Oral Medicine Tutorial 1

Question 1

what are oral lichenoid lesions (OLL)

Answer 1

similar lesions to lichen planus but are caused by a known agent (amalgam, ACE inhibitors, betablockers)

Question 2

what is the difference between OLL and OLP

Answer 2

OLP appears bilaterally, reticular pattern of slightly raised white lines, idiopathic
OLL is singular lesions in localised area, unilateral with known cause

Question 3

what is the pathogenesis of OLP

Answer 3

chronic T cell infiltrate with basal cell degeneration - death of basal cells and thickening of epithelial tissue

Question 4

what are the six subtypes of OLP

Answer 4

erosive, atrophic, reticular, bullous, plaque like, pappular

Question 5

what is the intra-oral manifestations of OLP

Answer 5

red or white patches
roughness of lining mucosa
sensitivity to hot or spicy food

Question 6

what three histopathological signs must be present to diagnose OLP

Answer 6

well defined band like zone of cellular infiltrate confined to superficial part of connective tissue
signs of liquefaction in basal cell layer
absence of epithelial dysplasia

Question 7

what is used in the management of OLP and OLLs

Answer 7

remove known triggers
avoid SLS containing toothpaste
beclomethasone inhaler and betamethasone rinse
clobetasol
tacrolimus
prednisolone

Question 8

what investigations are used for OLP

Answer 8

biopsy for histopathological investigation
FBC
haematinics
autoantibody screen if lupus suspected

Question 9

what is the malignant transformation rate of OLP/OLLs

Answer 9

0.2%

Question 10

what is sjogren’s syndrome

Answer 10

chronic autoimmune disorder characterised by salivary and lacrimal gland destruction

Question 11

when is sjogren’s syndrome primary

Answer 11

if not associated with any other diseases

Question 12

when is sjogrens syndrome secondary

Answer 12

if it occurs in association with another autoimmune condition

Question 13

what are intra-oral manifestations of sjogren’s syndrome

Answer 13

oral dryness
dysphagia and dysgeusia
pain and burning sensation
recurrent enlargement of salivary glands

Question 14

what are the special investigations from the ACR/EULAR used to screen for sjogren’s

Answer 14

labial salivary gland biopsy - focus score of more than 1 foci per 4mm squared
antibody positivity - Anti-Ro/ Anti-La
ocular staining score -
schirmers test - less than 5mm of tears in 15 mins
unstimulated salivary flow - less than 0.1ml per minute

Question 15

what is systemic lupus erythematous (SLE)

Answer 15

autoimmune disease with multisystem involvement

Question 16

what are intra-oral manifestations of lupus

Answer 16

ulcers, erosion, pigmentation, cheilitis, honeycomb plaque

Question 17

what are extra oral manifestations of SLE

Answer 17

malar/ butterfly rash
photosensitivity
pericarditis

Question 18

when is it only acceptable to test a patient for lupus

Answer 18

if they have a positive antinuclear antibody test positive first

Question 19

what are the seven areas a patient with suspected lupus would be investigated in

Answer 19

cardiac
haematological
immunological
musculoskeletal
neuropsychiatric
renal
skin/ mucosal

Question 20

how is Sjogrens syndrome and SLE managed

Answer 20

hydroxychloroquine used as first line
glucocorticoids (prednisolone) during flare ups
immunosuppressants (methotrexate and azathioprine)
monoclonal antibodies (belimumab)