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BDS4 BAMS > Oral Mucous diseases > Flashcards

Oral Mucous diseases Flashcards

1
Q

what medicines are used in oral med

A

anti virals - acyclovir
antifungals - nysatin, fluconazole
topical steroids
benzdamine mouthwash
carbamazepine

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2
Q

what is benzdamine mouthwash useful for

A

it is a non steroidal anti inflammatory, can provide analgesia for oral ulcers - make eating easier

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3
Q

what is a licensed medicine

A

a medicine that has been proven in evidence to the MHRA to be significantly effective at treating a disease - usually by clinical trial

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4
Q

what is an unlicensed medicine and give an example used in oral med

A

a medication that has not proven efficacy for the condition it is being treated for. It will be a licensed but for another condition, however, it doesnt mean it is not effective at treating the other condition. Just no evidence has been supplied. Inhaled steroid - beclomethasone

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5
Q

when supplying an unlicensed medicine what information must be given to patients

A

that it is being used for an unlicensed use - other medical conditions. But that it is proven to be effective at treating this condition
explain dose range and frequency of use
explain hazards of exceeding standard dose
explain possible side effects
add special instructions

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6
Q

what is the SDCEP guidance for steroid and non-steroid topical therapy in oral mucous lesions

A

non-steroid topical therapy should be used for inconvienent lesions with discomfort
steroid topical therapy should be used for disabling immunologically driven lesions

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7
Q

give examples of non-steroid topical therapy

A

chlorhexidine mouthwash
benzdamine mouthwash
OTC medication - igloo, listerine, bonjela

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8
Q

give examples of steroid topical therapy

A

hydrocortisone mucoadhesive pellet
betamethasone mouthwash
meclomethasone metred dose inhaler

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9
Q

how do hydrocortisone mucoadhesive pellets work

A

place over ulcer, then dissolves to form gel - covers the ulcer and releases hydrocortisone - concentrated in this are

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10
Q

how does the betamethasone mouthwash work and what should the patient be told about this

A

dissolve 2 0.5mg tablets in water, swirl around mouth and spit out. must be told to not swallow any mouthwash as it will have a systemic effect. there is also a small risk of oral candida

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11
Q

how does beclomethasone MDI work and why does it have to be a MDI

A

puffer is placed over ulcer and puffed twice - releases particles which are absorbed by tissue. Cannot be breathed activated device as would not be breathing into it

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12
Q

what mucosal lesion should a gdp refer

A

anything suspected to be cancer or dysplasia - cancer referral to hospital
any symptomatic oral lesions that cannot be controlled with SDCEP guidelines - prescribed all they can but symptoms not going away
any benign lesion that the patient cannot be convinced isnt cancer

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13
Q

what does orthokeratosis mean

A

thickening of stratum corneum layer of epithelium - in gingiva and hard palate where trauma is expected

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14
Q

what does parakeratosis mean

A

loss of non-nucleated cells in the epithelium, loss of stratum corneum

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15
Q

what layers make up epithelium

A

stratum basale, stratum spinosum, stratum granulosum, stratum lucidum and stratum corneum, and lamina dura

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16
Q

what are some reactive changes of the oral mucosa to disease in histology

A

keratosis - thickening of keratinised layer
acanthosis - hyperplasia of stratum spinosum
elongated rete ridges - hyperplasia of basal cells

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17
Q

what can be seen in the mucosa in response to disease or trauma

A

atrophy - loss of layers
erosive - partial thickness loss
ulcerative - fibrin on surface
oedema - within cells - intracellular or between cells - intercellular
blister - vesicle or bulla

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18
Q

what are common benign lesions of the tongue

A

hairy tongue, geographic tongue

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19
Q

what are symptoms of geographic tongue

A

sensitivity to acidic or spicy foods - due to thinning of epithelium

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20
Q

give an example of a type 3 hypersensitivity reaction

A

erythematous multiforme

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21
Q

give an example of antibody mediated reaction

A

pemphigoid, pemphigus

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22
Q

what is a systemic disease with local consequences

A

sjorgens syndrome, systemic scerlosis, pemphigoid

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23
Q

what is erythema multiforme, how does it present and how is it treated

A

antibody-antigen complex is large and wedges in capillaries, causes complement, results in inflammation. clinical signs include crusting of lips, vesicles/erosion around front of mouth, can include skin. very painful, can affect eating and drinking and result in dehydration. must be treated with immunosuppressants and can use acyclovir

