biopsies would be appropriate for leukoplakia?

A

Incisional and brush biopsies

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19
Q

What are the treatment options for leukoplakia?

A
  • removal of causative agent
  • surgical removal
  • photodynamic therapy
  • retinoids
  • specialist referral
  • regular review and biopsy as appropriate
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20
Q

Sjogrens syndrome is a well known cause of dry mouth, name 4 other causes of dry mouth

A
  • radiotherapy in the region of salivary glands
  • diabetes
  • dehydration
  • mumps
  • HIV infection
  • anxiety states
  • diuretics
  • sarcoidosis
  • amyloidosis
  • drugs
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21
Q

What type of biopsy is often carried out to diagnose sjogrens syndrome and why?

A

Labial salivary gland biopsy. This is because the minor glands are usually involved at microscopic level even though they may not be enlarged

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22
Q

What microscopic features would the biopsy show if the patient had sjogrens syndrome?

A

Focal collections of lymphoid cells are seen adjacent to blood vessels and the greater the number of foci the worse the disease. There is also acinar atrophy

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23
Q

What other investigations could be carried out to diagnose sjogrens syndrome?

A

Blood tests- antinuclear antibodies, SSA, SSB, rheumatoid factor, erythrocyte sedimentation rate, parotid salivary flow rate, schemers test, sialography

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24
Q

What are the oral signs of acute leukaemia?

A

Gingival hypertrophy and bleeding

25
Q

What are the oral signs of AIDS?

A

Kaposis sarcoma

26
Q

What are the oral signs of rheumatoid arthritis?

A

Recently developed anterior open bite

27
Q

What are the oral signs of a HIV carrier?

A

Hairy leukoplakia

28
Q

What are the oral signs of peutz jeghers syndrome?

A

Perioral pigmentation

29
Q

What are the oral signs of goblin goltz syndrome?

A

Multiple odontogenic keratocystic tumours

30
Q

What are the oral signs of crohns disease?

A

Cobblestoned buccal mucosa

31
Q

What are the oral signs of measles?

A

Kopliks spots

32
Q

What are the oral signs of syphilus?

A

Moon molars

33
Q

What are the oral signs of cleidocranial dystosis?

A

Multiple supernumerary teeth

34
Q

What are the oral signs of lichen planus?

A

Wickhams striae

35
Q

What is often seen histologically in erythroplakia?

A

The lesions often show dysplasia or even carcinoma in situ or frank carcinoma histologically

36
Q

What has more malignant potential erythroplakia or leukoplakia?

A

Erythroplakia

37
Q

What colour are kaposis sarcoma lesions and are they localised or generalised?

A

Reddish purple (localised)

38
Q

What colour are haemangiomas lesions and are they localised or generalised?

A

red/purple (localised to area of haemangioma)

39
Q

What colour are amalgam tattoo and are they localised or generalised

A

Blue/black (localised)

40
Q

What colour is addisons disease and are they localised or generalised?

A

Brown patches (localised to certain areas e.g occlusal line)

41
Q

What colour is irradiation mucositis?

A

Red (generalised in region of irradiation)

42
Q

A 45 year old patient presents with a lump in the palate. Give 4 possible diagnosis

A
  • torus palatines
  • unerupted tooth
  • dental abscess
  • papilloma
  • neoplasm
43
Q

What features would make you think that a patient had atypical/idiopathic facial pain? (4)

A
  • pain unrelated to the anatomical divisions of nerves and often crossing the midline
  • no organic cause can be found
  • investigations do not show anything abnormal
  • long standing and continuous, often with no exacerbating or relieving factors
  • conventional analgesics provide no relief
  • often described as unbearable
44
Q

A 30 year old man presents with weakness on the left side of his face. Name two possible intracranial and two possible extra cranial causes

A

Extra cranial:

  • bells palsy
  • malignant parotid neoplastic
  • post parotidectomy
  • sarcoidosis
  • incorrect administration of local anaesthetic
  • melkersson-rosenthal syndrome

Intracranial:

  • cerebrovascular accident
  • intracranial tumour
  • multiple sclerosis
  • HIV
  • lyme disease
  • ramsay hunt syndrome
  • trauma to base of skull
45
Q

How will you tell whether a nerve lesion causing a facial weakness had an upper motor neuron cause or a lower motor neurone cause?

