Special Care - Older people: oral medicine Flashcards
What is an haemangioma?
malformation of small blood vessels
where are haemangiomas found?
anywhere
commonly;
the lip
side of the tongue
under the tongue
What is a fibroepithelial polyp?
overgrowth of the mucosa after healing
(looks identical to healthy mucosa just more of it)
What is black hairy tongue?
overgrowth of the surface of the tongue which becomes stained.
can have a foul smell
How can we treat black hairy tongue?
Clean tongue with a toothbrush
What is atrophic glossitis?
An overly smooth/shiny tongue which can become ulcerated.
What causes atrophic glossitis?
iron deficiency
What is frictional keratosis?
keratinised areas around sites of trauma
what is speckled leukoplakia?
a unilateral or bilateral premalignant lesion
Where is speckled leukoplakia found? (2)
angle of the mouth
Smokers
When should we refer sublingual keratosis?
if it crosses the midline
What denture related problems can older people encounter?
traumatic keratosis
denture induced hyperplasia (looks like healthy tissue)
denture stomatitis (painless erythema)
angular chelitis
What are causes of xerostomia?
polypharmacy
sjogrens syndorme
radiotherapy
How do we manage dry mouth?
Change the medication – difficult
Salivary replacement – saliva orthana, biotene oral balance, bioXtra (don’t use glandosane as its very acidic) the effects are very short lived.
Salivary stimulus – chewing gum, glycerine and lemon
What does lichen planus look like within the mouth
white striae on the buccal mucosa, lips, gums and attached gingivae
what are the types of lichen planus?
erosive
reticular
what drugs can cause lichen planus? (7)
NSAIDS BB Diuretics oral hypoglycaemic statins antimalarials sulphonamides
What are Bisphosphonates taken for?
osteoporosis malignancies - multiple myeloma, breast, prostate padgets disease CF primary hyperparathyroidism
What is the action of Bisphosphonates?
inhibits osteoclast formation and migration and therefore inhibits bone turn over
What increases the risk of MRONJ?
how long Bisphosphonates been used for
extremes of age
concurrent use with corticosteroids
Potency and type of Bisphosphonates
use of Bisphosphonates in treating malignancy
chemo/radio therapy
systemic disease affecting bone turnover
What is herpes zoster?
unilateral reactivation of the varicella zoster virus on any branch of the trigeminal nerve which leads to shingles
what are the symptoms of herpes zoster/shingles?
Prodromal pain
followed by a unilateral rash that appears on the dermatome supplied by a branch of the trigeminal nerve
What is post herpetic neuralgia?
Complication of shingles where there is a constant burning sensation on a dermatomal distribution site once it has resolved
Who is at risk of post herpetic neuralgia?
those who have had shingles previously
How do we treat the pain from post herpetic neuralgia? (3)
gabapentin and carbamazepine
transcutaneous electrical nerve stimulation
antidepressants
What is trigeminal neuralgia?
a lancinating pain which commonly affects the maxillary and mandibular branches of the trigeminal nerve.
can either be spontaneous or triggered by an activity
How do we treat trigeminal neuralgia?
can only manage via carbamazepine
Who is affected by burning mouth syndrome?
females
those with anxiety and/or depression
What causes burning mouth syndrome?
50% no cause
20% psychogenic
dry mouth
candidiasis
haematinic deficiency
diabetes
Where are common sites of oral cancers?
lateral aspect of tongue
ventral tongue
buccal corridors
What are the physical attributes of oral cancer? (4)
heaped
speckled
white patches
different colour than healthy mucosa
