Overview of Oral Medicine

Question 1

Linea Albea

Answer 1

Elevation of buccal mucosa
Level of occlusal plane
Bilateral
White
Bruxism

Question 2

Morsicatio

Answer 2

Buccal/labial mucosa
Lateral/labial tongue
Roughened/ragged/thickened surface plaque; may also see ulceration and erosion intermixed

Question 3

Leukoedema

Answer 3

White-gray translucent appearance of the buccal mucosa
Superficial intra-epithelial oedema and retention of superficial keratin
Bilateral, soft to palpate
Disappears when mucosa stretched

Question 4

Fordyce spots

Answer 4

Developmental anomaly
Sebaceous glands
Buccal/labial mucosa and vermillion borders of the lips
Numbers increase with advancing age
They do not require treatment unless for cosmetic concerns

Question 5

Fissured tongue

Answer 5

5% of the population and increases with advancing age
M:F
Sometimes seen in combination with erythema migrans
Asymptomatic

Question 6

Varix

Answer 6

Red/blue/purple elevations of oral mucosa
<5mm
Buccal mucosa/lip/lateral and ventral tongue and floor of mouth
Asymptomatic and blanch on diascopy

Question 7

Circumvallate papillae

Answer 7

8-12 mushroom shaped swellings
Junction of the anterior 2/3 and posterior 1/3 of the dorsal aspect of the tongue
Supplied with taste buds responsive to bitter flavours

Question 8

Foliate papillae

Answer 8

Folds, grooves on the posterior lateral aspect of the tongue
Lingual tonsils found immediately below

Question 9

Torus Palatinus

Answer 9

Developmental malformation
Firm swelling midline of palate
20% of population
Can occur at any stage
Variable shape and size
Bony tissue covered by normal mucosa
Ulceration if traumatised

Question 10

Torus Mandibularis

Answer 10

Firm bony swelling
Normal overlying epithelium
Torus mandibularis - 6%
Ulceration

Question 11

Fibrous developmental malformation

Answer 11

Rare developmental swelling
Fibrous overgrowth
Maxillary tuberosity
Asymptomatic
Normal tissue appearance

Question 12

Erythema Migrans

Answer 12

2% population
Irregular depapillated erythematous areas
Fissured tongue
Appears and regresses
Usually asymptomatic

Symptomatic:
Zinc mouthwash
Corticosteroid mouth rinses

Question 13

Traumatic ulceration

Answer 13

Not site specific
Variable size and margins
Fibrinous base
Induration

Question 14

Recurrent Aphthous Stomatitis

Answer 14

Recurrent episodes of ulceration in otherwise healthy individual
Common (80% population)
Aetiology - stress/trauma
Three sub-types: minor/major/herpetiform

Question 15

Recurrent aphthous stomatitis minor

Answer 15

Most common
Crops of ulcers
<1cm in diameter
Oval in shape
Non-keratinised mucosa
Heal within 14 days

Question 16

Recurrent aphthous stomatitis major

Answer 16

Uncommon (10%)
1-5 ulcers
Affect keratinised and non-keratinised mucosa
Large
Persist for weeks
Heal with scarring

Question 17

Recurrent aphthous stomatitis - Herpetiform

Answer 17

Uncommon
Recurrent crops of multiple small ulcers
Often coalesce to form irregular areas of ulceration
Can affect any mucosal site
Heal within 14 days
No scarring

Question 18

Management of RAS

Answer 18

SLS free tp
Mucosal protectants
Topical analgesics
Topical antimicrobials - corsydl mouthrinse
Topical steroid preparations - reducing healing time

Question 19

Symptomatic management RAS

Answer 19

Orobase (reduces pain)
0.15% Benzydamine hydrochloride mouthrinse (reduces pain)
Chlorhexidine gluconate mouthwash 0.2% (aids healing)
Doxycycline 100mg soluble tablets as mouth rinse (anti-inflammatory)
Hydrocortisone oromucosal tablets 2.5mg (aids healing)

Question 20

When to refer RAS?

Answer 20

Single ulcers persisting for 3+ weeks
Speckling
Induration
Uncertain aetiology
Significant impact on quality of life
Recalcitrant ulceration

Question 21

Lichen Planus

Answer 21

Chronic inflammatory autoimmune disease
Affects SSE
Posterior buccal mucosa/tongue/gingivae/labial mucosa and vermilion of lower lip
Lesions on the palate, floor of the mouth and the upper lip
1-2% of population
2F:M
Risk of malignant transformation 1-3%

Question 22

Reticular lichen planus

Answer 22

Network of connecting and overlapping lines, papules or plaques
Rarely symptomatic
10% gingival involvement

Question 23

Erosive lichen planus

Answer 23

Ulceration within areas of hyperkeratosis, atrophy
Variable degrees of soreness

Question 24

Atrophic lichen planus

Answer 24

Erythematous lesions
Desquamative gingivitis
Most common type of gingival LP
Variable degrees of soreness

Question 25

lichen planus E/O lesions

Answer 25

Skin - 15% pts
Nails
Scalp

Question 26

Oral candidosis

Answer 26

50% of pts wearing removable dentures
65% of pts in acute and long term care facilities

Question 27

Pseudomembranous candidosis

Answer 27

Creamy plaques
Large areas of oral mucosa
Wiped off
Erythematous base

Question 28

Acute erythematous candidosis

Answer 28

Antibiotic use
Red areas
Common sites
Painful

Question 29

Chronic erythematous candidosis

Answer 29

Denture stomatitis
Chronic erythema of denture bearing area
Hyperplasia

Question 30

Median rhomboid glossitis

Answer 30

Rhomboid area
Midline dorsum of tongue
Asymptomatic
Atrophic filliform papillae
Predisposing factors - smoking and undiagnosed diabetes

Question 31

Angular cheilitis

Answer 31

Erythematous fissuring at commissures
2%
Mixed infection

Question 32

Management of oral candidosis

Answer 32

Biguanide antiseptics
Polyenes (nystatin suspension)
Azoles e.g., miconazole (Daktarin)

Question 33

Leukoplakia

Answer 33

A white patch of questionable risk
Cannot be characterised clinically or histopathologically as any other disease
Middle ages and elderly
Smokers

Question 34

Clinical presentation of leukoplakia

Answer 34

Asymptomatic - homogenous/thin/flat
Symptomatic- non homogenous/ speckled/ nodular/ verrucous

Question 35

Management of leukoplakia

Answer 35

Removal of aetiological factors
Preventative measures
Surveillance

Question 36

Oral cancer

Answer 36

Malignant neoplasm of upper aerodigestive tract
SCC
Metastasise

Question 37

Epidemiology of oral cancer

Answer 37

2% cancers
>55 yrs
NI - 329 cases per year
2M:F
Stage 1 - 91% at one year follow up, 60% at 5 year follow up
Stage 4 - 57% at one year follow up, 24% at 5 year follow up

Question 38

How does oral cancer arise?

Answer 38

Mutation
Oncogenes
Tumour suppressor genes

Question 39

What are risk factors for oral cancer?

Answer 39

Smoking/Alcohol/UV light/ Other e.g., potentially premalignant oral epithelial lesions (PPOEL)