The Mouth

Question 1

List of White intro oral lesions

Answer 1

Idiopathic keratosis
Leukoplakia
Lichen planus 
Poor dental hygiene
Candidiasis
Squamous papilloma 
Carcinoma 
Hairy oral leukoplakia 
Lupus erythematosus 
Smoking 
Aphthous stomatitis 
Secondary syphilis

Question 2

What is leukoplakia

Answer 2

Oral mucosal white patch that will not rub off and is not attributable to any other known disease. It is premalignant lesion, with a variable transformation rate
Oral hairy leukoplakia is seen in HIV caused by EBV

IF IN DOUBT REFER

Question 3

Aphthous ulcers

Answer 3

20% of people get shallow painful ulcers on the tongue oral mucosa that heal without scarring
Causes of severe ulcers, crohns, coeliac, behcets, trauma, erythema, multiform, lichen planus, pemphigoid, pemphigus, infection -herpes simplex, syphilis
Minor ulcers, trauma acidic foods
Treat minor, antimicrobial mouthwash, topical steroids, topical analgesia.
Severe ulcer treatment, systemic corticosteroids, or thalidomide
Any ulcer lasting 3weeks should be biopsies in case a malignancy.

Question 4

Candidiasis thrush

Answer 4

Causes white patches or erythema of the buckle mucosa. Patches may be hard to remove and bleed if scraped. Risk factors extremes of age diabetes mellitus antibiotics Immuno suppression, treatments- nystatin suspension, fluccanozole for oropharyngeal thrush

Question 5

Angular stomatitis

Answer 5

Fissuring of the mouth corners is caused by denture problems, candidiasis, or deficiency iron or riboflavin vitamin b12

Question 6

Gingivitis

Answer 6

Gum inflammation +- hypertrophy occurs with poor oral hygiene, drugs such as phenytoin, pregnancy, vitamin c deficiency and a acute myeloid leukaemia or Vincent’s angina.

Question 7

Microstomia

Answer 7

The mouth is too small from thickening and tightening of the Peri oral skin after burns or in epidermolysis bullosa (destructive skin and mucous membrane blisters +- ankyloglossia or systemic sclerosis.

Question 8

Oral pigmentation

Answer 8

Perioral Brown spots characterise Peutz-Jeghers. Pigmentation anywhere in the mouth suggests Addison’s disease or drugs such as antimalarials. You should consider malignant melanoma.
Telangiectasia - systemic sclerosis, Osler-Weber-rendu.
Fordyce glands - creamy yellow spots at the border of the oral mucosa and lip vermillion
Sebaceous cyst‘s are common and benign.
Aspergillosis niger causes a black tongue.

Question 9

Teeth

Answer 9

A blue line at the gum tooth margin suggests lead poisoning. Prenatal or childhood tetracycline exposure causes a yellow brown discolouration. White bands on the teeth can be caused by excessive fluoride intake.

Question 10

Tongue

Answer 10

This may be furred or dry in dehydration, drugs, after radiotherapy, Crohn’s disease, Sjorgens , Mikulicz’s syndrome.
Glossitis means a smooth red sore tongue E.G.caused by iron, folate, B 12 deficiency. If local loss of papillae leads to also ulcer like lesions that change in colour and size is it a geographic tongue (harmless migratory glossitis)
Macroglossia- The tongue is too big. Causes myxoedema, acromegaly, amyloid.
A ranula is a blueish salivary retention cyst to one side of the frenulum, named after the bulging vocal pouch of frogs throats.
Tongue cancer appears as a raised ulcer with firm edges. risk factors include smoking alcohol. Spread anterior third of the tongue drains to the submental nodes. The middle 3rd to the submandibular nodes. Posterior 3rd to the deep cervical nodes.