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210 OSPE > Oral Mucosal Diseases > Flashcards

Oral Mucosal Diseases Flashcards

1
Q

What is the role of the OHT in oral medicine?

A

Early identification, timely referral, educate products/medicines. Work collaborately within a teeam, identify and modify pt risk factors.

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2
Q

Define ulcer

A

Loss of continuity of epithelium & exposure of underlying CT

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3
Q

Define desumation/mucosal atrophy

A

Thinning of epithelum, read appearance develips due to lamina propria showing through

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4
Q

Define erosion

A

Superficial breaches in epithelium, redish appearance initially covered with yellowish exudate

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5
Q

Define mucosal inflammation

A

Mucositis/stomitis on the mucosal lining that can result in pain

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6
Q

Define a mouth ulcer

A

A result of a localised defect of the oral mucosal surface, which is covering the epithelium which is destroyed, leaving an inflamed area of exposed CT. Can be a response to spicy foods.

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7
Q

What will you document on the lesion?

A
  • Site
  • Size and shape
  • Symptom
  • Duration
  • Systemic signs
  • Other location
    Uni or bilateral. Keratinised or non-keratinised tissue
    Single or multiple
    Margins: elevated different colour. Association with surround structures. Depth. Surface of ulcer, regular or irregula shape.
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8
Q

How do you manage an ulcer?

A
  1. Address and eliminate possible cause of trauma or causative agent.
  2. If it persists for 3+ requires specialist referral
  3. If suspect neoplasm refer immediately.
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9
Q

What is the Aetiology of mouth ulcers?

A
  1. Trauma
  2. Infective (herpes)
  3. Dematological (lichen planus, pempigoid or pemphigus)
  4. Immunuosuppression (HIV)
  5. Neoplastic (cancers)
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10
Q

What are possible causes of traumatic ulceration?

A

Pain is usually accompanied with this traumatic ulceration.

  1. Identify cause of trauma that fits clinical presentation
  2. Remove the cause
  3. Monitor - should show signs of healing 10 days
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11
Q

Define recurrent Apthous Ulcerative Disease?

A

Periodic eruption of non-traumatic solitary or multiple ulcerations of the oral mucosa.
- Prodromal symptoms decibed as soreness, burning or prickling.

3 types; minor, major and herpetiform**

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12
Q

Define Minor Apthous Ulceration

A

Most common. Peak age of onset 10-19y. Smaller, round/ovid lesion 2-4mm diameter (under 10m). Grey with yellow bse, erthematous margin, single or few at a time.
Presents on non-keratinised mucosa with no vesticle formation.
Heals within 7-10 days, no scaring

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13
Q

Define major aphthous Ulceration

A

PICPeak age of onset 10-19y. Larger than 10mm, can occur anywhere, Can persist upto 6 weeks. Painful, heals with submucosal scarring

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14
Q

Define Herpetiform Apthous Ulceration

A

Recurrent crops of non-vesicular small ulcers. Clusters of multiple, small round lesion 1-2mm diameter. Can coalase into larger irregular lesion. Can involve any area.

Heals 1-2 weeks, recur frequently

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15
Q

How do you manage herpetiform apthous ulceration?

A

Exclude possible underlying causes:

  • Recurrences
  • Pattern
  • Onset
  • Family history

NOTE: Not caused by herpes

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16
Q

What is the assessment of recurrent aphthous stomatitis (RAS)?

A

Minor RAS: managment of local factors, possible triggers and recommending products for relief. Dentst may prescribetopical corticosteroid, OHT aids in education

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17
Q

Define oral mucutaneous herpes simplex

A

Primary episode is herpetic gingivostomatitis.
- Can occur in kids
- Fever, malaise and associated lymphadenopathy.
- May present with stomatitis
Tongue, cheek. gingivae, hard palate. Pinpoint and fuse
- Gingival oedema, erythema, ulceration.

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18
Q

Define oral muctaneous herpes simplex - recurrent episodes

A

Due to latent virus activation. Can be referred to herpes labialis.
Prodromal symptoms of pain, burnng, tingling or itching for several hrs to days.
Lesions appear as macules - Vesticles occur 48hrs. Crust over and scab 3-4 days

(Bulla/vesticle appearance)

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19
Q

How long does it take oral muctaneous herpes simplex to heal?

A

7-10 days

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20
Q

How long does it take minor apthous ulcers to heal?

A

7-10 days

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21
Q

How long does it take major apthous ulcers to heal?

