Ulcers continued Flashcards
Minor ulcer ______ in diameter: lasts 5–10 days
and heals without scarring
<5 mm
Major ulcer >8 mm: can persist for up to _____weeks
6
Recurrent ulcers: consider ______, _____ and _____
Behçet syndrome.
Check serum iron and folate
Healing options for ulcers
________0.1% (Kenalog in Orabase) paste,
apply three times daily after meals and nocte
(preferred method but be careful of herpes
simplex ulcers).
Triamcinolone
Tx considerations for large ulcers
Consider:
injection of steroids into the base of the ulcer
and/or
oral prednisolone 25mg daily, 5–7 days
Complementary measures for ulcers
1
2
3
Teabag method.
Melaleuca (tea-tree) oil.
Acupuncture.
_______are caused by people leaving
salicylate-based tablets to dissolve against oral
mucosa.
Aspirin ‘burns’
Several drugs can induce a lichenoid drug reaction
of the oral mucosa, that is, cause shallow mucosal
erosions similar to lichen planus. The drugs
include ____, ______, _______, _____
gold, the NSAIDs, carbimazole, selected
antihypertensives and cytotoxics
Tx of herpes infection
aciclovir or similar antiviral
if seen early, e.g. 48 hours from onset;
fluids + + + ; analgesic mouth rinses, e.g.
Difflam; consider admission for IV aciclovir and
hydration
Neoplasia that can look red includes
1
2
3
squamous
cell carcinoma, Kaposi sarcoma and erythroplakia
_______ is similar in significance to leucoplakia
except for the erythematous feature. It is an
important condition to recognise since about 90% of
cases are either dysplastic or cancer
Erythroplakia
An interesting condition is ________
on the dependent floor of the mouth, which appear
white. Causes include tea-tree oil mouthwash and the
sucking of aspirin
hyperkeratotic burns
________ is any white lesion that cannot be
removed by rubbing the mucosal surface (unlike
oral candidiasis). About 5% of cases represent either
dysplasia or early SCC
Leucoplakia
This is usually tender and looks like white or yellowish
curd-like patches overlying erythematous mucosa.
Unlike lichen planus or leucoplakia, they are usually readily rubbed off and hence only the underlying red
patch may be seen.
Oral candidiasis (thrush)
The carriage rate of Candida albicans in the oral
cavity is________. The diagnosis is made clinically
but a wet preparation using _________ will
reveal spores and perhaps mycelia.
60–75%
potassium hydroxide
Tx of oral candida
nystatin suspension, rinse and swallow qid
or
miconazole oral gel (as directed by manufacturer)
or
amphotericin 10 mg or nystatin 100 000 U
lozenges dissolved slowly in oral cavity, 6 hourly,
for 7–14 days
Feature is redness, soreness and maceration of the
corners of the mouth. Usually associated with oral candidiasis
Angular cheilitis
_____________(Vincent
infection or trench mouth) caused by anaerobic
organisms is rarely seen but is more common in
undernourished or ill young adults under stress
Acute necrotising ulcerative gingivitis
Caused by plaque (bacterial biofilm) with calculus
tartar secondary to poor oral hygiene
Gingivitis
Features of gingivitis
- Red, swollen gingivae adjacent to teeth
- Bleeds with gentle probing
- Halitosis
- Usually no pain
This is a very painful form of gingivitis. Treatment is
as for gingivitis but add antibiotics e.g. metronidozole
400 mg (o) 12 hourly or tinidazole 2 g (o) single dose
and drain pus from abscess.
Acute ulcerative gingivitis
It is a sequel to gingivitis and shows periodontal ligament
breakdown with recession or periodontal pocketing
and alveolar bone loss. There is possible loosening of
teeth and periodontal abscess formation
Periodontitis
Oral dermatoses include 1 2 3 4
lichen planus, pemphigus
vulgaris (uncommon), mucous membrane
pemphigoid (uncommon) and lupus erythematosus
• affects 2% of the population, usually over 45 years
• can vary from asymptomatic to severely painful
• usually white lace-like patterns on mucosa,
cheeks and tongue
• may form superficial erosions
Lichen planus
Where are SLE oral lesions found?
usually on lateral aspects of the hard palate
Labs for painful tongue
Investigations may include an FBE, serum vitamin
B 12 , folate and ferritin levels, a swab or a biopsy of a
suspicious lesion
A miserable child with a painful mouth and
tongue is likely to have _______
acute primary herpetic
gingivostomatitis or hand, foot and mouth disease
A long history of soreness with spicy or other
foods indicates___________
benign migratory glossitis
(geographic tongue) or median rhomboid
glossitis
Macroglossia (large tongue): consider 1 2 3 4
acromegaly,
myxoedema, amyloidosis, lymphangioma
Strawberry tongue: consider_____ and _____
scarlet fever,
Kawasaki disease
______ (painful tongue): characteristically
presents as a burning pain on the tip of the
tongue. It can be a real ‘heartsink’ presentation.
Consider _______ as an underlying
cause.
