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My BDS3 > Paeds - Oral Medicine > Flashcards

Paeds - Oral Medicine Flashcards

1
Q

name viral fro-facial soft tissue infections. (3)

A
  1. Primary herpes
  2. Herpangina
  3. Hand foot and mouth
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2
Q

what causes primary herpetic gingivostomatitis?

A

herpes simplex virus 1

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3
Q

what is rarely affected by primary herpetic gingivostomatitis and why?

A

children in their 1st year of life - still have circulating maternal antibodies

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4
Q

how is herpes transmitted?

A

via droplets

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5
Q

what are the signs and symptoms of primary herpetic gingivostomatitis?

A

fluid filled vesicles which can rupture and leave painful ragged ulcers

severe oedematous marginal gingivitis

  • Fever
  • Headache
  • Malaise
  • Cervical Lymphadenopathy
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6
Q

how do we treat primary herpetic gingivostomatitis?

A

Bed rest
Hydrating and soft diet
Paracetamol
Antimicrobial gel/mouthwash

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7
Q

what can we use in immunocompromised children with primary herpetic gingivostomatitis that doesn’t work in healthy children?

A

acyclovir

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8
Q

how does primary herpetic gingivostomatitis present as a secondary infection?

A

cold sores

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9
Q

what triggers a secondary infection of primary herpetic gingivostomatitis?

A

sunlight

stress

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10
Q

what virus can cause hand, foot and mouth and herpangina?

A

coxsackie A

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11
Q

what is the difference between herpangina and primary herpetic gingivostomatitis?

A

the fluid filled vesicles which can rupture and leave painful ragged ulcers and found in the tonsillar/pharyngeal region.

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12
Q

how does hand foot and mouth present?

A

Presents initially with a fever, sore throat and a maculopapular rash in mouth which presents on hands and feet later

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13
Q

what do we want to investigate regarding ulcers in children? (10)

A
  1. Onset – when did it begin?
  2. Frequency
  3. Number
  4. Site
  5. Size – are they always the same size?
  6. Duration
  7. Exacerbating factors – dietary factors?
  8. Lesions in other areas
  9. Associated medical problems/ drugs
  10. Treatment so far – was it helpful?
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14
Q

what are the causes of oral ulceration in children? (9)

A
  1. The most common cause is no cause! - recurrent aphthous stomatitis
  2. Infection:
    • Viral – HFM, herpes simples, coxsackie
    • Bacterial – TB
  3. Immune mediated disorders:
    • Crohns
    • Coeliac
    • SLE
  4. Vesticulobullous disorders
  5. Inherited/aquire immunodeficiency
  6. Neoplastic- leukaemia
  7. haematological – anaemia
  8. trauma – physical, thermal or chemical
  9. vitamin deficiency – iron, B12, folate
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15
Q

what do recurrent aphthous stomatitis ulcers look like?

A

Round/ovoid
Yellow/grey base
Perilesional erythema

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16
Q

how do we classify recurrent aphthous stomatitis ulcers?

A
  • Minor = < 10mm – heal within 10-14 days
  • Major = > 10mm - heal within several weeks with potential scarring
  • Herpetiform = 1-2mm - multiple ulcers with no systemic symptoms
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17
Q

what are the causes of recurrent aphthous stomatitis ulcers?

A
  • Genetic predisposition
  • Haematological deficiency
  • GI disease
  • Stress
  • Trauma
  • Allergies
  • Hormonal disturbance
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18
Q

how do we manage recurrent aphthous stomatitis ulcers?

A
  • Correct nutritional deficiencies
  • Avoid sharp/spicy foods
  • Dietary exclusion in allergy
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19
Q

what are the aims of pharmacological management of recurrent aphthous stomatitis ulcers and what do we use?

A
  • Prevent superinfections – Corsodyl 0.2%
  • Protect healing ulcers – gelclair mouthwash
  • Provide relief of symptoms – diflam or LA spray
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20
Q

what’s the common age of onset for orofacial granulomatosis?

A

11

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21
Q

what can orofacial granulomatosis in children predict in the future?

