Oral Medicine in Primary Dental Care Flashcards
what is needed for diagnosis of most forms of oral mucosal disease - in particular the detection of oral cancer
histopathological examination of biopsy tissue
what should be noted from an extra-oral examination
mobility
facial asymmetry
appearance of skin
lips
palpate soft tissues of neck
what lymph nodes do we palpate in extra oral examination
submental
submandibular
supraclavicular
what is the technique used to palpate the salivary glands
bimanual technique
what types of lesions can be biopsied in primary dental care
simple benign localised lesion
what is involved in an incisional biopsy
taking an allipse of tissue from affected site
what should the size of a biopsy be for mucosal investigations
three times as long as it is wide
how is a biopsy stored after taking from patient’s mouth
supported on filter paper before being placed in pre-labelled specimen pot containing 10% neutral buffered formalin
why is neutral buffered formalin used with biopsies
to minimise impact of shrinking and distortion during fixation
what is a punch biopsy
removes cylindrical specimen of tissue between 0.4 and 0.8mm in diameter
what is one advantage and one disadvantage of punch biopsy
adv - simple and quick
disadv - potential to not obtain sufficient material when assessing epithelium for dysplasia
what is labial gland biopsy
involves collection of at least five lobules of minor glands from the lower lip
where should samples be taken from in a labial gland biopsy
an area of clinically normal ucosa
what are the requirements when transporting a biopsy
use of padded containers to absorb any fluid in the event of leakage
label to indicate presence of pathological specimen
what is a smear sample
scraping soft tissue with a firm instrument and then spreading the material onto a glass microscope slide
what is a swab sample
used to investigate presence of a range of bacteria, fungi and viruses in the laboratory
what is an oral rinse sample
includes 10ml phosphate buffered saline that is held in the mouth for 1 minute prior to recollection
what is a needle aspiration sample
used for taking pus samples
what are the veins of choice for venepuncture
the ones in the antecubital fossa (basilic, cephalic)
what antibody tests should be performed when a patient presents with xerostomia and if Sjogren’s syndrome is suspected
Anti-La and Anti-Ro
Anti-nuclear antibody
what antibody tests should be performed on a patient suspected of low VitB12 or folate levels
intrinsic factor (pernicious anaemia)
anti-tissue transglutamase (anti-tTG for coeiac)
what adjunctive tests are used for cancer detection
toludine blue
chemiluminescent visualisation
brush biopsy for cytopathology
what disorders are most commonly diagnosed through immunofluorescence
pemphigoid and pemphigus
what is sialography
investigation of major salivary glands- involves radiography with infusion of radiopaque dye that is iodine based into the gland via the duct
what is traumatic ulceration
presents as single ulcer which the patient can ususally attribute to previous incident
how are traumatic ulcers treated
removal of any causaive factors
prescription of antiseptic mouthwash (chlorhexidine 0.2%)
when is recurrent aphthous stomatitis most seen
childhood and early adulthood
what are the three subtypes of RAS
minor
major
herpetiform
how does minor RAS present
small ovoid or circular lesions affecting NON keratinised sites in the anterior part of oral cavity which heal without scarring
how does major RAS present
larger ulcers that affect posterior part of the mouth and also involve keratinised sites and may leave residual scarring once healed
what disease is major RAS linked to
HIV infection
how does herpetiform RAS present
multiple small round ulcers which are so numerous they coalesce to form larger areas of irregular ulceration with no associated scarring
what should be investigated if a patient presents with RAS
haematological assessment for deficiency
what can induce RAS in susceptible individuals
penetrating injuries or trauma associated with oral cavity
what food preservatives are linked to RAS
benzoic acid
E211-E219
how is RAS treated
removal of causative factor
if no causative factor - treat symptoms
what disease are episodes of RAS recognised as a central component of
Behcets disease
what is necrotising gingivitis
rapid development of painful ulceration affecting gingival margins and inter-dental papillae with marked halitosis
what type of bacteria is associated with NG
anaerobic - in particular the fusobacterium species
name three precipitating factors to NG
tobacco smoking, stress and immune deficiency
how is NG managed
initial - mechanical cleaning and debridement
antimicrobial - metronidazole (400mg TID for three days)
what is required of an oral ulcer that fails to respond to initial treatment within 2-3 weeks
biopsy to exclude the presence of malignancy
what type of infection can cause oral ulceration
herpes simplex virus type 1