A

6+ weeks with corticosteroids

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22
Q

How long does it take herpetiform ulcerations to heal?

A

1-2 weeks

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23
Q

How do you manage oral mucocutaneous herpes simplex?

A

Supportive care: fluid balance and intake, analgesia if required.
5% Aciclovir cream topically, 5x per day.

+ Chlorhexadine mouthrinse

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24
Q

Define Varcella-zoster virus

A

Primary infection - chicken pox. Prodromal symptoms - oral vesticles and ulcers. 5-10days.

SECONDARY INFECTION - shingles/herpes zoster.
Viral reactivation, unilateral veticles and ulcers/facial rash - invovled with trigeminal n.
Lymphadenpathy, pain, malaise and fever

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25
Q

Describe hand-food-and-mouth disease

A

Cause: coxsackie virus. Mostly common in school children.

Presents as a small vestcle on OM, palms, and soles of feet. Painless.

Highly infectious.

Resolves in 1 week

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26
Q

Describe Herpangina

A

Cause: coxsackie virus. Common in childhood.
Ulcers last 3-4 days.

Fever and sore throat 1-3mm vestibules on tonsils, palate ad uvula.

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27
Q

What are the similarities between Pemphigus Vulgaris & Mucous membrane pehigoid

A

Uncommon autoimmune vesiculobullous disorders. Middle age onset.

28
Q

Describe Pemphigus Vularis

A

Vesticles and bullae on skin and mucous membranes. Oral lesions precede skin lesions. It may appear as extensive erosive disease, or as small clear fluid filled vesicles appearing on OM including gingivae.

Vesticles and bullae rupture rapidly to leave erosion lesions
Positive Nikolsky sign

29
Q

Describe Mucous Membrane Pemphigoid

A

Uncommon. Limited to OM. Bullae and vesicles (sometimes blood filled).
Predominately on palate and gingivae.

Ulcers follow blisters after 24hr. Positive Nikolsky sign.
(Desquamtive gingivitis is common)

30
Q

Management of Mucous Membrane Pemphigoid

A

Required specialist referral for biopsy - subsquency pahology tests and immunofluorescence.

Specialst will manage potential topical/systemic cortcosteroids

31
Q

Describe Erythemia Multiform

A

“Redness multiple formations”
Acute onset, may last several weeks.

Affects OM can be associated with generalised skin lesions.

Occcurs in young male adults.

Predisposing factors (HSV)

32
Q

What are the characteristics of Erythemia Multiforme

A

Presents: blood crusted cracked, swollen lips. Sloughing and haemorrhage. Healing slow

33
Q

What is the management of Erythemia multiforme?

A

Urgent referral for specialist assessment.

34
Q

Define Oral Candidosis

A

Caused by overgrowth of candida albicans.

Opportunist infection

35
Q

What are predisposing factors for Candidosis?

A

Denture wearing. Smoking, Carbohydrate rich diet, poor OH, anitibotics/immunosuppressants

36
Q

What is Pseudomembranous Candidosis

A

Thrush.
Canwipe off with gauze and bleeding underneath; creamy white plaques, not fixed.
Symptoms: pain, burning

Common locations: labial/buccal mucosa. Hard and soft palate Tongue, Oropharynx

37
Q

Define Erythematous Candidosis

A

Acute infection, commonly red. May have burning sensation.

Predisposing factors: penicillin v antibiotics, steroids, immunodeficiency

Common sites, dorsum of tongue, palate and bucal mucosa

38
Q

Define Denture stomatitis

A

Red inflammed mucosa, directly associated with denture or ortho appliance.

Presentation:

  • Pinpoint erythema
  • Diffuse erythema of mucosa
39
Q

What is the management of denture stomatitis?

A

Denture OH, denture clearer, advise pt to take denture out at night.

May take a month for inflammation to resolve

40
Q

Define Hyperplastic Candidosis

A

FIXED lesion on OM, also known as candidal Leukoplakia.

Appears white, dense, opaque patches of irregular thickness.
Buccal mocsa near commissure of lips.

Associated with smoking.

Differential: Oral SCC.

41
Q

How do you manage Pseudomembranous Candidosis ?

A

Anti-fungals such as nystatin

42
Q

How do you manage Oral Candidosis?

