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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
Describe hand-food-and-mouth disease
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
26
Describe Herpangina
Cause: coxsackie virus. Common in childhood. Ulcers last 3-4 days. Fever and sore throat 1-3mm vestibules on tonsils, palate ad uvula.
27
What are the similarities between Pemphigus Vulgaris & Mucous membrane pehigoid
Uncommon autoimmune vesiculobullous disorders. Middle age onset.
28
Describe Pemphigus Vularis
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
Describe Mucous Membrane Pemphigoid
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
Management of Mucous Membrane Pemphigoid
Required specialist referral for biopsy - subsquency pahology tests and immunofluorescence. Specialst will manage potential topical/systemic cortcosteroids
31
Describe Erythemia Multiform
"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
What are the characteristics of Erythemia Multiforme
Presents: blood crusted cracked, swollen lips. Sloughing and haemorrhage. Healing slow
33
What is the management of Erythemia multiforme?
Urgent referral for specialist assessment.
34
Define Oral Candidosis
Caused by overgrowth of candida albicans. Opportunist infection
35
What are predisposing factors for Candidosis?
Denture wearing. Smoking, Carbohydrate rich diet, poor OH, anitibotics/immunosuppressants
36
What is Pseudomembranous Candidosis
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
Define Erythematous Candidosis
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
Define Denture stomatitis
Red inflammed mucosa, directly associated with denture or ortho appliance. Presentation: - Pinpoint erythema - Diffuse erythema of mucosa
39
What is the management of denture stomatitis?
Denture OH, denture clearer, advise pt to take denture out at night. May take a month for inflammation to resolve
40
Define Hyperplastic Candidosis
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
How do you manage Pseudomembranous Candidosis ?
Anti-fungals such as nystatin
42
How do you manage Oral Candidosis?
- 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
Define Median Rhomboid Glossitis
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
Define Angular Chellitis
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
Define Lichen Planus
[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
What are contributing factors or Linchen PLanus
Stress, mucosal irritation, plaque
47
What areas are affected in Lichen PLanus?
Buccal mucosa, tongue, gingivae. Can affect border of lower lip. May present as desquamative gingivitis
48
What is the clinical apperance of Oral Lichen Planus?
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
What is the management of Oral Lichen Planus?
Pt history, exam, biopsy to confirm, referal. Reticular - if asymptomatic no tx, review. If Erosive, referral to OMG
50
What are some other potential management strategies for Oral Lichen Planus?
``` Cessation of smoking Avoid alchol Soft diet Avoid spicy/citrus foods Good OH ```
51
Define Leukoplakia
Fixed white patches that cannot be explained. Can be maligant. White patch that does not rub off.
52
How does Leukoplakia present?
Homogenous - smooth white plaques. | Non-homogenous (speckled texture) increased risk of malignancy.
53
Whats the possible aetiology of Leukoplakia?
Tobacco, alcohol, betel quid,
54
How do you manage Leukoplakia?
Referral for biopsy
55
What is Oral Hairy Leukoplakia?
Is a secondary infection with Epstein-Barr virus, or immunosupressions. Mostly occurs in HIV pts.
56
How does Oral Hairy Leukoplasia present?
Fixed, white (corrugated) lesion on the lateral border of the tongue.Extending from dorsal to ventral surface, bening
57
Define Erythroplakia
Less common, but has higher rate of malignant transformation.
58
What are the predisposing factors for Erythroplakia?
Alcohol, tobacco
59
How do you manage Erythroplakia?
Removal of any aeitological factors- referral for biopsy
60
Define Geographic tongue
Multiple demarcated zones or erythema due to atrophy of the filiform papillae, surrounded by white/yellowish vorder.
61
How do you manag geographic tongue?
Usually asymptomatic, association with burning, h/s foods
62
Define Oral submcous fibrosis
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
What is the Aetiology of oral submucous fibrosis?
Chewing betal quid. Excessive consumptionof spicy food, malnurtriotn - Refer for biopsy and management as high risk of maligancy.
64
What are the clinical characteristics of Hairy Tongue
Excessively long filiform papillaethat becoe stained, generally black/brown discolouration.
65
What predisposing factors prompt Hairy Tongue?
Heavy smokers, poor OH, use of chlorhexadine MW, antibiotics. Tx: OH, eliminate predisposing factors (smoking). Sodium bicarb MR can help
66
What is the clinical appearance of nicotine stomatitis?
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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