how does primary infection of HSV1 present
widespread oral ulceration
how does secondary infection of HSV1 present
reactivation of latent virus presents as localised crop of small ulcers
how does erythema multiforme present
rapid onset of extensive oral ulceration with blood crusted lips
how are symptoms treated in RAS in first line
chlorhexidine 0.2% mouthwash or spray TID
benzydamine 0.15% mouthwash or spray TID
if no improvement has occurred after first line symptomatic treatment of RAS what should be done next
beclometasone MDI - 2 x 50 microgram puffs onto ulcers twice a day
what should be done if there is no response to topical antiseptics or betametasone MDI in RAS
refer to specialist and arrange haematological investigation
what is angular cheilitis
inflammatory changes causing erythema and soreness/ ulceration occurring at the angle of the mouth
what should be a differential diagnosis of angular cheilitis
recurrent herpes labialis and lichen planus
what haematological investigations are taken for angular cheilitis
FBC
haematinics
what species are thought to be present in angular cheilitis
candida (galbrata)
staphylococcus
what is chronic erythematous candidosis
associated with wearing intra-oral appliance which presents as erythema in palatal mucosa
what anti-fungal treatment should not be given to a patient taking warfarin or statins
miconazole
what is acute erythematous candidosis associated with
patients who use a steroid inhaler
what is geographic tongue
areas of erythema surrounded by white margins on dorsum of the tongue
what may patients with geographic tongue complain of
discomfort on eating spicy foods or hot foods
what is erythroplakia
a red patch that cannot be characterised clinically or pathologically as any other definable lesion
what is white sponge naevus
developmental condition clinically affecting buccal sulcus and labial mucosa with areas of white plaque like deposits - benign so doesn’t require treatment
what is leukoedema
white patch which only affects older adults who smoke
what causes leukoedema
excess hydration of the surface keratin on buccal mucosa
how do you test for leukoedema
pull the cheek laterally and the lesions will appear
what are fordyce spots
ectopic sebaceous glands that can present on buccal mucosa and lips
what is traumatic keratosis
traumatic injury of oral mucosa due to chemical or thermal irritation that produces a white patch
what area of the oral mucosa is most affected in smoking habits
the palate producing a white appearance of the mucosa - smoker’s keratosis
what is pseudomembranous candidosis
pseudomembranes of desquemated epithelial cells, fungal hyphae and fibrin in which you can remove the white membrane to discover area of erythema underneath
what is the most frequently seen local predisposing factor for pseudomembranous candidosis
inhaled steroids
what is chronic hyperplastic candidosis
occurs bilaterally in the commissure regions
speckled lesions
what is prescribed when fungal hyphae are found in chronic hyperplastic candidosis
antifungal - fluconazole
what are the five subtypes of lichen planus
reticular
erosive
plaque like
atrophic
bullous
what is lichen planus
white patches that affect buccal mucosa, lips, tongue and attached gingivae giving symmetrical and bilateral pattern
what is a lichenoid reaction
white patch almost indistinguishable from lichen planus expect occurs unilaterally and is asymmetrical and often involves palate
what drugs are associated with lichen planus
ACE inhibitors
NSAIDs
beta blockers
what are the two forms lupus erythematous (LE) occurs as
discoid
systemic
what will patients with SLE have high titres of
circulating anti-nuclear factor
where do lesions from discoid lupus erythematous present
any area of the skin
ear
areas exposed to sunlight
oral lesions consist of white patches similar to lichen planus
how are oral lesions in discoid lupus erythematous treated
topical steroid
how should you class a white term lesion of no known cause
leukoplakia like plaque lesion
what investigations are done for leukoplakia
biopsy for histopathological investigation
punch biopsies not acceptable
what is hairy leukoplakia
occurs bilaterally on lateral margins of the tongue
associated with EBV
managed by sucking peach stones or tongue scraping
how does submucous fibrosis present
irregular flat white patches with fibrous bands that can be palpated like harp strings
what is fibrous submucous fibrosis associated with
chewing betel
name four topical steroid preparations for management of lichen planus
beclomethasone MDI (0.5 micrograms per puff, 2 x puffs twice daily)
clobetasol 0.05% ointment applied twice daily
prednisolone soluble 5mg tablet dissolved in 10ml water as mouthwash rinse 2 mins TID
betamethasone 0.5mg tablet x2 in 10ml water rinse for 2 mins TID
what should be considered when prescribing topical steroids to treat disease
antifungal treatment to eradicate secondary candidosis
fluconazole 50mg daily for 7 days
