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clinical considerations Flashcards

1
Q

what are papillae

A

specialised epithelia found on the tongue

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2
Q

what are the different forms of oral ulcerations

A

infections
neoplasms
trauma

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3
Q

infectious causes of ulcerations

A

bacterial
deep fungal
viral

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4
Q

neoplasmic causes of oral ulcerations

A

squamous cell carcinoma
lymphoma
malignant salivary gland tumours

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5
Q

traumatic causes of oral ulcerations

A

biting
contact with sharp cusps
thermal burns
chemical burns

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6
Q

what is squamous cell carcinoma

A

cancer occuring on sun exposed skin that can occur in the mouth

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7
Q

describe pancreatic cancer

A

this can affect the exocrine or endocrine portion of the pancreas and surgical treatment can be ineffective

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8
Q

describe cystic fibrosis

A

caused by chloride channel protein genetic defect and affects the exocrine portion of the pancreas

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9
Q

what are the oral implications of diabetes mellitus

A

periodontitis
dry mouth
susceptibility to infections

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10
Q

what are disorders of the endocrine system

A

reduced hormone release
excessive hormone release
hormone resistance

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11
Q

what causes scurvy

A

lack of vitamin C

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12
Q

oral implications of scurvy

A

loose teeth
skin haemorrhages
death

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13
Q

what is systemic lupus erythematosis

A

an autoimmune disease in which auto antibodies target host tissues

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14
Q

what are examples of host tissues affected by lupus

A

skin
bones
tendons
kidneys

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15
Q

what are the oral implications of lupus

A

dryness, soreness, buccal and palatal lesions

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16
Q

what is sjogrens

A

an autoimmune disease caused by autoantibodies affecting glands that produce the tears and saliva.

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17
Q

symtoms of sjogrens disease

A
  • dry eyes and mouth
  • dental caries
  • candidiasis
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18
Q

what can cause sjogrens to develop

A

it can develop independently or it can be caused by other disorders like lupus or arthritis

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19
Q

what is the resolution used for light microscopy

A

0.2 micrometers

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20
Q

what is is the resolution for electron microscopy

A

one nanometer

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21
Q

how many times greater is electron microscopy compared to light microscopy

A

200

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22
Q

what does the periodic acid schiff stain

A

mucins, brush borders and basement membranes as they are PAS positive and will stain magenta

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23
Q

what are ulcerations

A

a break in the epithelium

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24
Q

what is herpatic stomatitis

A

pale vesicles and ulcers visible on the palate and gingivae, especially anteriroly, and the gingivae impacted are erythematous and swollen. infectious

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25
Q

what is an example of a non infectious ulceration

A

large traumatic ulcers which have minimal inflammation and a white patch formed by keratin

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26
Q

what causes squamous cell carcinoma

A

dysplastic epithelial cells proliferating in an uncontrolled manner, destroying and invading adjacent tissue
the ulcers are classically having a rolled border and a central nectrosis

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27
Q

describe histological viewing of squamous cell carcinoma

A

the epithelium invades deeply into the connective tissue and underlying muscle

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28
Q

what are autoimmune disease

A

reactions to self antigens

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29
Q

what can antihistamines do

A

cause drowsiness and dry mouth

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30
Q

oral implications of corticosteroid inhalers

A

oropharyngeal thrush and chronic candidosis

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31
Q

what are systemtic corticosteroids used for

A

asthma

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32
Q

name the features of rheumatoid arthritis that are important for dentistry

A
  • associated with sjogrens disease
  • aspirin can lead to bleeding and anaemia
  • antimalarials can lead to oral and skin pigmentation
  • pencillamine can lead to taste loss
  • methotrexate can lead to poor healing, oral ulcers and folate deficiency
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33
Q

in which salivary gland is salivary calculi most common

A

submandibular gland - 80% of the calculi occur here

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34
Q

what forms salivary calculi

A

accretion of calcium salts and round organic nidus

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35
Q

do salivary calculi cause dry mouth

A

no

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36
Q

what is a stricture

A

narrowing of a duct in the body

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37
Q

where do salivary gland strictures commonly occur and why

A

in the parotid papilla in the buccal mucosa due to chronic trauma from projecting denture claps, faulty restorations, sharp edges on broken teeth leading to fibrosis

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38
Q

what causes salivary duct strictures

A

fibrosis

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39
Q

what are mucoceleles

A

cavities filled with mucous that can occur in minor salivary glands - saliva can leak into the surrounding tissues to excite an inflammatory reaction, forming a rounded collection of fluid