Glossodynia
depressive illness
Also known as __________ this
benign condition shows changing patterns of
desquamatous areas and erythema on the dorsum
and edges of the tongue
benign migratory glossitis,
Cause of the geographic tongue
It is considered to be a hypersensitivity reaction
but the offending allergen has not been identified.
This is due to overgrowth of papillae or reduced wear
of papillae, e.g. debility and lack of fibrous foods.
Black or hairy tongue
What is the appearance of a Black or hairy tongue
dark, elongated filiform papillae
giving brownish appearance to dorsum
(posterior) of tongue.
Causes of black hairy tongue
• Unknown
• Poor oral hygiene/debility
• Iatrogenic (e.g. antibiotics, major tranquillisers,
corticosteroids
SCC is the most common malignancy of the oral
cavity, accounting for ______of cases
90%
It has a 5-year
survival rate of _______ without lymph node involvement
and ______with local node metastases
65%
50%
Cancer of the
lip is usually treated successfully by_______
but intraoral cancer has significant morbidity and
mortality.
excisional biopsy
Predisposing or associated factors for SCC include
tobacco and marijuana abuse, alcohol abuse, excessive
sunlight and immune suppressive disorders such as
HIV, lymphoma and various medications
Usual locations of SCC
SCC is usually found as a chronic indurated ulcer on
the_______ and ________surfaces of the tongue followed by the floor of the mouth and buccal mucosa
ventral
lateral
What are considered pre-malignant lesions for SCC
The red patches of erythroplakia (in particular)
and the white patches of leucoplakia may be
premalignant or early invasive cancer and necessitate
further investigation, particularly incisional biopsy.
Tx of SCC
Treatment for oral cancer is surgery ± radiotherapy and chemotherapy
An_______is a benign, localised gingival swelling. It is
a very ancient term with no pathological significance,
meaning a ‘tumour situated on the gum’.
epulis
2 types of epulis
There are two distinct types—a fibrous epulis and giant cell epulis
Where do epulis usually emerge
An epulis emerges between two teeth from the
periodontal membrane where there is usually dental
decay or a site of irritation, such as a partial denture
When is epulis more common
It appears to be more common during pregnancy
where the epulis has a more vascular appearance
These may occur on the gums or oral mucosa of the
lips and look like pyogenic granulomas of the skin,
which also are associated with minor trauma. It is
best treated by excision
Pyogenic granuloma
________ are probably caused by minor
trauma to the duct. They may rupture spontaneously
Small retention cysts
Tx of Small retention cysts
Treatment is by incision and enucleation under local
anaesthesia
Tx of larger retention cysts
Larger ones require marsupialisation
A special type of retention
cyst is the _____
ranula.
Usual location of the ranula
floor of the mouth
Hyperplasia of the oral mucosa, a very common
condition, is usually seen on the floor of the mouth and
is due to chronic irritation from ill-fitting dentures.
Fibrous (fibroepithelial) hyperplasia
These appear as a dark blue/purple sessile or modular
swelling anywhere in and around the mouth, especially
on the vermilion border of the lips, floor of the mouth
and tongue.
Haemangioma
Tx of Haemangioma
No treatment is
needed except for pressing cosmetic reasons
The most common benign intraoral salivary
neoplasm is the __________ usually
presenting as an asymptomatic swelling of the hard
palate or cheeks
pleomorphic adenoma
The most common Bony outgrowths of the maxilla and mandible
torus palatinus
bony exostosis that occurs inside the mandible,
opposite the premolar teeth and is usually bilateral
torus
mandibularis,
When to remove bony exostoses
These lesions are hamartomas and do not require
removal except if there is impending dental obstruction
This is a symptom rather than a disease entity. It occurs
in about 10% of the population and approximately
70% of patients have a systemic cause
Xerostomia (dry mouth
MCC cause xerosthomia
side effect of drug therapy and it is relative rather than absolute
Causes of primary xerostomia
• Salivary gland atrophy due to ageing
• Salivary gland infections
• Autoimmune salivary gland disease (e.g. Sjögren
syndrome)
Drugs causing xerostomia
antidepressants (especially tricyclic
agents), diuretics, anticholinergics, tranquillisers,
antihistamines, anti-emetics, antihypertensives
(some), antimigraine (some), antiparkinson,
lithium and opioids
Anemias causing xerostomia
Anaemias: iron, folate, vitamin B12 deficiency
CX of xerostomia
interferes with speech, mastication and
swallowing and causes difficulty in managing oral
hygiene, especially dentures.
WHat type of infection is pt predisposed to if he has xerostomia
There is an increase in dental decay and perhaps a
tendency to Candida albicans infection
MCC of halitosis
The
commonest causes are orodental disorders secondary
to poor oral hygiene and inappropriate diet.
A 1999 survey showed
that 87% of patients with halitosis had an ______
8% an ear, nose and throat cause with 5% having
other or unidentified causes.]
oral cause,
What drugs cause halitosis
as isosorbide dinitrate and
various antidepressants as a cause
What to consider for unusual mouth ulcers?
acute
leukaemia, cancer, blood dyscrasias, Crohn
disease and drug therapy such as anti-epileptics
and antihypertensives.
