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SCR Revision > Oral Medicine in Primary Dental Care > Flashcards

Oral Medicine in Primary Dental Care Flashcards

1
Q

what is needed for diagnosis of most forms of oral mucosal disease - in particular the detection of oral cancer

A

histopathological examination of biopsy tissue

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2
Q

what should be noted from an extra-oral examination

A

mobility
facial asymmetry
appearance of skin
lips
palpate soft tissues of neck

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3
Q

what lymph nodes do we palpate in extra oral examination

A

submental
submandibular
supraclavicular

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4
Q

what is the technique used to palpate the salivary glands

A

bimanual technique

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5
Q

what types of lesions can be biopsied in primary dental care

A

simple benign localised lesion

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6
Q

what is involved in an incisional biopsy

A

taking an allipse of tissue from affected site

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7
Q

what should the size of a biopsy be for mucosal investigations

A

three times as long as it is wide

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8
Q

how is a biopsy stored after taking from patient’s mouth

A

supported on filter paper before being placed in pre-labelled specimen pot containing 10% neutral buffered formalin

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9
Q

why is neutral buffered formalin used with biopsies

A

to minimise impact of shrinking and distortion during fixation

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10
Q

what is a punch biopsy

A

removes cylindrical specimen of tissue between 0.4 and 0.8mm in diameter

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11
Q

what is one advantage and one disadvantage of punch biopsy

A

adv - simple and quick
disadv - potential to not obtain sufficient material when assessing epithelium for dysplasia

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12
Q

what is labial gland biopsy

A

involves collection of at least five lobules of minor glands from the lower lip

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13
Q

where should samples be taken from in a labial gland biopsy

A

an area of clinically normal ucosa

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14
Q

what are the requirements when transporting a biopsy

A

use of padded containers to absorb any fluid in the event of leakage
label to indicate presence of pathological specimen

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15
Q

what is a smear sample

A

scraping soft tissue with a firm instrument and then spreading the material onto a glass microscope slide

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16
Q

what is a swab sample

A

used to investigate presence of a range of bacteria, fungi and viruses in the laboratory

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17
Q

what is an oral rinse sample

A

includes 10ml phosphate buffered saline that is held in the mouth for 1 minute prior to recollection

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18
Q

what is a needle aspiration sample

A

used for taking pus samples

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19
Q

what are the veins of choice for venepuncture

A

the ones in the antecubital fossa (basilic, cephalic)

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20
Q

what antibody tests should be performed when a patient presents with xerostomia and if Sjogren’s syndrome is suspected

A

Anti-La and Anti-Ro
Anti-nuclear antibody

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21
Q

what antibody tests should be performed on a patient suspected of low VitB12 or folate levels

A

intrinsic factor (pernicious anaemia)
anti-tissue transglutamase (anti-tTG for coeiac)

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22
Q

what adjunctive tests are used for cancer detection

A

toludine blue
chemiluminescent visualisation
brush biopsy for cytopathology

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23
Q

what disorders are most commonly diagnosed through immunofluorescence

A

pemphigoid and pemphigus

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24
Q

what is sialography

A

investigation of major salivary glands- involves radiography with infusion of radiopaque dye that is iodine based into the gland via the duct

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25
Q

what is traumatic ulceration

A

presents as single ulcer which the patient can ususally attribute to previous incident

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26
Q

how are traumatic ulcers treated

A

removal of any causaive factors
prescription of antiseptic mouthwash (chlorhexidine 0.2%)

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27
Q

when is recurrent aphthous stomatitis most seen

A

childhood and early adulthood

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28
Q

what are the three subtypes of RAS

A

minor
major
herpetiform

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29
Q

how does minor RAS present

A

small ovoid or circular lesions affecting NON keratinised sites in the anterior part of oral cavity which heal without scarring

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30
Q

how does major RAS present

A

larger ulcers that affect posterior part of the mouth and also involve keratinised sites and may leave residual scarring once healed

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31
Q

what disease is major RAS linked to

A

HIV infection

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32
Q

how does herpetiform RAS present

A

multiple small round ulcers which are so numerous they coalesce to form larger areas of irregular ulceration with no associated scarring

