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Oral Medicine BDS4 > Oral Medicine in Primary Dental Care > Flashcards

Oral Medicine in Primary Dental Care Flashcards

1
Q

what conditions is taking an oral rinse helpful for

A

suspected cases of altered taste ,dry mouth, burning mouth syndrome

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2
Q

what are the routine haematological investigations

A

full blood count
vitamin B 12
ferritin
folate
HbA1c

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3
Q

what do the presence of antibodies anti-ro and anti-la suggest

A

sjogrens

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4
Q

what does the presence of antibody ANA suggest

A

systemic lupus erythematous

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5
Q

what does the presence of RF antibody suggest

A

rheumatoid arthritis

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6
Q

what questions should we ask about ulcer history

A

is it painful
how many
how long
which sites in mouth
suffered from similar ulcers?
started any new drugs?

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7
Q

if a patient gives a history of previous ulceration what further questions need to be asked

A

at which sites
how long to heal
how many at one time
does it happen at other body sites
aware of predisposing factors
do you have any allergies

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8
Q

what is the treatment of a traumatic ulcer

A

remove any persistent traumatic factor
chlorhexidine 0.2%

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9
Q

what does minor RAS present as

A

small ovoid or circular lesions affecting non-keratinised sites in anterior oral cavity

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10
Q

what does major RAS present as

A

<1cm in diameter affecting posterior part of mouth and involve keratinised mucosa

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11
Q

what does herpetiform RAS present as

A

multiple small round ulcers which can coalesce to form larger areas of irregular ulceration

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12
Q

how do you manage RAS in primary dental care

A

history
chlorhexidine 0.2% or benzydamine 0.15% 3x daily
diet advice
avoid SLS
review after 4 weeks

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13
Q

if after 4 weeks there is no improvement of RAS what do you do

A

doxycycline 100mg broken into 10ml water used as mouthwash for 2mins 3x daily
beclometasone MDI 2x daily

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14
Q

if after 8 weeks from initial appointment there is no improvement of RAS what do you do

A

arrange haematological investigations with GMP
consider referral

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15
Q

what bacteria is involved in necrotising gingivitis

A

anaerobic bacteria
fusobacterium species

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16
Q

what is the management of necrotising gingivitis

A

debridement
metronidazole 400mg 3x daily for 3 days

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17
Q

when does an ulcer require biopsy

A

if it fails to respond to initial treatment within 2-3 weeks

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18
Q

if there are lots of small ulcers on a keratinised part of mucosa on the posterior part of the mouth what disease could this be

A

herpes simplex virus

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19
Q

what is the oral clinical presentation of erythema multiforme

A

rapid onset of extensive oral ulceration with blood crusted lips

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20
Q

what is angular cheilitis characterised by

A

erythema, soreness and ulceration occurring at the angle of the mouth
yellow crusting

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21
Q

what should be in the differential diagnosis of angular cheilitis

A

recurrent herpes labialis
lichen planus

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22
Q

what is the common microorganisms found in angular cheilitis

A

candida species like candida albicans
staph aureus

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23
Q

what tests should be done for angular cheilitis

A

swab or smear of angle of mouth
swab of anterior nares
swab or imprint of palate
swab or imprint of fitting surface of upper appliance

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24
Q

what is the management of angular cheilitis in primary dental care

A

provide topical antimicrobial agent to erythematous tissues and potential source of infection
improve hygiene

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25
Q

what is it called when there is an erythematous pattern where the upper appliance is usually worn

A

chronic erythematous candidosis

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26
Q

how is chronic erythematous candidosis treated

A

apply sugar free miconazole oromucosal gel to fitting surface of appliance four times a day

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27
Q

what can a patient with denture stomatitis soak their denture in for a short term period to clear candidal infection

A

chlorhexidine

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28
Q

who is acute erythematous candidosis seen in

A

patients who use steroid inhaler

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29
Q

how do steroids cause candida

A

they suppress host defence system locally and promote candidal colonisation within certain areas of the mouth

30
Q

what should you tell a patient with a steroid inhaler to do

A

rinse after using inhaler or use a spacer

31
Q

what is geographic tongue characterised by

A

areas of erythema surrounded by white margins on the dorsum of tongue

32
Q

what can the symptoms of geographic tongue be

A

discomfort on eating hot or spicy foods

33
Q

how do you manage geographic tongue

A

reassure it is non-serious
no treatment really
dispersible form of zinc sulphate at dose of 125mg dissolved in 10ml of water used as mouthwash for 2 mins three times daily for 3 months