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24
Q

what is angina bullous haemhorrhagica, how does it present and how is it treated

A

tight blood blisters, caused by trauma (eating or steroidal inhaler), normally asymptomatic but at vibrating line might be painful, burst after an hour, leave blood stained fluid and ulcer appearance. treated by treating symptoms - chlorhexidine mouthwash or difflam spray

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25
Q

what is the immunology of pemphigoid

A

antibody attacking hemi desmosomes, causes epithelium to come away from basement membrane and CT, allows fluid and inflammatory exudate to flow in, produces large bullae, thick and full of epidermis

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26
Q

how does pemphigoid present clinically

A

multiple thick large bullae, normally persistant but if they burst, expose underlying connective tissue

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27
Q

how does pemphigoid present on immunofluorescent

A

biopsy should be taken from peri lesion tissue, immunofluorescent of linear along basement membrane, as antibody binds along here

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28
Q

how is pemphigoid treated

A

immunosuppressant to reduce antibody activity - prednisolone, azathioprine, mycophenolate, dapsone

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29
Q

what is the immunology of pemphigus

A

antibodys attack desmosomes, bind epithelial cells together, allows for separation of cells, intra epithelial fluid and bullae

30
Q

how does pemphigus present clinically

A

very rarely presents with bullae, desquamative gingivitis - bullae have burst and epithelium has thinned out, erythematous, shedding of top layer

31
Q

how does pemphigus present in immunofluorescence

A

basket weave appearance - desmosomes surround cells therefore antibody attacks on all surfaces - enclosed in green but only supra basal, not below BM

32
Q

how is pemphigus treated

A

immunosuppressants and immune modulating medications - prednisolone, azathioprine, dapsone, mycophenolate

33
Q

what is the role of saliva

A

IgA for immunity, antimicrobial, acidity buffering, lubrication

34
Q

what are causes of a dry mouth

A

medication, radiotherapy, salivary disease, infection, anxiety

35
Q

what medications can result in a dry mouth

A

tri-cyclic antidepressants - amytriptaline,
diuretics - bendrofluazide
lithium

36
Q

what medical conditions can have an indirect effect on saliva

A

diabetes, renal disease, addisons disease, stroke

37
Q

what medical conditions have a direct effect on saliva

A

ectodermal dysplasia, sarcoidosis, amyloidosis

38
Q

how does HIV cause salivary gland enlargement

A

lymphoproliferative change into gland, reduces function but increases bulk

39
Q

what are the parts in the challocombe scale of mucosal dryness

A

scale of severity of dryness
part 1 - score 1-3 - mirror sticking to tongue or buccal mucosa, mild, sips of water and gum required - medication related
4-6 - glossy appearance of gingiva, reduced papillae of tongue, no saliva pooling - moderate - requires enhanced prevention
7-10 - debris sticking to teeth and palate, smooth mucosa, scarring of tongue - requires specialist input

40
Q

what tests should be done when investigating salivary disease

A

FBC
U&E’s
LFT
antibody test - ro and la
glucose test - diabetes
functional assay test
labial gland biopsy
sialogram
ultrasound

41
Q

what is sialography and when should it be done

A

should be carried out when duct obstruction suspected but no stone seen in radiograph - could be mucous plug
this investigates architecture of duct whilst washing it through - dislodging plug

42
Q

how should subacute obstruction of salivary gland be managed

A

removal of sialoth if possible
sialography if suspect mucous plug
if fixed and painful - consider gland removal but only if benefit to the patient

43
Q

what is sialosis and how does it differ from sjogrens

A

hyperplasia of gland tissue
on biopsy - tissue normal just more of it
doesnt normally cause dry mouth
no symptoms associated - mild discomfort
diagnosis of exclusion

44
Q

what is sjogrens syndrome

A

an autoimmune disease affecting the acinar of salivary and lacrimal glands

45
Q

what other diseases can be associated with sjogrens syndrome and what is the name for this

A

undifferentiated connective tissue disease - rheumatoid arthritis, SLE (lupus) and sclerodema

46
Q

what components contribute to autoimmune disease

A

genetics, infection, diet and toxins

47
Q

what are the classifications of sjogrens syndrome

A

primary - no other connective tissue disease, begins with sjogrens
secondary - other connective tissue disease present which begins first

48
Q

what are the consequences of sjogrens syndrome

A

increased caries risk, increased risk of infection, increased risk of lymphoma, difficulty swallowing