A
  • Exclude predisposing factors eg. smoking etc
  • Correct ill-fitting dnetures, overuse of cortcosteroid inhalers, poor PH.
  • Consult with dentst re: antifungals
  • Pt to continue tx after 7 days to minise spoors
  • If pt immunoconpromised refer to specialist.
43
Q

Define Median Rhomboid Glossitis

A

Candida albicans pathogensis (hyperplastic candidosis)
AKA central papillary atrophy.
Located in the midline of the doral surface of the tongue, anterior to circumvallate papullae.
Well demarcated, symmetric, depapillated erythematous area (atrophhic filiform papillae.

44
Q

Define Angular Chellitis

A

Lesions found at the combissures of mouth (angle of mouth) (candida & bacterial). In elderly pts with impaired vertical dimensions due to dentures or edendtulous.

45
Q

Define Lichen Planus

A

[RARE] Immunologically mediated disease, skin, hair, nails and mucosal surfaces affected. Chronic. most common in women.

A chronic mediated-mucotaneous disorder, related to T lymphocytes - damaging the surface of the epithelium.

46
Q

What are contributing factors or Linchen PLanus

A

Stress, mucosal irritation, plaque

47
Q

What areas are affected in Lichen PLanus?

A

Buccal mucosa, tongue, gingivae. Can affect border of lower lip. May present as desquamative gingivitis

48
Q

What is the clinical apperance of Oral Lichen Planus?

A

White, lacy lesions (reticular) [Wickham striae].
Papules (5mm)
Plaques (5mm++)
Atrophy/erosion
Bullae.
Usually asymptomatic
RETICULAR, ERYTHEMATOUS AND EROSIS. Bilateral and symmetrical

(erosive type is less common) _ erythematous+ bullae)

49
Q

What is the management of Oral Lichen Planus?

A

Pt history, exam, biopsy to confirm, referal.

Reticular - if asymptomatic no tx, review.

If Erosive, referral to OMG

50
Q

What are some other potential management strategies for Oral Lichen Planus?

A 
Cessation of smoking
Avoid alchol
Soft diet
Avoid spicy/citrus foods
Good OH
51
Q

Define Leukoplakia

A

Fixed white patches that cannot be explained. Can be maligant.
White patch that does not rub off.

52
Q

How does Leukoplakia present?

A

Homogenous - smooth white plaques.

Non-homogenous (speckled texture) increased risk of malignancy.

53
Q

Whats the possible aetiology of Leukoplakia?

A

Tobacco, alcohol, betel quid,

54
Q

How do you manage Leukoplakia?

A

Referral for biopsy

55
Q

What is Oral Hairy Leukoplakia?

A

Is a secondary infection with Epstein-Barr virus, or immunosupressions. Mostly occurs in HIV pts.

56
Q

How does Oral Hairy Leukoplasia present?

A

Fixed, white (corrugated) lesion on the lateral border of the tongue.Extending from dorsal to ventral surface, bening

57
Q

Define Erythroplakia

A

Less common, but has higher rate of malignant transformation.

58
Q

What are the predisposing factors for Erythroplakia?

A

Alcohol, tobacco

59
Q

How do you manage Erythroplakia?

A

Removal of any aeitological factors- referral for biopsy

60
Q

Define Geographic tongue

A

Multiple demarcated zones or erythema due to atrophy of the filiform papillae, surrounded by white/yellowish vorder.

61
Q

How do you manag geographic tongue?

A

Usually asymptomatic, association with burning, h/s foods

62
Q

Define Oral submcous fibrosis

A

Exess build-up of collagen bands in cheeks. Causing OM to become fibrotic, and contracts = difficulty opening (trismus). Most areas affected: buccal mucosa, soft palate, lips

  • Difficulty swallowing and opening mouth, burnng and dry mouth
63
Q

What is the Aetiology of oral submucous fibrosis?

A

Chewing betal quid.
Excessive consumptionof spicy food, malnurtriotn

  • Refer for biopsy and management as high risk of maligancy.
64
Q

What are the clinical characteristics of Hairy Tongue

A

Excessively long filiform papillaethat becoe stained, generally black/brown discolouration.

65
Q

What predisposing factors prompt Hairy Tongue?

A

Heavy smokers, poor OH, use of chlorhexadine MW, antibiotics.

Tx: OH, eliminate predisposing factors (smoking). Sodium bicarb MR can help

66
Q

What is the clinical appearance of nicotine stomatitis?

A

Dissues whitening of the posterior HP with extention into SP. Cracked and crator like. Asymptomatic, usually common in pipe smokers.

Management: smoking cessation

210 OSPE (3 decks)

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