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40
Q

what are mucous retention cysts

A

dilation of salivary ducts due to obstruction

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41
Q

in which glands are mucous retention most common

A

the parotid and minor glands

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42
Q

what causes mumps

A

paramyxovirus

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43
Q

what does mumps cause

A

swelling of the parotids and other exocrine glands. highly infectious and is the most common cause of acute parotid swelling. leads to headahces and fever

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44
Q

what is sialadenitis

A

swelling of the salivary glands

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45
Q

is mumps infectious

A

yes

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46
Q

how does mumps spread

A

by saliva

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47
Q

what can confirm the diagnosis of mumps

A

a rise in the titre of IgG antibodies in those who are not vaccinated

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48
Q

what does bacterial parotitis mean

A

pain in one or both parotid glands, leads to leaking from the parotid papilla on the buccal mucosa.
seen in those who are dehydrated after surgery, due to xerostomia, sjogrens disease etc

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49
Q

what are the bacterial causes of bacterial parotitis

A

staphyloccocus aureus, streptococci, oral anaerobes

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50
Q

what are the organic causes of xerostomia

A
  • sjogrens disease
  • irradiation
  • mumps
  • HIV infection
  • hep c
  • sarcoidosis
  • amyloidosis
  • iron deposition
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51
Q

what are the functional causes of xerostomia

A
  • dehydration from haemorrhage, fluid deprevation or loss
  • drugs
  • anxiety
  • depression
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52
Q

which drugs cause xerostomia

A

diuretic overdose
atropine
ipratropium
hyoscine
some antidepressents
antihistamines
decongestants
bronchodilators
appetite suppressants like amphetamines

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53
Q

what do patients with xerostomia typically complain of

A
  • unpleasant taste
  • difficulty eating and swallowing
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54
Q

what is the most effective analgesic agent

A

2% lidocaine with adrenaline

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55
Q

what is the chief cause of sudden death under anaesthesia

A

cardiovascular disease

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56
Q

who is at risk of developing endocarditis

A

patients with congenital anomalies such as valve or septal defects, and those with prosthetic valves

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57
Q

what are the non cardiac risk factors for developing infective endocarditis

A

age
diabetes
poor oral hygience
prior kindey disease

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58
Q

what proportion of infective endocarditis cases result from oral organisms

A

30-40%

59
Q

what clears bacteria from the blood

A

phagocytic cells lining the sinusoids in the liver or spleen, and circulating leukocytes

60
Q

how does infective endocarditis occur

A

damaged valves are infected by bacteria passing through the lumen of large vessels, causing bacteria to come into contact with the endothelium
they adhere to the valve using fibronectin and other carbohydrate receptors and bind to platelets and fibrin on the damaged surface
platelets and fibrin deposit over them
lumpy vegetations of bacteria and fibrin form on the free edges of the valves, which are progressively destroyed by inflammation and immune response against bacteria - this renders the valves incompetent

61
Q

how can bacteria enter the blood

A

from tissue infections, during surgery and from peripherally inserted central catheters (PICC lines)

62
Q

what are the main sources of oral bacteria causing bacteraemia

A

the gingival crevice and periodontal pockets. large numbers of bacteria are in close contact with inflammed tissues containing dilated, thin walled blood vessels. chance of bacteria entering the vessels is increased by the movement of teeth during mastication

63
Q

what is acute endocarditis linked to

A

staphyloccocus aureus
fungi

64
Q

what is subacute infective endocarditis linked to

A

bacteraemias of oral organisms - viridans streptococci

65
Q

which valve is most commonly impacted by infective endocarditis

A

the mitral valve

66
Q

what can infective endocarditis do to the rest of the body

A

the valve vegetations can shed small foreign bodies called emboli into systemic circulation which can cause distant effects like splinter haemorrhages and damage to various organs

67
Q

what is used to prevent and treat infective endocarditis

A

antiobiotic prophylaxis which kills any bacteria before entering the circulation so they do not have the opportunity to adhere to the heart valves

68
Q

what is systemic lupus eyrthematous

A

this is when antibodies are against DNA and its associated proteins, and there are usually genetic predispositions affecting the genes involved in non specific immune mechanisms

69
Q

describe how systemic lupus erythematous manifests

A

circulating autoantibodiy antigen complexes lodge in small vessels where they activate neutrophils and macrophages to damage the tissue

70
Q

how can lupus affect the mouth

A

it can cause stomatitis and sjogrens syndrome if it affects the mouth
oral lichen planus like lesions (white, lacy patches)
the lower lip vermillion border can become malignant, and bleeding tendencies.
non steroidal anti inflammatory drugs can lead to bleeding, anaemia and lichenoid reactions

