Swelling & Ulceration

Question 1

Definition of congenital

Answer 1

Disease, defect or deformity dating from birth but not hereditary

Question 2

VIITAMIIN meanings

Answer 2

Vascular
Infection
Inflammatory
Trauma
Autoimmune
Metabolic
Iatrogenic
Idiopathic
Neoplasm

Question 3

Important features to note of a mucaosal swelling

Answer 3

site/shape/colour/surface/consistency/bleeding/functional limitation
Pedunculated - stalk Sessile - broad base

Question 4

Denture induced hyperplasia cause

How to combat during impression stage of new denture

Answer 4

Poorly fitting/old denture/combination syndrome
Chronic trauma of buccal sulcus
Can also cause a leaf fibroma to form

Impression compound used as a base impression then window cut out for use of PVS lightbody in areas of significant hyperplasia

Question 5

Fibroepithelial polyp presentation

Treatment

Answer 5

Chronic trauma/frictional irritation
Semi pedunculated/sessile
pink and smooth - buccal mucosa or inner lip surface

Surgical excision

Question 6

drug induced firous overgrowth causes

Treatment in accordance with SDCEP

Answer 6

Phenytoin - antiepileptic
Amlodipine -Calcium channel blocker
Ciclosporin - immunosuppresion

-non-surgical treatment but in more severe cases modification of the drug regimen by the patient’s physician may be considered. Periodontal surgery may also berequired to reduce and recontour the gingival enlargement.

Question 7

Pregnancy gingivitis causes and treatment in accordance with SDCEP

Answer 7

Increased progesterone levels, causing a greater inflammatory responce to plaque levels

-Where the condition is mild, use the Oral Hygiene TIPPS behaviour change strategy to
highlight the importance of effective plaque removal and to show the patient how she can
achieve this. Where applicable, give smoking cessation adviceWhere the condition is severe, give oral hygiene and smoking cessation advice as detailed
above. Remove supra-gingival plaque, calculus and stain and sub-gingival deposits using
an appropriate method. Highlight to the patient areas where supragingival deposits are detected. These patients may require more frequent recall visits during
pregnancy and additional care.
Ensure that local plaque retentive factors are corrected - for example, remove overhanging
restorations or alter denture design
Explain to the patient that the condition is likely to resolve once her baby is born or following
the cessation of breastfeeding, assuming her oral hygiene is adequate.
Re-assess at a future visit to determine whether the gingivitis has resolved.

Question 8

what is a pyogenic granuloma?

Treatment?

Answer 8

Hyperplastic lesion of granulation tissue - failure of normal healing . A proliferating mass of endothelial cells and fibroblasts.

• Clinically - soft red painless pedunculated lesion. Gingivae - epulis, Anywhere else - granuloma
• Histology - dilated blood vessels, loose oedematous CT stroma. Over time becomes more fibrous. Inflammation variable- usually absent

Treat - excision and currettage of base.

Question 9

What is a giant cell epulis?

Treatment?

Answer 9

Hyperplastic lesion - arises on gingival margin interdentally. Caused by local chronic irritation, infective agent eg TB, hormonal disturbance - PT hormone
- Clinically - rounded soft maroon/purple 2cm
-Histology - Numerous multinucleated cells lie in vascular stroma of spindle cells
Superficial to cortical bone

Treatment - excision and currettage of base
Need xray to ensure not centrally originating, excluse systemic disease - PT hormone levels >, low vitamin D in diet, malabsorption, renal disease

Question 10

Features of OFG

Answer 10

Lymphacytic obstruction from giant cell granulomas, accumulation of fluid causing oedema.
Related to T4 hypersensitivity - Cell mediated
Crohn’s disease or Sarcoidosis
Clinically - swollen lips/cheeks/gingivae
mucosal tags, cobblestoning of buccal mucosa, erythema of gingivae, apthous pattern ulceration, Angular chelitis
Allergey to benzoates, cnammonaldehyde, sorbic acid, chocolate

Question 11

Features of crohns

Answer 11

Inflammatory bowel disease - any part of GI tract

Question 12

Ulceration causes

Answer 12

-Trauma - Remove cause and should heal in 2 weeks
-infection
Immunological - RAU, lichen planus, lupus, vesiculobullous, erythema multiforme
GI - crohns/UC
Carcinoma,
Drugs - nicorandil

Question 13

Management of ulceration

Answer 13

-Dietary avoidance - benzoates, sorbic acid, cinamonaldehyde
- Antibiotics - macrolides
intralesional steroid inj
oral steriods +/- Azathiprine

Question 14

RAU Features & Treatment

Answer 14

Onset frequently in childhood, attacks variable time frame, healthy aptient otherwise, non smokers
Preceded by prodromal phase

-Treatment - Self limiting, advise Salt water to garge 2x daily
If symps:
- Prescribe benzydamine MW 300ml 0.15% (LA)
- Lidocaine ointment 15g tube 5%
If severe:
- Beclometasone inh 50microg - 1-2puffs 2x daily
- Betamethasone tablets (500mg) 2 tablets, dissolved in 2ml water and swished for 2mins 2x daily
- CHX Mw 0.2% 300ml, rinse with 10ml 2x daily for 1 min

Question 15

What is Behchet’s disease?
Where is it most common and features
Name the 4 patterns of disease
Diagnosis and management

Answer 15

Systemic vasculitis of small blood vessels
Common in Turkey, central asia and middle east. Young adult males 20-40yr

• Mucocutaneous -Oral apthae, general ulceration and rashes, erythema nodosa
• Arthritic - joint invilvement, large weight bearing joints, pain but NO destructive arthritis
• Neurological - Vasculitis within brain = sensory and motor disturbance, seizures, confusion. Thrombosis of vessels - >intracranial pressure, blurred vision and headaches.
• Ocular - Inflammation and thrombosis of renal artey = blind

Diag/manage = Ciclosporin and tacrolimus, steroids for acute exaccerbations

Question 16

How does Nicorandil cause ulcers.

Features?

Answer 16

Nicorandil is a potassium channel activator, this causes dilation of arterioles in angina. This can cause ulceration of skin and mucosa. Usually on lateral border of tongue, buccal mucosa, gingivae 1-3cm. Also delay wound healing.
V Painful, deep and punched out overhanging margin

Question 17

What is primary herpetic gingivostomatitis.

Treatment of this condition.

Answer 17

A viral infection (HSV) that causes multiple painful small ulcers intraorally with halitosis and a refusal to brush teeth. These can discourage patients from eating and drinking and so cause dehydration. There can be a systemic involvement causing malaise, fever and regional lymphadenopathy.

Treat - supportive - bed rest, fluids, ibuprofen/paracetemol (calpol in small children)
Aciclovir only if patient is immunocomprimised.

Question 18

FBC contents and normal levels

Answer 18

RBC count, MCV(80-100), WCC , Haemoglobin Concentration, Platelet count(150-400, <50 don‛t treat)
Haematinics: ferratin, folate, vit B12