49
Q

what must be present for an AECG diagnosis of sjogrens syndrome

A

must have at least 4 of the following
oral symptoms - dry mouth ongoing for at least 3 months, use of water to aid swallowing, salivary gland involvement
ocular symptoms - dry eyes ongoing for at least 3 months, use of tear replacement, sensation of sand or gravel in eye
histology
antibodies - ro or la
ultra sound
functional saliva test

50
Q

what is the histology in sjogrens syndrome

A

50 lymphocytes surrounding ductal acinar - forms focus
must have more than 1 focus for diagnosis

51
Q

what is the ultrasound appearance of sjogrens

A

leopard spot - holes in gland where tissue is missing

52
Q

what has the most weighting in the ACR-EULAR diagnosis of sjogrens

A

labial gland biopsy
then anti-ro
then swallowing test

53
Q

how is a dry mouth managed

A

if the cause can be removed - should do so. I.e. medications removed or changed (anti-muscarinic), diabetes better control, increase hydration

if not, salivary replacements used

54
Q

name some salivary substitutes

A

glandosane, salivary orthana
biotene gel and mouthwash
lozenges, chewing gum

55
Q

what tests can be done to check for crohns in OFG

A

faecal calprotectin

56
Q

what test can be done to check for coeliac in ulcer patients

A

TTG

57
Q

how should OFG be managed initially

A

consider if part of GI problem - crohns - calprotectin
diet history - overuse of allergens - complete exclusion dietary trial
topical treatment - miconazole for A.C., tacrolimus ointment
intralesional steroid injection
systemic treatment - azithromycin, prednisolone

58
Q

what should be avoided in exclusion trial

A

benzoic acid
sorbic acid
cinnamon
chocolate

59
Q

what drives gingival lichen planus

A

plaque - requires good oral hygiene

60
Q

what can gingival lichen planus appear as

A

pemphigus or pemphigoid
LP is most common

61
Q

how can you tell gingival lichen planus from gingivitis

A

full thickness of gingiva inflammed, not just at marginal gingiva

62
Q

what would raise suspicision for cancer referral

A

persistent, unexplained head and neck lumps longer than 3 weeks
ulceration or unexplained swelling of oral mucosa for more than 3 weeks
all red or mixed red and white patches of the oral mucosa for more than 3 weeks

63
Q

what is done at max facs after referral

A

biopsy
lymph node biopsy
ct scan
patient medical assessment
stage and grade

64
Q

what is the aim of the dental pre-assessment prior to cancer treatment

A

identify any existing oral disease or potential sources of disease
remove infection and potential infection prior to treatment
prepare the patient for the expected side effects
establish a good base line for oral hygiene
develop plan for maintaining oral hygiene and prevention

65
Q

what treatment can you provide at a pre-assessment

A

definitively restore teeth
extraction of hopeless teeth
PMPR
fluoride varnish
impressions - for planning restorative work and to produce mouthguard
OHI - for when mouth is sore too

66
Q

what is the role of the dentist during cancer treatment

A

denture and oral hygiene
chlorhexidine mouthwash - can be diluted if too stingy
diet advice
delivering fluoride
symptomatic relief of xerostomia
assess for opportunistic infections

67
Q

what is mucositis and when can it occur

A

inflammation and ulceration of the mucosa
starts 1-2 weeks after beginning treatment and can last for 6 weeks after treatment

more common with chemotherapy

68
Q

how can mucositis be treated

A

strong analgesic
good oral hygiene
remove sharp edges or provide mouthguard to reduce rubbing of teeth
oral cooling
mouth rinses - calcium phosphate, tee tree oil, aloe vera

69
Q

why is it important to treat herpes labialis before appearance in cancer patients

A

has an atypical clinical appearance, ulcerative and very painful
better to treat prophylactically or treat when tingling felt

70
Q

what is osteoradio necrosis

A

an area of exposed bone of at least 3 months duration in an irradiated site

71
Q

how is ORN prevented

A

remove teeth of doubtful prognosis in the radiation field prior to treatment - 10 days prior to treatment
high prevention
close extraction sites with primary closure
antibiotic prophylaxis and continued antibiotics until healing achieved

72
Q

what increases the likelihood of someone developing ORN

A

trauma as a result of extraction - periodontitis, ill fitting dentures
radiation dose higher than 60 greys
patient is immunodeficient
patient is malnourished

BDS4 BAMS (4 decks)

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