71
Q

what can systemic sclerosis look like

A

raynauds and joint pain
the skin thins and becomes stiff and pigmented
facial features become smoothed out and mask like
opening of the mouth can become limited

72
Q

what is sarcoidosis

A

collection of inflammatory cells - granulomas are small and round with occasional small multinucleate cells

73
Q

what can cause cervical lymphadenopathy

A

apical abscesses, cellulitis, periodontitis and pericoronitis

74
Q

what is syphilis

A

enlarged, soft and rubbery cervical lymph nodes

75
Q

what is cervical lympadenopathy

A

swelling of the lymph nodes in the neck

76
Q

what is a common cause of the symptoms of heart burn

A

gastrooesphageal reflux and consequent oesophagitis

77
Q

what causes barrett’s oesophagus

A

persistent gastrooesophageal reflux leading to the oesophageal lining undergoing metaplasia to become a more gastric mucosa

78
Q

what causes gastrooesophageal reflux

A

smoking
excessive alcohol consumption
obesity
overlarge meals

79
Q

what is coeliac disease

A

inflammation of the ileal mucosa, loss of villi, leading to malabsorption

80
Q

what are the dental implications of coeliac disease

A

glossitis, recurrent aphthae

81
Q

what does glossitis mean

A

inflammation and pain in the tongue

82
Q

what is aphthae

A

ulcers

83
Q

what can happen to the enamal in coeliac disease

A

hyperplasia - hypoplastic mottling, localised, opacities, and discolouration

84
Q

why is enamel hyperplasia common in coeliac disease

A

malabsorption

85
Q

what is crohns disease

A

inflammatory bowel disease causing thickening and ulceration of the ileocaecal junction

86
Q

what are the oral effects of crohns

A

none direct although the anaemia caused by crohns can lead to ulcers and candidosis

87
Q

orofacial features of crohns disease

A
  • diffuse soft or tense swelling of the lips and mucosal thickening
  • gingivae may be erythmatous and swollen
  • mucosal tags in the sulcuses
  • glossitis
88
Q

why does malabsorption lead to glossitis

A

iron, folate and vitamin 12 deficiency

89
Q

what are orofacial granulomatosis

A

oral mucosal granulomatous inflammation without an identifiable cause

90
Q

which sites of the mouth are most commonly involved in orofacial granulomatosis

A

lip and buccal mucosa

91
Q

what does diagnosis of orofacial granulomatosis require

A

biopsy

92
Q

which conditions can lead to malabsorption

A
  • coeliac disease
  • crohns
  • resection of the stomach or ileum
  • pancreatic insufficiency
  • liver disease due to failure of bile secretion into the gut
93
Q

what is ulcerative colitis

A

inflammatory disease of the large intestine causing ulceration and fibrosis

94
Q

symptoms of ulcerative colitis

A

blood and mucous in the stools

95
Q

what is the impact of anaemia on the mouth

A
  • prolonged bleeding
  • mucosal lesions
  • oral infections
  • anaesthetic complications
  • glossitis
  • angular stomatitis
  • recurrent aphthae
  • candidosis
  • lowered resistance to infection
96
Q

what is angular stomatitis

A

red and swollen area around the mouth caused by candida infection or by staphylococcus aureus

97
Q

what are polyps

A

fleshy growths forming on the lining of the colon or rectum

98
Q

what is gardners syndrome

A

polyposis of the colon and osteomas on the jaw

99
Q

what are osteomas

A

bone tumours that usually form on the skull

100
Q

what is pseudomembranous colitis

A

a complication of prolonged antibiotic therapy that results in the passage of blood and mucous in the stools and sometimes fragments of necrotic bowel mucosa

101
Q

what are the three main causes of liver failure

A
  • idiopathic cirrhosis
  • alcoholic cirrhosis
  • hepatitis
102
Q

what is idiopathic cirrhosis

A

spontaneous i think

103
Q

how is hep a acquired

A

contaminated food or water, incubation period of 2-6 weeks
mild jaundice
long term complications are rare

104
Q

how is hep e transmitted

A

faecal oral route

105
Q

how is hep b transmitted

A

spread at birth, through sexual contact or through infected blood

106
Q

how does the hepatitis virus replicate

A

within hepatocytes

107
Q

how does hepatits infection cause cirrhosis

A

it replicates in the hepatocytes, so the immune response to the virus eventualy clears the infection damaging the liver in the process

108
Q

why is hep c more relevant in dentistry than hep b

A

it has no vaccination, and its impacts are more severe and frequently fatal.

