TONGUE, MOUTH & GUM Flashcards by Maddie YEAR 3 & 4

What is glossitis?

An inflamed tongue
It’s red, sore, swollen, smooth in appearance due to papillae atrophy

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What can cause glossitis?

IDA
B12 or folate deficiency
Coeliac disease
Injury or irritant exposure
Allergies

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What is angioedema?

Fluid accumulating in tissues causing swelling - affects tongue, limbs, face, lips

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Causes of angioedema?

Allergic reactions
ACEi
hereditary angioedema (C1 esterase inhibitor deficiency)

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What is oral thrush?

An overgrowth of candida causing white spots or patches that coat the surface of the tongue and palate

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What can predispose to oral thrush?

Inhaled corticosteroids - esp bad technique
Antibiotics
Diabetes
Immunodeficiency
Smoking

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Treatment options for oral thrush?

Miconazole gel
Nystatin suspension
Fluconazole tablets in severe/recurrent cases

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What is geographic tongue?

An inflammatory condition where patches of the tongue surface lose epithelium and papillae - this forms irregular shapes on the tongue resembling a map
This tends to relapse and remit with episodes of abnormal tongue lasting days-weeks
Its a harmless condition that doesnt require Tx

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What can cause geographic tongue?

Unknown
Thought to be related to stress & mental illness, psoriasis, atrophy and diabetes

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What are the 2 key causes of strawberry tongue?

Scarlet fever
Kawasaki disease

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What is strawberry tongue?

Tongue becomes swollen and red with enlarged white papillae

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What is black hairy tongue?

A common condition resulting from defective desquamation of the filiform papillae giving the appearance of black hair on the tongue
May also cause sticky saliva and a metalic taste

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Predisposing factors for black hairy tongue?

poor oral hygiene
Dehydration
Smoking
antibiotics
head and neck radiation
HIV
intravenous drug use

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Management of black hairy tongue?

Swab to exclude candida
Tongue scraping, stopping smoking, adequate hydration, good oral hygiene

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What is leukoplakia?

A pre malignant condition to SCC characterised by white, hard spots on the mucous membrane of the mouth

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How do we tell the difference between candidiasis + lichen planus and leukoplakia?

Candidiasis and lichen planus lesions can be ‘rubbed off’

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How does leukoplakia present?

Asymtpmatic
Irregular white patches on buccal mucosa or tongue. Slightly raised. Fixed in place and can’t be scraped off

Who is leukoplakia more common in?

Smokers

Management of leukoplakia?

Biopsy to exclude DDx e.g. SCC
Regular follow up to exclude malignant transformation to SCC
Stop smoking, reduce alcohol
Potentially surgical excision/laser removal

How often does leukoplakia transform to SCC?

In 1% of cases

What is hairy leukoplakia?

A type leukoplakia caused by EBV - occurs in pt with low immune system e.g. HIV
Causes fuzzy white patches that look folded or ridged
No risk of mouth cancer!

What is erythroplakia?

Red lesions on mucous membranes with a high risk of SCC

What is erythroleukoplakia?

A mixture of red and white lesions on mucous membranes associated with a high risk of SCC

What is lichen planus? Who is it most common in?

Lichen planus is an autoimmune condition that causes localised chronic inflammation of the skin that often only affects the mouth.

It usually occurs in patients over 45 and is more common in women.

Features of lichen planus?

itchy, papular rash most common on the palms, soles, genitalia and flexor surfaces of arms rash often polygonal in shape, with a 'white-lines' pattern on the surface (Wickham's striae) Koebner phenomenon may be seen (new skin lesions appearing at the site of trauma) oral involvement in around 50% of patients: typically a white-lace pattern on the buccal mucosa nails: thinning of nail plate, longitudinal ridging

Management of lichen planus?

potent topical steroids are the mainstay of treatment benzydamine mouthwash or spray is recommended for oral lichen planus extensive lichen planus may require oral steroids or immunosuppression

What is gingivitis?

Inflammation of the gums that can lead to periodontitis if not adequately managed

What is periodontitis?

severe and chronic inflammation of the gums and the tissues that support the teeth. This often leads to loss of teeth.

What causes gingivitis?

Poor dental hygiene

Clinical presentation of gingivitis?

Simple - painless, red swelling of gum margin that bleeds on contact Acute necrotizing ucerative gingivitis - rapid onset painful bleeding gums with halitosis and punched-out ulcers on the gums

Management of simple gingivitis?

Regular review by dentist Good oral hygiene Stopping smoking

Management of acute necrotizing ulcerative gingivitis?

Refer to dentist Oral metronidazole for 3 days and a chlorine iodine or hydrogen peroxide mouth wash Simple analgesia

What is gingival hyperplasia?

Abnormal growth of the gums making them noticeably large around the teeth

Possible causes of gingival hyperplasia?

Drugs - phenytoin, Ciclosporin, CCb (esp nifedipine) AML - myelomonocytic and monocytic types Gingivitis Scurvy

What are aphthous ulcers?

Very common smal painful ulcers of the mucosa that are well-circumscribed, punched-out and appear white

whatcan cause aphthous ulcers?

Normally in healthy individuals triggered by emotional or physical stress, trauma to mucosa or particular foods IBD - crohns Coeliacs Behcet disease Vitamin deficiency e.g. iron, B12, folate, vit D HIV

Management of aphthous ulcers?

Usually heal within 2 weeks without Tx Topical Tx for symptoms - choline salicylates (bonjela), benzydamine, lidocaine If severe then topical corticosteroids can be used e.g. hydrocortisone buccal tablets

2WW guidelines for an aphthous ulcer?

2WW for unexplained ulceration lasting >3 weeks

In most cases where does epistaxis originate?

In 80-95% of cases Littles area on thr anterior nasal septum

Causes of nose bleeds?

Trauma e.g. nose picking, vigorous nose blowing Inflammation e.g. allergic rhinosinusitis or polyps Topical drugs e.g. cocaine, steroids Vascular causes e.g. GPA or HHT Post-op Tumours e.g. nasopharyngeal Nasal oxygen therapy Coagulation disorders or anticoagulant therapy

How common is epistaxis?

Up to 60% of UK population have experienced it! More common in children of 2-10 and then in adults >45 Posterior epistaxis is more common in older people Recurrent epistaxis is more common in children <15

What is a possible complication of nasal cautery treatment?

Septal perforation due to a direct effect of the silver nitrate stick