A

In a lower motor neuron lesion, the patient cannot wrinkle their forehead on the affected side, but in an upper motor neuron lesion they retain movement of their forehead. Hence to determine which one it is, you need to ask the patient to raise the eyebrows and wrinkle the forehead

46
Q

What is ramsay hunt syndrome?

A

Herpes zoster infection of the geniculate ganglion which produces a facial palsy. There will also be vesicles in the region of the external auditory meatus and the palate due to the viral infection

47
Q

Give the following information regarding herpes zoster:

a) cause
b) who affects
c) symptoms
d) treatment

A

a) Herpes zoster is caused by the varicella zoster virus which lies latent in the dorsal root ganglia.
b) It tends to affect middle aged or older patients
c) the main complaint is pain or tenderness in dermatomes. The lesions are in the form of rash, vesicles or ulcerations
d) the treatment is systemic acyclovir at a dose of 200-800mg five times a day for 7 days. medication for pain relief is also prescribed and systemic corticosteroids may also help with the pain and speed healing

48
Q

What is post herpetic neuralgia?

A

Pain developing during the acute phase of herpes zoster and persisting for more than 6 months

49
Q

Give 4 causes of localised gingival swelling

A
  • periodontal abscess
  • fibrous epulis
  • denture induced granuloma
  • pregnancy epulis
  • papilloma
  • giant cell lesion
  • tumour
50
Q

What are the signs and symptoms of primary herpetic gingivostomatitis?

A

Patients have multiple vesicles in their mouth, which burst to leave painful ulcers. There is often gingivitis. Patients feel generally unwell with fever and malaise. There is cervical lymphadenopathy

51
Q

Primary herpetic stomatitis may be followed by recurrent herpes labialise. How does this happen?

A

The virus remains dormant in the trigeminal ganglion and can be reactivated by factors such as sunlight, stress, menstruation, immunosuppression, common cold or fever

52
Q

Describe the lesions of herpes labialise and how you would manage them

A

Lesions appear at the mucocutaneous junction of the lips. The patient often has a prodromal itching/prickling sensation prior to the appearance of the lesion, which starts off as a papule and then forms vesicles that burst leaving a scab. They usually heal without scarring after 7-10 days. The lesions will heal without treatment but if given early, i.e. in the prodromal phase, antiviral cream such as penciclovir or acyclovir may prevent lesions from curing or at least speed the healing

53
Q

In patients with trigeminal neuralgia what should you consider requesting?

A

In patients with trigeminal neuralgia, consider requesting MRI of the brain, especially in young patients, because this may be the presenting feature of multiple sclerosis

54
Q

Lichen planus may have other presentations in the mouth- name 4?

A
  • reticular
  • atrophic
  • desquamative gingivitis
  • erosive
  • papular
  • plaque like
55
Q

What extra oral sites could a patient get lichen planus?

A
  • flexor surfaces of wrists
  • genitals
  • nails
  • head
56
Q

What drugs cause lichen planus?

A
  • B blockers
  • oral hypoglycaemic
  • NSAIDs
  • gold
  • penicillamine
  • some tricyclic antidepressants
  • antimalarials
  • allopurinol
57
Q

What is coeliac disease and what are the signs?

A

Coeliac disease is due to sensitivity to gluten. Patients may suffer from malabsorption of vitamin B12, folate and iron and may have the following oral signs: oral ulceration, angular cheilitis and glossitis

58
Q

What is crohns disease and what are the signs?

A

Crohns disease is a chronic granulomatous disease that may affect any part of the gastrointestinal tract, but most commonly affects the ileum. Oral signs may be seen such as mucosal tags, cobblestone mucosa, lip swelling and oral ulceration

SAQs for dentistry (4 decks)

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