Overview of Oral Medicine Flashcards
Linea Albea
Elevation of buccal mucosa
Level of occlusal plane
Bilateral
White
Bruxism
Morsicatio
Buccal/labial mucosa
Lateral/labial tongue
Roughened/ragged/thickened surface plaque; may also see ulceration and erosion intermixed
Leukoedema
White-gray translucent appearance of the buccal mucosa
Superficial intra-epithelial oedema and retention of superficial keratin
Bilateral, soft to palpate
Disappears when mucosa stretched
Fordyce spots
Developmental anomaly
Sebaceous glands
Buccal/labial mucosa and vermillion borders of the lips
Numbers increase with advancing age
They do not require treatment unless for cosmetic concerns
Fissured tongue
5% of the population and increases with advancing age
M:F
Sometimes seen in combination with erythema migrans
Asymptomatic
Varix
Red/blue/purple elevations of oral mucosa
<5mm
Buccal mucosa/lip/lateral and ventral tongue and floor of mouth
Asymptomatic and blanch on diascopy
Circumvallate papillae
8-12 mushroom shaped swellings
Junction of the anterior 2/3 and posterior 1/3 of the dorsal aspect of the tongue
Supplied with taste buds responsive to bitter flavours
Foliate papillae
Folds, grooves on the posterior lateral aspect of the tongue
Lingual tonsils found immediately below
Torus Palatinus
Developmental malformation
Firm swelling midline of palate
20% of population
Can occur at any stage
Variable shape and size
Bony tissue covered by normal mucosa
Ulceration if traumatised
Torus Mandibularis
Firm bony swelling
Normal overlying epithelium
Torus mandibularis - 6%
Ulceration
Fibrous developmental malformation
Rare developmental swelling
Fibrous overgrowth
Maxillary tuberosity
Asymptomatic
Normal tissue appearance
Erythema Migrans
2% population
Irregular depapillated erythematous areas
Fissured tongue
Appears and regresses
Usually asymptomatic
Symptomatic:
Zinc mouthwash
Corticosteroid mouth rinses
Traumatic ulceration
Not site specific
Variable size and margins
Fibrinous base
Induration
Recurrent Aphthous Stomatitis
Recurrent episodes of ulceration in otherwise healthy individual
Common (80% population)
Aetiology - stress/trauma
Three sub-types: minor/major/herpetiform
Recurrent aphthous stomatitis minor
Most common
Crops of ulcers
<1cm in diameter
Oval in shape
Non-keratinised mucosa
Heal within 14 days
Recurrent aphthous stomatitis major
Uncommon (10%)
1-5 ulcers
Affect keratinised and non-keratinised mucosa
Large
Persist for weeks
Heal with scarring
Recurrent aphthous stomatitis - Herpetiform
Uncommon
Recurrent crops of multiple small ulcers
Often coalesce to form irregular areas of ulceration
Can affect any mucosal site
Heal within 14 days
No scarring
Management of RAS
SLS free tp
Mucosal protectants
Topical analgesics
Topical antimicrobials - corsydl mouthrinse
Topical steroid preparations - reducing healing time
Symptomatic management RAS
Orobase (reduces pain)
0.15% Benzydamine hydrochloride mouthrinse (reduces pain)
Chlorhexidine gluconate mouthwash 0.2% (aids healing)
Doxycycline 100mg soluble tablets as mouth rinse (anti-inflammatory)
Hydrocortisone oromucosal tablets 2.5mg (aids healing)
When to refer RAS?
Single ulcers persisting for 3+ weeks
Speckling
Induration
Uncertain aetiology
Significant impact on quality of life
Recalcitrant ulceration
Lichen Planus
Chronic inflammatory autoimmune disease
Affects SSE
Posterior buccal mucosa/tongue/gingivae/labial mucosa and vermilion of lower lip
Lesions on the palate, floor of the mouth and the upper lip
1-2% of population
2F:M
Risk of malignant transformation 1-3%
Reticular lichen planus
Network of connecting and overlapping lines, papules or plaques
Rarely symptomatic
10% gingival involvement
Erosive lichen planus
Ulceration within areas of hyperkeratosis, atrophy
Variable degrees of soreness
Atrophic lichen planus
Erythematous lesions
Desquamative gingivitis
Most common type of gingival LP
Variable degrees of soreness
lichen planus E/O lesions
Skin - 15% pts
Nails
Scalp
Oral candidosis
50% of pts wearing removable dentures
65% of pts in acute and long term care facilities
Pseudomembranous candidosis
Creamy plaques
Large areas of oral mucosa
Wiped off
Erythematous base
Acute erythematous candidosis
Antibiotic use
Red areas
Common sites
Painful
Chronic erythematous candidosis
Denture stomatitis
Chronic erythema of denture bearing area
Hyperplasia
Median rhomboid glossitis
Rhomboid area
Midline dorsum of tongue
Asymptomatic
Atrophic filliform papillae
Predisposing factors - smoking and undiagnosed diabetes
Angular cheilitis
Erythematous fissuring at commissures
2%
Mixed infection
Management of oral candidosis
Biguanide antiseptics
Polyenes (nystatin suspension)
Azoles e.g., miconazole (Daktarin)
Leukoplakia
A white patch of questionable risk
Cannot be characterised clinically or histopathologically as any other disease
Middle ages and elderly
Smokers
Clinical presentation of leukoplakia
Asymptomatic - homogenous/thin/flat
Symptomatic- non homogenous/ speckled/ nodular/ verrucous
Management of leukoplakia
Removal of aetiological factors
Preventative measures
Surveillance
Oral cancer
Malignant neoplasm of upper aerodigestive tract
SCC
Metastasise
Epidemiology of oral cancer
2% cancers
>55 yrs
NI - 329 cases per year
2M:F
Stage 1 - 91% at one year follow up, 60% at 5 year follow up
Stage 4 - 57% at one year follow up, 24% at 5 year follow up
How does oral cancer arise?
Mutation
Oncogenes
Tumour suppressor genes
What are risk factors for oral cancer?
Smoking/Alcohol/UV light/ Other e.g., potentially premalignant oral epithelial lesions (PPOEL)
