Oral Medicine in the Elderly

Question 1

What causes haemangioma and where is it commonly seen?

Answer 1

A collection of blood vessels forming a lump commonly seen on the inside of lips, edge of the tongue and under the tongue

Question 2

What is the treatment for haemangioma?

Answer 2

Removal in a hospital setting due to risk of bleeding

Question 3

What is a fibroepithelial polyp?

Answer 3

A build up of tissue commonly caused by trauma

Question 4

What does a fibroepithelial polyp look like

Answer 4

An excess lump of mucosa similar to the surrounding mucosa

May be ulcerated due to rubbing against the teeth

Question 5

What is the treatment for fibroepithelial polyps?

Answer 5

The lesion is not a concern however it should be removed before it grows in size

Question 6

What is black hairy tongue?

Answer 6

an overgrowth on the surface of the tongue that can stain

Question 7

What is the treatment for black hairy tongue?

Answer 7

Clean from the midline forwards to prevent pushing the bacteria down the throat

Question 8

What causes geographic tongue?

Answer 8

Erythema migrans

Question 9

What does geographic tongue look like?

Answer 9

Areas of atrophy with white slightly raised snake like margins

Question 10

What does geographic tongue because sensitivity to?

Answer 10

spicy or citrus foods

Question 11

What causes Atrophic Glossitis?

Answer 11

Low Iron Levels

OR

Low Vitamin B12

Question 12

What does Atrophic Glossitis look like?

Answer 12

A really smooth tongue which appears shiny

Question 13

What is Frictional Keratosis?

Answer 13

A white patch caused by trauma and keratinisation

Question 14

What is speckled leucokplakia?

Answer 14

Hyperplastic candidosis where the angles of the mouth appear speckled

It is premalignant and needs to be monitored

Question 15

What is a risk factor for speckled leucokplakia?

Answer 15

Smoking

Question 16

When do you refer sublingual Keratosis to Oral Medicine

Answer 16

When the white lesion crosses the midline of the tongue

Question 17

What is Denture Induced Hyperplasia?

Answer 17

A condition caused by the lifting/rubbing of dentures which causes overgrowth of tissues in the mouth

More common in the mandible

Question 18

What is the treatment for Denture Induced Hyperplasia?

Answer 18

Remove denture OR ease denture dramatically in that area

Create new denture and surgically remove tissue

Question 19

What bacteria causes Denture stomatitis

Answer 19

Candida albicans

Question 20

What is Angular Cheilitis?

Answer 20

An infection caused by bacteria or fungi that affects the corners of the mouth

Question 21

What Is xerostomia?

Answer 21

drug induced dry mouth

Question 22

What is the treatment of xerostomia?

Answer 22

• Saliva replacements (saliva orthana)
• Salivary stimulants (chewing gum)
• Take frequent sips of water to moisten mucosa

Question 23

What medications commonly cause mucosal burns in the elderly?

Answer 23

• aspirin
• iron tablets

Question 24

What is lichen plans?

Answer 24

mucocutaneous disorder affecting the oral mucosa commonly caused by reaction to specific drugs (e.g. NSAIDS, statins and diuretics)

Question 25

What is the function of bisphosphonates?

Answer 25

They inhibit osteoclast formation decreasing bone resorption Bisphosphonates have a high affinity for bone minerals and bind strongly to hydroxyapatite in bone. It persists for a period of time (half life of 10 years)

Question 26

What conditions are treated by bisphosphonates?

Answer 26

- non malignant conditions: osteoporosis, Paget's disease - malignant conditions: myeloma, breast cancer

Question 27

What is MRONJ?

Answer 27

a side effect of anti-resorptive drugs that causes exposed sensitive bone that persists for more than 8 week

Question 28

What are risk factors for MRONJ?

Answer 28

- concurrent use of corticosteroids - medical conditions affecting bone turnover (e.g. osteoporosis) - Malignancy - chemotherapy/radiotherapy - previous diagnosis of BRONJ

Question 29

What are signs of MRONJ?

Answer 29

- delayed healing following extraction - soft tissue infection - exposed bone

Question 30

What are symptoms of MRONJ?

Answer 30

- swelling - numbness - pain - altered taste or sensation - signs of infection

Question 31

What is indicative of high risk for MRONJ?

Answer 31

- previous diagnosis of MRONJ - if the patient is taking anti-resorptive or anti-angiogenic drugs - undergoing cancer treatment - if patient was/is taking RANKL inhibitor (denosumab) AND steroids - if the patient has been taking or has taken bisphosphonates for 5 years or more

Question 32

What is advice given to patients on bisphosphonates?

Answer 32

- regular dental checks - maintain good oral hygiene - Limit alcohol and smoking - report any symptoms of dental pathology (pain, swelling, loose teeth)

Question 33

What is Post herpetic Neuralgia?

Answer 33

an area of constant burning on the skin where there previously was shingles

Question 34

What is the treatment for Post Herpetic Neuralgia?

Answer 34

- Antidepressants - Gabapentin - Carbamazepine - topical capsaicin 0.025% may use antivirals and or steroids

Question 35

What is trigeminal neuralgia?

Answer 35

severe facial pain that feels like an electric shock and lasts for a few seconds

Question 36

What is the treatment for trigeminal neuralgia?

Answer 36

- Carbamazepine - Gabapentin -Phenytoin neurectomy

Question 37

What are the features of an ulcer that would indicate referral to oral surgery?

Answer 37

- non healing lesion - ulcerated base - rolled margins - speckled lesion may not have all of these features together