Oral Medicine Problems in Elderly Flashcards
1
Q
What is the percentage of elderly with chronic disease?
A
- 75% have chronic disease
- Atypical presentation
- Polypharmacy
- Abnormal reactivity to drugs
- Compliance is poor
2
Q
What are the oral conditions affecting the elderly?
A
- Lichen planus
- Mucous membrane pemphigoid
- Herpes Zoster
- Carcinoma
- Potentially malignant lesions
- Sore tongue
- Candidosis
3
Q
What is a haemangioma?
A
- Benign vascular tumour derived from blood vessel cell types
- If you traumatise this can bleed profusely (be careful of blood thinners)
- Most common on inside of lip or side of tongue
- Cryotherapy used to treat in oral surgery hospital setting due to risk of bleeding
4
Q
What is a fibroepithelial Polyp?
A
- Not sinister as the mucosa covering the bump looks like the skin as rest of mouth
- Caused by trauma like sharp tooth etc and it doesn’t heal properly
- Lump on inside of mouth
- When they get large best to get it removed
5
Q
What is black hairy tongue?
A
- Staining on tongue
- Common with smokers, elderly, people who use pipe
- Overgrowth of normal surface of tongue
- May have smell attached with it
- Not sinister but unpleasant for patient
- Hard to get rid of but clean with tongue scraper or toothbrush
6
Q
What is geographic tongue?
A
- Erythema migrains aka
- 10% population
- Red areas of atrophy of tongue surrounded by white margins
- Spicy citrus foods can irritate it for some people]
- Areas can change shape and size over time
- Normal and not to worry
7
Q
What is Atrophic Glossitis?
A
- Smooth tongue
- Low iron or folate or B12 can cause this
- If iron and vit B12 drops further it can begin to ulcer which is very uncomfortable
- If discover this then ask GP to do haematics and bloods
8
Q
What is Frictional Keratosis?
A
- White patch caused by trauma
- Essentially calluses on soft tissue
- Sharp tooth or sharp filling for example
- If you can’t find obvious cause then review as this can turn malignant
- If can find obvious cause then sort it out
9
Q
What is Speckled Leukoplakia?
A
- AKA hyperplastic candidiasis
- Speckled appearance of white over the red mucosa
- Can be unilateral or bilateral
- Common in smokers
- Premalignant and needs to be monitored every 6months
- May need antifungals so swab this and biopsy may be required
10
Q
What is Sublingual Keratosis?
A
- Under the tongue is a homogenous thick white patch
- If site is ventral or crossing the mid line then it is considered high risk site
- Concerned and refer to oral medicine for inspection
11
Q
What is Traumatic Keratosis?
A
- Very common
- Dentures in mouth for long time and are ill fitting
- AKA frictional keratosis
- White patch along line of denture fitting surface
12
Q
What is denture-related hyperplasia?
A
- Excess mucosa due to rubbing of ill fitting denture
- Very common
- More common in lower
- Looks like a flap of skin
- Remove the denture and surgically remove the excess skin
- If don’t want surgical resolve then trim the denture as much as poss in
- Mucosa is same colour as other mucosa therefore not dangerous
13
Q
What is denture induced stomatitis?
A
- Poor denture hygiene and leaving denture in 247
- Redness and inflammation of mucosa under the fitting surface of denture
- Painless and patients not massively bothered
- Encourage to take out as much as poss and give chlorohexidine rinse and really good clean before putting back in
- Don’t sleep with denture in at night and let your mouth breath
14
Q
What is angular cheilitis?
A
- Inflammatory condition causing swollen red patches at corners of mouth
- Bacterial or fungal infection
- Useful to swab area to see which bacteria is causing it
- Usually ass with old dentures
-Useful to ask GP for bloods to check for deficiency as usually deficiency makes it worse - Find cause of problem before prescribing antibiotics
15
Q
What is Xerostomia?
A
- Dry mouth (salivary glands don’t make enough saliva to keep mouth wet)
- Common causes are Polypharmacy, chemotherapy, aging, high salt intake, dehydration
- Drug induced dry mouth give fissures on tongue, sjogrens
- Use mirror stick test, put mirror on tongue or mucosa and if it sticks then dry mouth
- Bacteria builds up as saliva not removing it and can enter blood stream which
16
Q
How do you manage Xerostomia?