109
Q

how does hep b get transmitted

A

via blood through needle sharing, needle stick injuries and tattooing

110
Q

which proportion of patients diagnosed with hepatitis C progress to chronic hepatitis

A

85%

111
Q

what does chronic hepatitis eventually lead to

A

cirrhosis and liver failure

112
Q

is hep c transmitted in dentistry

A

rarely

113
Q

what does riboflavin deficiency lead to in dentistry

A

glossitis and angular stomatitis

114
Q

what does nicotinamide deficiency lead to

A

glossitis, stomatitis, and gingivitis

115
Q

what does vitamin B12 deficiency lead to

A

pernicious anaemi
glossitis
aphthae

116
Q

what does folic acid deficiency lead to

A

glossitis
aphthae

117
Q

what does vitamin C deficiency lead to

A

scurvy, gingival swelling, bleeding

118
Q

what does vitamin D deficiency lead to

A

rickets and hypocalcification of the teeth

119
Q

what does vitamin A deficiency lead to

A

night blindedness

120
Q

what is pellagra

A

nicotinamide deficiency

121
Q

what does nicotinamide deficiency do to the tongue

A

the tip and lateral regions become red and swollen, the dorsum becomes covered by a heavily infecte greyish fur

122
Q

when is folid acid deficiency often observed

A

during pregnancy

123
Q

why are pregnant women advised to take supplements of folic acid

A

reduce the risk of neural tube defects

124
Q

what causes gigantism

A

overproduction of growth hormone by the anterior pituitary during skeletal growth causes overgrowth of the skeleton and soft tissues

125
Q

what causes acromegaly

A

this is caused by excessive growth hormone release in middle age, and increases the growth of the hands and feet. the mandible becomes enlarged and protrusive, and the whole jaw is lengthened, and the angle becomes more oblique. vocal cord thickens and the voice becomes deeper. the nose, lips, tongue and ears are bigger

126
Q

what is goitre

A

diffuse thyroid enlargement

127
Q

what is graves disease

A

autoimmune thyroiditis caused by stimulatory autoantibodies

128
Q

what is cretinism

A

deficient thyroid activity from birth can lead to this, and results in short stature, intellectual impairment, overlarge tongue, dry skin, dull facial expression, sensitivity to cold and bradycardia

129
Q

can cretinism be treated

A

yes but it must be done in early life to allow for normal physical and mental development

130
Q

what are the symptoms of adult hypothyroidism

A

weight gain
fatigue
dry skin and hair loss
intolerance to cold

131
Q

what is the dental management for patients with a deficient thryoid

A

avoid diazepam and opioid analgesics

132
Q

what is a lingual thyroid

A

when there is a failure of the embryonic thyroid anlage to descend into the neck, the patients thyroid gland will lie somewhere around the dorsum of the tongue

133
Q

can a lingual thyroid be removed

A

only in the instance where there is a confirmed thyroid gland in the neck, identified through ultrasound scanning

134
Q

what are the dental implications of hyperthyroidism

A

dentine may not be completely mineralised, and the roots of the teeth may be short

135
Q

what is addisons disease

A

adrenocortical hypofunction, which is usually an autoimmune disease with organ specific circulating autoantibodies

136
Q

why may patients crave salt if they have addisons disease

A

due to the lack of production of aldosterone

137
Q

symptoms of addisons found

A

salt craving
loss of weight
low blood pressure
susceptibility to hypotensive crises
abnormal oral pigmentation

138
Q

why can abnormal oral pigmentation be observed in patients who have addisions disease

A

due to the adrenocorticotropic hormone secretion as the peptide hormone has a similar amino acid sequence to melanocyte stimulating hormone

139
Q

what is cushings disease

A

adrenocorticotropic hypofunction caused by a pituitary adenoma

140
Q

symptoms of cushings disease

A

headaches
hypertension
oesteoporosis
obesity of the trunk and the face

141
Q

what is the trunk of the body

A

the central part of the body

142
Q

how can dentists manage diabetic patients

A
  • time treatment so as not to disturb routine insulin administration
  • local anaesthesia (adrenaline has no significant impact on blood sugar)
  • deal with diabetic complications
  • if using general anaesthesia, special precautions must be taken
143
Q

what are the oral effects of pregnancy

A

aggravated gingivities
hypersensitive gag reflex
iron or folate deficiency

144
Q

what are the impacts of renal failure on the oral cavity

A

mucosal pallor
xerostomia
mucosal ulcerations
thrush
bacterial plaque

Revision (48 decks)

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