The Mouth Flashcards
What are the causes of mouth ulcers?
Idiopathic GI disease (IBD) Infection Systematic disease (SLE, Bechet syndrome) Trauma Neoplasia Drugs (chemo, erythema multiform major) Skin disease (pemphigoid, lichen planus)
What are types of infection that can cause mouth ulcers, with examples of each?
Viral - HSV, HIV, Coxsackie
Fungal - candidiasis
Bacterial - syphilis, TB
What is the most common type of mouth ulcers?
Idiopathic aphthous ulceration
What do recurrent aphthous ulcers look like?
Recurrent painful round mouth ulcers with inflammatory halos
How are minor and major recurrent aphthous ulcers differentiated?
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
Who do recurrent aphthous ulcers most commonly affect?
Females
Non-smokers
Appear first in childhood and reduce before the age of 40
How are recurrent aphthous ulcers managed?
Avoid oral trauma and acidic food and drink
Topical or systemic corticosteroids (tetracycline mouthwash, azathioprine) may lessen duration and severity
What are examples of premalignant mouth lesions?
Leukoplakia (white adherent patch)
Lichen planus
Submucous fibrosis
Erythroplakia (red patch)
How do malignant tumours of the mouth appear?
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
Who tends to get tumours of the mouth?
Smokers
Alcohol excess
Areca nut
HPV
What type of tumour are mouth tumours?
Squamous cell carcinoma
How are tumours of the mouth managed?
Surgical excision
What could an oral white patch be?
Transient - candidiasis, SLE (rare), trauma from chemicals, mechanical or drugs
Persistent - leukoplakia or oral lichen planus
Which patients are more likely to get candidiasis?
Broad spectrum antibiotics
Inhaled steroids
Diabetes
Seriously ill or immunocompromised patients
What risk factors are leukoplakia associated with?
Alcohol abuse and smoking
What will a biopsy of leukoplakia show?
Alteration in keratinisation
Dysplasia of the endothelium
What causes the oral pigmented lesion amalgam tattoo?
Blue-black macules involve the gingivae.
Results from dental amalgam sequestering into the tissues
What diseases cause pigmentation?
Peutz-Jeghers syndrome
Addison’s disease
What cause pigmentation of the gums?
Heavy metals
Drugs
Describe glossitis.
A red, smooth, sore tongue
Which deficiencies are associated with glossitis?
Vitamin B12 Folate Iron Riboflavin Nicotinic acid
What causes a black hairy tongue?
Proliferation of chromogenic microorganisms causing brown staining of elongated filiform papillae
What is a geographic tongue?
Idiopathic condition, usually painless and patients should be reassured.
Erythematous areas surrounded by well defined, slightly raised irregular margins
What are the gingivae?
The gums
What is the purpose of the gums?
A mucous membrane covering the alveolar processes of the mandible and maxilla
What diseases affect the gums?
Chronic gingivitis
Acute necrotising ulcerative gingivitis (Vincent’s angina)
Desquamative gingivitis
Gingival swelling
What is the cause and management for chronic gingivitis?
Cause: bacterial plaque
Management: plaque removal
What is the cause and management for acute necrotising ulcerative gingivitis (Vincent’s angina)
Cause: spirochete and fusiform bacteria due to poor hygiene and smoking
Management: oral metronidazole, chlorohexidine mouthwash
What is the cause and management for desquamative gingivitis?
Cause: lichen planus or mucous membrane pemphigoid
Management: confirmation with biopsy
What is the cause and management for gingival swelling?
Cause: inflammation, infiltrations or fibrous hyperplasia
Management: depends on cause
Which virus is strongly associated with characteristic oral lesions?
HIV, less common with the introduction of anti-retroviral therapy
What are examples of salivary gland disease?
Dry mouth (Sjören's syndrome, drugs, radiotherapy, psychogenic, dehydration) Acute sialadentitis (e.g. mumps) Salivary duct obstruction Sarcoidosis Neoplasma
