The Mouth

Question 1

What are the causes of mouth ulcers?

Answer 1

Idiopathic
GI disease (IBD)
Infection
Systematic disease (SLE, Bechet syndrome)
Trauma
Neoplasia
Drugs (chemo, erythema multiform major)
Skin disease (pemphigoid, lichen planus)

Question 2

What are types of infection that can cause mouth ulcers, with examples of each?

Answer 2

Viral - HSV, HIV, Coxsackie
Fungal - candidiasis
Bacterial - syphilis, TB

Question 3

What is the most common type of mouth ulcers?

Answer 3

Idiopathic aphthous ulceration

Question 4

What do recurrent aphthous ulcers look like?

Answer 4

Recurrent painful round mouth ulcers with inflammatory halos

Question 5

How are minor and major recurrent aphthous ulcers differentiated?

Answer 5

Minor are <10mm in diameter and heal within 14 days without scarring
Major are >10mm in diameter and often persister weeks or months, leaving scarring

Question 6

Who do recurrent aphthous ulcers most commonly affect?

Answer 6

Females
Non-smokers
Appear first in childhood and reduce before the age of 40

Question 7

How are recurrent aphthous ulcers managed?

Answer 7

Avoid oral trauma and acidic food and drink

Topical or systemic corticosteroids (tetracycline mouthwash, azathioprine) may lessen duration and severity

Question 8

What are examples of premalignant mouth lesions?

Answer 8

Leukoplakia (white adherent patch)
Lichen planus
Submucous fibrosis
Erythroplakia (red patch)

Question 9

How do malignant tumours of the mouth appear?

Answer 9

On floor of mouth or lateral borders of tongue
Early lesions may be painless
Advanced tumour are hard indurated ulcers with raised and rolled edges

Question 10

Who tends to get tumours of the mouth?

Answer 10

Smokers
Alcohol excess
Areca nut
HPV

Question 11

What type of tumour are mouth tumours?

Answer 11

Squamous cell carcinoma

Question 12

How are tumours of the mouth managed?

Answer 12

Surgical excision

Question 13

What could an oral white patch be?

Answer 13

Transient - candidiasis, SLE (rare), trauma from chemicals, mechanical or drugs
Persistent - leukoplakia or oral lichen planus

Question 14

Which patients are more likely to get candidiasis?

Answer 14

Broad spectrum antibiotics
Inhaled steroids
Diabetes
Seriously ill or immunocompromised patients

Question 15

What risk factors are leukoplakia associated with?

Answer 15

Alcohol abuse and smoking

Question 16

What will a biopsy of leukoplakia show?

Answer 16

Alteration in keratinisation

Dysplasia of the endothelium

Question 17

What causes the oral pigmented lesion amalgam tattoo?

Answer 17

Blue-black macules involve the gingivae.

Results from dental amalgam sequestering into the tissues

Question 18

What diseases cause pigmentation?

Answer 18

Peutz-Jeghers syndrome

Addison’s disease

Question 19

What cause pigmentation of the gums?

Answer 19

Heavy metals

Drugs

Question 20

Describe glossitis.

Answer 20

A red, smooth, sore tongue

Question 21

Which deficiencies are associated with glossitis?

Answer 21

Vitamin B12
Folate
Iron
Riboflavin
Nicotinic acid

Question 22

What causes a black hairy tongue?

Answer 22

Proliferation of chromogenic microorganisms causing brown staining of elongated filiform papillae

Question 23

What is a geographic tongue?

Answer 23

Idiopathic condition, usually painless and patients should be reassured.
Erythematous areas surrounded by well defined, slightly raised irregular margins

Question 24

What are the gingivae?

Answer 24

The gums

Question 25

What is the purpose of the gums?

Answer 25

A mucous membrane covering the alveolar processes of the mandible and maxilla

Question 26

What diseases affect the gums?

Answer 26

Chronic gingivitis
Acute necrotising ulcerative gingivitis (Vincent’s angina)
Desquamative gingivitis
Gingival swelling

Question 27

What is the cause and management for chronic gingivitis?

Answer 27

Cause: bacterial plaque
Management: plaque removal

Question 28

What is the cause and management for acute necrotising ulcerative gingivitis (Vincent’s angina)

Answer 28

Cause: spirochete and fusiform bacteria due to poor hygiene and smoking
Management: oral metronidazole, chlorohexidine mouthwash

Question 29

What is the cause and management for desquamative gingivitis?

Answer 29

Cause: lichen planus or mucous membrane pemphigoid
Management: confirmation with biopsy

Question 30

What is the cause and management for gingival swelling?

Answer 30

Cause: inflammation, infiltrations or fibrous hyperplasia
Management: depends on cause

Question 31

Which virus is strongly associated with characteristic oral lesions?

Answer 31

HIV, less common with the introduction of anti-retroviral therapy

Question 32

What are examples of salivary gland disease?

Answer 32

Dry mouth (Sjören's syndrome, drugs, radiotherapy, psychogenic, dehydration)
Acute sialadentitis (e.g. mumps)
Salivary duct obstruction
Sarcoidosis
Neoplasma