34
Q

if someone has a nutritional deficiency what does the oral mucosa appear like

A

erythematous
tongue depapillated and painful
angular cheilitis and RAS

35
Q

what does erythroleukoplakia mean

A

speckled red and white appearance

36
Q

what is white sponge naevus

A

developmental condition affecting males and females

37
Q

what does pseudomembranous candidosis look like

A

white patch which can be scraped off with underlying erythema

38
Q

what is the treatment for pseudomembranous candidosis

A

systemic fluconazole

39
Q

what is chronic hyperplastic candidosis

A

candida occurring bilaterally in commissure region as homogenous or speckled lesions

40
Q

how do you treat chronic hyperplastic candidosis

A

systemic fluconazole
smoking cessation

41
Q

what is seen in the histopathology of chronic hyperplastic candidosis

A

candida hyphae

42
Q

what is the management of lichen planus in primary dental care

A

steroid preparation e.g., beclomethasone MDI 2x daily or betamethasone 0.5mg tablets in 10ml used 3x daily
consider fluconazole to eradicate secondary candidosis

43
Q

if there is no improvement of lichen planus after 4 weeks of topical steroid treatment what do you do

A

refer to oral medicine

44
Q

what can cause a lichenoid reaction

A

contact with restorative material or adverse event with systemic drug therapy

45
Q

what is the difference in pattern of lichen planus and lichenoid reactions

A

lichen planus is bilateral
lichenoid reactions occur asymmetrically

46
Q

what drugs most commonly cause lichenoid reactions

A

NSAIDS
ACE inhibitors
beta blockers

47
Q

what viral infection is responsible for primary herpetic gingivostomatitis

A

HSV type 1

48
Q

how does primary herpetic gingivostomatitis occur

A

widespread oral ulceration
blistering of lips
pyrexia

49
Q

what is the management of primary herpetic gingivostomatitis in primary dental care

A

aciclovir oral suspension 200mg in 5mL 5x/day for 5 days
use chlorhexidine 0.2% to reduce bacterial infection
dont touch lesions
encourage fluids

50
Q

what is the treatment for recurrent herpes labialis (cold sore)

A

aciclovir 5% cream applied topically

51
Q

what treatment is offered for erythema multiforme

A

chlorhexidine
dietary exclusion for persistent disease

52
Q

what is angina bullosa haemorrhagica

A

blister formation when eating and then it bursts

53
Q

what are the oral features of pemphigoid caused by

A

subepithelial blistering seen as ulceration or desquamative gingivitis

54
Q

what is the treatment for angina bullosa haemorrhagica

A

chlorhexidine

55
Q

what is the treatment for oral pemphigoid

A

topical corticosteroids like betamethasone

for gingival lesions can use fluocinolone acetonide cream in vaccuum formed splint

refer for systemic treatment if persistent

56
Q

what is the treatment of pemphigus

A

high dose prednisolone

57
Q

what are the oral features of pemphigus

A

non-specific mucosal erosions

58
Q

what is the treatment of squamous cell papilloma

A

simple excision

59
Q

what does a fibroepithelial polyp look like

A

rubbery and round

60
Q

what is a pyogenic granuloma

A

nodular red lesion that is ulcerated and bleeds easily on touch

61
Q

what are the clinical signs of OFG

A

facial or lip swelling
angular cheilitis
full width gingivitis
oral ulceration
mucosal tags
cobble stoned appearance of buccal mucosa

62
Q

what is the management of ofg

A

exclusion diet for 3 months

63
Q

what is the treatment of sialadenitis when it produces pus

A

ensure drainage of gland using hot salty mouthwash and analgesia
amoxicillin if required
sialography after resolution

64
Q

what medications can give gingival hyperplasia

A

phenytoin
nifedipine
oral contraceptives

65
Q

what does addisons disease (raised ACTH) present like in the mouth

A

diffuse mucosal pigmentation due to addison’s disease

66
Q

what is the treatment for trigeminal neuralgia

A

carbamazepine 3x daily

67
Q

what does trigeminal neuralgia present like

A

unilateral intense stabbing pain along the trigeminal nerve lasting a few seconds

68
Q

what is the treatment of post herpetic neuralgia

A

aciclovir

69
Q

what are the 5 main causes of prolonged reduction of salivary production

A

drug induced
diabetes
autoimmune disease
radiotherapy
congenital absence of salivary glands

70
Q

what drugs can give a dry mouth

A

anticholinergic drugs like tricyclics

71
Q

what is the management of xerostomia in primary dental care

A

frequent sips of water
saliva substitutes
salivary stimulant
OHI
topical fluoride
diet advice
avoid smoking

72
Q
A

Oral Medicine BDS4 (28 decks)

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