A
- Change medication
- Salivary replacement
- Saliva orthana
- Glandosane (don’t use in people with teeth as very acidic)
- Biotene oral balance
- BioXtra (not suitable for vegans and muslims due to cow mucins) - Salivary stimulants
- Chewing gum
- Glycerine and lemon (acidic and can be damaging)
17
Q
What is a topical drug reaction?
A
- Common with aspirin and iron
- When patient holding tablet in mouth for too long and ends up burning the mucosa (chemical burn)
- Sore
- Elderly population have difficulty swallowing
- Switch tablet to liquid tablets
18
Q
What is lichen planus?
A
- White red or mixed patches
- If skin lesions present most likely to have oral lesions
- Need to be seen by oral medicine
- Very sore
- Can have the different types in different places in mouth
19
Q
What do bisphosphonates do?
A
- Inhibit osteoclast formation, migration and osteolytic activity
- Promote apoptosis
- Modulate signalling from osteoblasts to osteoclasts
- Concentrated in newly mineralising and under osteoclasts
- Local release during bone resorption
Strengthen the bone
20
Q
What are bisphosphonates used for?
A
Non malignant
- Osteoporosis
- Paget’s disease
- Osteogenesis imperfecta
- Fibrous dysplasia
- Primary hyperparathyroidism
- Osteopenia
Malignant
- Multiple myeloma
- Breast cancer
- Prostate cancer
- Bony metastatic lesions
- Hypercalcemia of malignancy
21
Q
What are the MRONJ risk factors?
A
- Extremes of age
- Concurrent use of corticosteroids
- Systemic conditions affecting bone turnover like paget’s disease
- Malignancy
- Coagulopathies, chemotherapy and radiotherapy
-Duration of therapy - Previous diagnosis of MRONJ
- Potency of drug
- Invasive dental procedure
- Dental trauma
- Poor oral hygiene
- Periodontal disease
- Alcohol or tobacco use
- Thin mucosal coverage
22
Q
What to do if person is on bisphosphonate?
A
- Advise patient of MRONJ risk
- Informed consent
- Emphasise rarity of condition
- Don’t discourage from taking medication as it will be in system for 10 years
23
Q
What advice do you give a patient if they have MRONJ risk factor?
A
- Regular dental checks
- Maintain good oral hygiene
- Limit alcohol and stop smoking
- Report any symptoms e.g. loose teeth, pain and swelling
24
Q
What is Herpes Zoster?
A
- Affects any branch of trigeminal nerve
- Shingles
- Usually unilateral
- Rash on one side of face and mouth and very painful
25
Q
What is post herpetic neuralgia?
A
- Constant burning sensation in dermatomal distribution
- Usually from previous episode of shingles
- Resolves within 2 months in 50% patients
- May persist for two years or longer
- So painful it is a suicide risk
- Incidence poss reduced by antiviral therapy with or without steroids (GP)
26
Q
What is the treatment of Post herpetic neuralgia?
A
- Antidepressants
- Gabapentin
- Carbamezepine
- Topical capsaicin 0.025%
- Transcutaneous electrical nerve stimulation (TENS)
27
Q
What is trigeminal neuraglia?
A
- Affects women more
- Affects mandibular and maxillary branch more
- Pain like an electrical shock and very painful
- Can be triggered by lots of different things like shaving or the cold
28
Q
What is the medical management of Trigeminal neuralgia?
A
- Carbamazepine
- Oxcarbazepine
- Lamotrigine
- Phenytoin
29
Q
What is the surgical management of trigeminal neuralgia?
A
- Cryotherapy
- Injection of alcohol or glycerol
- Neurectomy
- Avulsion of nerve
Ganglion procedure
- Balloon compression
- Radiofrequency thermocoagulation
30
Q
What is burning mouth syndrome?
A
- More common females
- Link with anxiety or depression
- Burning sensation all over or on tongue
- No cause identified 50% time
- Signalling problem from mouth to brain , wrong message passed on
31
Q
What patient advice for burning mouth syndrome?
A
- May lead to malnutrition
- Slow rehabilitation
- Slow recovery
- Reduce quality of life
