Oral Medicine

Question 1

Define oral medicine:

Answer 1

Oral medicine: the speciality of dentistry concerned with the oral health care of patients with chronic recurrent and medically related disorders of the oral and maxillofacial region, and with their diagnosis and non-surgical management

• symptoms arising from the mouth that do not relate directly to teeth

Question 2

How do oral medicine and GPs work together?

Answer 2

GMP:

• normal anatomy e.g. circumvallate papillae, lingual tonsil
• diabetes/anaemia with oral manifestations
• haematinic deficiency e.g. Vit B12, foalte, iron deficiency –> recurrent oral ulceration

Question 3

Symptoms associated with Diabetes (undiagnosed):

Adverse reactions to which medication?

Answer 3

Diabetes:

• dry mouth
• thrush - acute pseudomembranous candidosis

Adverse reactions to medications:

• nicorandil induced oral ulceration

Question 4

What is trigeminal neuralgia?

What is burning mouth syndrome?

How is it treated?

Answer 4

Trigeminal neuralgia: sudden, usually unilateral, severe, stabbing, recurrent episodes of pain in the distribution of one or more branches of the trigeminal nerve

Burning mouth syndrome: idiopathic burning discomfort or pain affecting people with clinically normal oral mucosa in whom a medical or dental cause has been excluded

Treatment: amitriptyline, gabapentin, cognitive behaviour therapy

Question 5

List some dermatological conditions which can cause oral medicine specialists to consult with dermatologists?

Why may we need to liase with opthalmology?

Answer 5

Lichen planus - oral mucosa, scalp, skin, nails, genitals

Increased risk of oral cancer, often require a biopsy for diagnosis

Mucous membrane pemphigoid - blisters form beneath epithlium on oral mucosa, conjunctiva, nasal mucosa, burst and cause scarring, can lead to loss of sight

Question 6

Why do oral physicians need to work closely with rheumatologists?

Gastroenterologists?

Answer 6

Sjogrens syndrome: dry mouth and/or dry eyes

• primary/secondary
• secondary - accompanying connective tissue disorder

GI Disease: recurrent oral ulceration

Crohns disease - direct involvement of the oral mucosa, blood loss (anaemia), malabsorption (haematinic deficiencies to anaemia)

Coeliac disease - malabsorption with or w/out anaemia –> recurrent oral ulceration

Question 7

What infectious diseases can have oral manifestations?

Answer 7

HIV/AIDS

• hairy leukoplakia
• kaposi’s sarcoma cancer caused by herpes human virus 8
• candidosis (suppressed immune system)