A

Crohns disease

22
Q

what are the features of OFG?

A
  • Lip swelling (common)
  • Full thickness gingival swelling
  • Swelling of non-labial facial tissues
  • Cobblestone mucosa
  • Lip/tongue fissuring
  • Angular chelitis
23
Q

What is the cause of OFG?

A

Atopic allergy - cinnamon and benzoate’s

24
Q

what investigation is useful in determining OFC from crohns disease?

A

Measure growth as crohns is associated with growth failure and pubertal delay

25
Q

what is the most common mucosal lesion of the tongue in children?

A

geographical tongue

26
Q

what does geographic tongue look like?

A
  • Smooth red areas from loss of filiform papillae
  • Surrounded by white margins
  • Areas migrate
27
Q

how do we rule out haematinic deficiency as the cause of geographic tongue?

A

if the tongue is sensitive to foods

28
Q

how do we manage geographic tongue?

A
  • Reassurance

- Bland diet during flare ups/dietary restrictions

29
Q

name solid swellings that can affect children tongues.

A
  1. Fibroepithelial polyp
  2. Epulides
  3. Congenital epulis
  4. HPV associated mucosal swellings
  5. Neurofibromas
30
Q

what causes fibroepithelial polyps?

A
  • Minor trauma

- Irritation

31
Q

where are fibroepithelial polyps commonly found?

A
  • Cheeks
  • Lips
  • Tongue
32
Q

what are epiludes?

A

Benign hyperplastic lesions

33
Q

what are epiludes caused by?

A

chronic irritation i.e. from calculus and plaque

34
Q

where are epiludes commonly found?

A

Anterior to the molar teeth in the maxilla

35
Q

name the types of epiludes.

A
  • Fibrous
  • Pyogenic
  • Peripheral giant cell granuloma
36
Q

what type of epilude appears the same colour as the surrounding gingivae?

A

fibrous epilude

37
Q

what type of epilude forms interproximally and is hourglass shaped?

A

peripheral giant cell granulomatosis

38
Q

what makes peripheral giant cell granulomatosis histologically distinct?

A

Has focal collections of multinucleate osteo-clast like giant cells seen lying in a richly vascular and cellular stroma

39
Q

where are congenital epiludes commonly found?

A

incisor area of the maxilla

40
Q

name the type of oral swelling associated with HPV 2 &4.

A

Verruca vulgaris

41
Q

name the type of oral swelling associated with HPV 6 &11.

A

squamous cell papillomas

42
Q

describe how HPV associated swellings appear in the mouth.

A

Pedunculated Cauliflower growths

43
Q

what is a mucocele?

A

a fluid swelling/Cyst arising from a minor salivary gland

44
Q

name the two types of mucoceles and what they are caused by?

A
  1. Extravasion cysts = caused by rupture of the salivary duct
  2. Retention cysts = caused by Cystic dilation
45
Q

what is a ranula?

A

A mucocele (fluid swelling) arising from a salivary duct/gland on the floor of mouth.

46
Q

what are ranulas further investigated?

A

Could be a plunging ranula – extends into the submental/submandibular space - requires specialist intervention

47
Q

what are Bohns nodules?

A

Benign Gingival cysts filled with keratin which are remnants of the dental lamina. – disappear by 3 months old .

48
Q

what is TMJ dysfunction characterised by?

A
  • Pain
  • Masticatory muscle spasm
  • Limited jaw opening
49
Q

what is normal opening of the jaws?

A

40-50mm

50
Q

What shoulf we ask when taking a history of TMJ dysfuntion?

A
  • Description of symptoms – clicking, cracking?
  • When the discomfort started – any trauma?
  • When is it painful – in morning? (nocturnal clenching)
  • Is there anything that makes the pain worse – chewing, yawning?
  • Have they got anything stressful going on? – exams, death?
51
Q

how do we manage TMJ dysfunction?

A
  • Explain the condition
  • Reduce exacerbating factors – manage stress and bite raising appliance
  • All muscles to rest – avoid wide opening and soft diet
  • Symptomatic relief – ibuprophen and hot/cold packs

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