Oral Medicine in Elderly Flashcards
What are the predominantly oral conditions in the elderly
lichen planes mucous membrane pemphigoid herpes zoster post herpetic neuralgia carcinoma potentially malignant lesions sore tongue candidosis
What are the predominantly cardiovascular conditions in the elderly
hypertension and ischemic heart disease
cardiac heart failure
temporal arteritis
What are the predominantly respiratory conditions in the elderly
chronic bronchitis and emphysema
pneumonia
What are the musculoskeletal conditions in the elderly
osteoarthritis
osteoporosis
paget’s disease
What are the hematological conditions in the elderly
anaemia
chronic leukaemia
multiple myeloma
What are the genito-urinary conditions in the elderly
urinary retention
urinary incontinence
prostatic hypertrophy and cancer
renal failure
What are the neurological conditions in the elderly
poor vision multi-infarct dementia parkinsons disease storkes ataxia trigeminal neuralgia alzheimers disease
What are the psychological conditions in the elderly
insomnia dependence on hypnotics loneliness depression paranoia acute confusional states atypical facial pain
What are other conditions seen in the elderly
nutritional deficiency
accidents
malignancies
What is a hemangioma
collection of BV
looks like a red bump
What is a fibroepithelial polyp
there is a bit of trauma and instead of healing properly there is a build up of tissue
can be sessile or on a stalk
What is black hairy tongue
overgrowth of the surface of the tongue
commoner in those who smoked
What is geographic tongue
looks like a map
10% find it sensitive
What is atrophic glossitis
smooth and shiny tongue
uncomfortable
commonest cause if low iron or B12
What are denture related problems
traumatic keratosis
frictional keratosis
What is traumatic keratosis
trauma lines that run through white patch
need to take away the pressure
What is frictional keratosis
trauma
keratinization around it to protect it
What is speckled leukplakia
rare type of leukaplakia
can be unilateral or bilateral
more common in pipe smokers
premalignant lesion so must be followed up
linked to candidiasis
What is sublingual keratosis
seen under tongue
What is denture induced hyperplasia
results in flaps of tissue to protect itself
may see ulcers
What’s denture stomatitis
often people don’t know they have it because its painless
there is an area of erythema that corresponds to the denture fitting surface is the candida hyphe burrow onto the surface of the mucosa and into the plastic of the denture
What is angular cheilitis
often a staph element to it
check dentures to ensure no issue
take bloods for iron levels
for some elderly face sags and can get moisture into the skin folds creating irritation
What is xerostomia often due to in the elderly
polypharmacy most common
radiotherapy
What is a good test of xerostomia
use front of mouth mirror
does it stick to tongue?
if sticks then saliva quality is bad
What is management of xerostomia
change medication
salivary replacement
salivary stimulants
What are possible salivary replacements
saliva orthana
glandosane
biotene oral balance
bioXtra
What are possible salivary stimulants
chewing gum
glycerine and lemon
What drugs can cause topical drug reactions
aspirin and iron can cause burns
What drugs can cause lichen planus / lichenoid reactions
NSAIDs Beta blockers diuretics oral hypoglycaemics statins antimalarials sulphonamides
What do bisphosphonates do
incorporated into skeleton
inhibit bone turnover
no repair of microdamage
anti-angiogenic
What are the non malignant use of bisphosphonates
osteoporosis paget's disease osteogenesis imperfecta fibrous dysplasia primary hyperparathyroidism osteopenia
What are the malignant uses of bisphosphonates
multiple myeloma breast cancer prostate cancer bony metastatic lesions hypercalcemia of malignancy
What are risk factors for MRONJ
extremes of age concurrent use of corticosteroids systemic conditions affecting bone turnover malignancy coagulopathies, chemotherapy radiotherapy duration of therapy previous diagnosis of MRONJ potency of drug invasive dental procedures denture trauma poor oral hygiene periodontal disease alcohol or tobacco use thin mucosa coverage
How do we treat patients at risk fo MRONJ
advise patient of risk
informed consent
emphasize rarity of conditions
don’t discourage from meds
What are patient advice for those at risk fo MRONJ
regular dental checks
maintain good OH
limit alcohol and stop smoking
report any symptoms
What is post herpetic neuralgia
previous episode of shingles
constant burning sensation in dermatomal distribution
resolves within 2 months
may persist for 2 years or longer
suicide risk
incidence possibly reduced by antiviral therapyy and steroids
What is tx for post herpetic neuralgia
antidepressants gabapentin carbamazepine topical capsaicin TENS
What is medical management of trigeminal neuralgia
carbamazepine oxcarbazepine gabapentin pregabalin lamotrigine sodium valproate phenytoin
What can surgical management for trigeminal neuralgia split into
peripheral procedures
ganglion procedures
What are the peripheral procedures for trigeminal neuralgia
cryotherapy
injection of alcohol or glycerol
neurectomy
avulsion of nerve
What are the ganglion procedures for trigeminal neuralgia
balloon compression radio frequency thermocoagulation alcohol or glycerol injection microvascular decompression gamma knife radiosrgery
What other conditions should you consider for trigeminal neuralgia esp if in younger people
MS
space occupying lesion
What is burning mouth syndrome
more common in females
very often underlying degree of depression and anxiety
What are causes of burning mouth syndrome
most common is no cause psychogenic drugs (ACE or protease inhibitors) dry mouth candidosis hematinic deficiencies diabetes parafunctional acitivty denture factors hypothyroidism allergy
What are the issues with burning mouth syndrome
may lead to malnutrition
slow rehabilitation
slow recovery
reduce QoL
