Oral Medicine in Primary Dental Care Flashcards
what conditions is taking an oral rinse helpful for
suspected cases of altered taste ,dry mouth, burning mouth syndrome
what are the routine haematological investigations
full blood count
vitamin B 12
ferritin
folate
HbA1c
what do the presence of antibodies anti-ro and anti-la suggest
sjogrens
what does the presence of antibody ANA suggest
systemic lupus erythematous
what does the presence of RF antibody suggest
rheumatoid arthritis
what questions should we ask about ulcer history
is it painful
how many
how long
which sites in mouth
suffered from similar ulcers?
started any new drugs?
if a patient gives a history of previous ulceration what further questions need to be asked
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
what is the treatment of a traumatic ulcer
remove any persistent traumatic factor
chlorhexidine 0.2%
what does minor RAS present as
small ovoid or circular lesions affecting non-keratinised sites in anterior oral cavity
what does major RAS present as
<1cm in diameter affecting posterior part of mouth and involve keratinised mucosa
what does herpetiform RAS present as
multiple small round ulcers which can coalesce to form larger areas of irregular ulceration
how do you manage RAS in primary dental care
history
chlorhexidine 0.2% or benzydamine 0.15% 3x daily
diet advice
avoid SLS
review after 4 weeks
if after 4 weeks there is no improvement of RAS what do you do
doxycycline 100mg broken into 10ml water used as mouthwash for 2mins 3x daily
beclometasone MDI 2x daily
if after 8 weeks from initial appointment there is no improvement of RAS what do you do
arrange haematological investigations with GMP
consider referral
what bacteria is involved in necrotising gingivitis
anaerobic bacteria
fusobacterium species
what is the management of necrotising gingivitis including antibiotic dose
debridement
metronidazole 400mg 3x daily for 3 days
when does an ulcer require biopsy
if it fails to respond to initial treatment within 2-3 weeks
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
herpes simplex virus
what is the oral clinical presentation of erythema multiforme
rapid onset of extensive oral ulceration with blood crusted lips
what is angular cheilitis characterised by
erythema, soreness and ulceration occurring at the angle of the mouth
yellow crusting
what should be in the differential diagnosis of angular cheilitis
recurrent herpes labialis
lichen planus
what is the common microorganisms found in angular cheilitis
candida species like candida albicans
staph aureus
what tests should be done for angular cheilitis
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
what is the management of angular cheilitis in primary dental care
provide topical antimicrobial agent to erythematous tissues and potential source of infection
improve hygiene
what is it called when there is an erythematous pattern where the upper appliance is usually worn
chronic erythematous candidosis
how is chronic erythematous candidosis treated
apply sugar free miconazole oromucosal gel to fitting surface of appliance four times a day
what can a patient with denture stomatitis soak their denture in for a short term period to clear candidal infection
chlorhexidine
who is acute erythematous candidosis seen in
patients who use steroid inhaler
how do steroids cause candida
they suppress host defence system locally and promote candidal colonisation within certain areas of the mouth
what should you tell a patient with a steroid inhaler to do
rinse after using inhaler or use a spacer
what is geographic tongue characterised by
areas of erythema surrounded by white margins on the dorsum of tongue
what can the symptoms of geographic tongue be
discomfort on eating hot or spicy foods
how do you manage geographic tongue
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
if someone has a nutritional deficiency what does the oral mucosa appear like
erythematous
tongue depapillated and painful
angular cheilitis and RAS
what does erythroleukoplakia mean
speckled red and white appearance
what is white sponge naevus
developmental condition affecting males and females
what does pseudomembranous candidosis look like
white patch which can be scraped off with underlying erythema
what is the treatment for pseudomembranous candidosis
systemic fluconazole
what is chronic hyperplastic candidosis
candida occurring bilaterally in commissure region as homogenous or speckled lesions
how do you treat chronic hyperplastic candidosis
systemic fluconazole
smoking cessation
what is seen in the histopathology of chronic hyperplastic candidosis
candida hyphae
what is the management of lichen planus in primary dental care
steroid preparation e.g., beclomethasone MDI 2x daily or betamethasone 0.5mg tablets in 10ml used 3x daily
consider fluconazole to eradicate secondary candidosis
if there is no improvement of lichen planus after 4 weeks of topical steroid treatment what do you do
refer to oral medicine
what can cause a lichenoid reaction
contact with restorative material or adverse event with systemic drug therapy
what is the difference in pattern of lichen planus and lichenoid reactions
lichen planus is bilateral
lichenoid reactions occur asymmetrically
what drugs most commonly cause lichenoid reactions
NSAIDS
ACE inhibitors
beta blockers
what viral infection is responsible for primary herpetic gingivostomatitis
HSV type 1
What is the presentation of primary herpetic gingivostomatitis
widespread oral ulceration
blistering of lips
pyrexia
what is the management of primary herpetic gingivostomatitis in primary dental care
aciclovir oral suspension 200mg in 5mL 5x/day for 5 days
use chlorhexidine 0.2% to reduce bacterial infection
dont touch lesions
encourage fluids
what is the treatment for recurrent herpes labialis (cold sore)
aciclovir 5% cream applied topically
what treatment is offered for erythema multiforme
chlorhexidine
dietary exclusion for persistent disease
what is angina bullosa haemorrhagica
blister formation when eating and then it bursts
what are the oral features of pemphigoid caused by
subepithelial blistering seen as ulceration or desquamative gingivitis
what is the treatment for angina bullosa haemorrhagica
chlorhexidine
what is the treatment for oral pemphigoid
topical corticosteroids like betamethasone
for gingival lesions can use fluocinolone acetonide cream in vaccuum formed splint
refer for systemic treatment if persistent
what is the treatment of pemphigus
high dose prednisolone
what are the oral features of pemphigus
non-specific mucosal erosions
what is the treatment of squamous cell papilloma
simple excision
what does a fibroepithelial polyp look like
rubbery and round
what is a pyogenic granuloma
nodular red lesion that is ulcerated and bleeds easily on touch
what are the clinical signs of OFG
facial or lip swelling
angular cheilitis
full width gingivitis
oral ulceration
mucosal tags
cobble stoned appearance of buccal mucosa
what is the management of ofg
exclusion diet for 3 months
what is the treatment of sialadenitis when it produces pus
ensure drainage of gland using hot salty mouthwash and analgesia
amoxicillin if required
sialography after resolution
what medications can give gingival hyperplasia
phenytoin
nifedipine
oral contraceptives
what does addisons disease (raised ACTH) present like in the mouth
diffuse mucosal pigmentation due to addison’s disease
what is the treatment for trigeminal neuralgia
carbamazepine 3x daily
what does trigeminal neuralgia present like
unilateral intense stabbing pain along the trigeminal nerve lasting a few seconds
what is the treatment of post herpetic neuralgia
aciclovir
what are the 5 main causes of prolonged reduction of salivary production
drug induced
diabetes
autoimmune disease
radiotherapy
congenital absence of salivary glands
what drugs can give a dry mouth
anticholinergic drugs like tricyclics
what is the management of xerostomia in primary dental care
frequent sips of water
saliva substitutes
salivary stimulant
OHI
topical fluoride
diet advice
avoid smoking