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33
Q

what should be investigated if a patient presents with RAS

A

haematological assessment for deficiency

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34
Q

what can induce RAS in susceptible individuals

A

penetrating injuries or trauma associated with oral cavity

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35
Q

what food preservatives are linked to RAS

A

benzoic acid
E211-E219

36
Q

how is RAS treated

A

removal of causative factor
if no causative factor - treat symptoms

37
Q

what disease are episodes of RAS recognised as a central component of

A

Behcets disease

38
Q

what is necrotising gingivitis

A

rapid development of painful ulceration affecting gingival margins and inter-dental papillae with marked halitosis

39
Q

what type of bacteria is associated with NG

A

anaerobic - in particular the fusobacterium species

40
Q

name three precipitating factors to NG

A

tobacco smoking, stress and immune deficiency

41
Q

how is NG managed

A

initial - mechanical cleaning and debridement
antimicrobial - metronidazole (400mg TID for three days)

42
Q

what is required of an oral ulcer that fails to respond to initial treatment within 2-3 weeks

A

biopsy to exclude the presence of malignancy

43
Q

what type of infection can cause oral ulceration

A

herpes simplex virus type 1

44
Q

how does primary infection of HSV1 present

A

widespread oral ulceration

45
Q

how does secondary infection of HSV1 present

A

reactivation of latent virus presents as localised crop of small ulcers

46
Q

how does erythema multiforme present

A

rapid onset of extensive oral ulceration with blood crusted lips

47
Q

how are symptoms treated in RAS in first line

A

chlorhexidine 0.2% mouthwash or spray TID
benzydamine 0.15% mouthwash or spray TID

48
Q

if no improvement has occurred after first line symptomatic treatment of RAS what should be done next

A

beclometasone MDI - 2 x 50 microgram puffs onto ulcers twice a day

49
Q

what should be done if there is no response to topical antiseptics or betametasone MDI in RAS

A

refer to specialist and arrange haematological investigation

50
Q

what is angular cheilitis

A

inflammatory changes causing erythema and soreness/ ulceration occurring at the angle of the mouth

51
Q

what should be a differential diagnosis of angular cheilitis

A

recurrent herpes labialis and lichen planus

52
Q

what haematological investigations are taken for angular cheilitis

A

FBC
haematinics

53
Q

what species are thought to be present in angular cheilitis

A

candida (galbrata)
staphylococcus

54
Q

what is chronic erythematous candidosis

A

associated with wearing intra-oral appliance which presents as erythema in palatal mucosa

55
Q

what anti-fungal treatment should not be given to a patient taking warfarin or statins

A

miconazole

56
Q

what is acute erythematous candidosis associated with

A

patients who use a steroid inhaler

57
Q

what is geographic tongue

A

areas of erythema surrounded by white margins on dorsum of the tongue

58
Q

what may patients with geographic tongue complain of

A

discomfort on eating spicy foods or hot foods

59
Q

what is erythroplakia

A

a red patch that cannot be characterised clinically or pathologically as any other definable lesion

60
Q

what is white sponge naevus

A

developmental condition clinically affecting buccal sulcus and labial mucosa with areas of white plaque like deposits - benign so doesn’t require treatment

61
Q

what is leukoedema

A

white patch which only affects older adults who smoke

62
Q

what causes leukoedema

A

excess hydration of the surface keratin on buccal mucosa

63
Q

how do you test for leukoedema

A

pull the cheek laterally and the lesions will appear

64
Q

what are fordyce spots

A

ectopic sebaceous glands that can present on buccal mucosa and lips

65
Q

what is traumatic keratosis

A

traumatic injury of oral mucosa due to chemical or thermal irritation that produces a white patch

65
Q

what area of the oral mucosa is most affected in smoking habits

A

the palate producing a white appearance of the mucosa - smoker’s keratosis

66
Q

what is pseudomembranous candidosis

A

pseudomembranes of desquemated epithelial cells, fungal hyphae and fibrin in which you can remove the white membrane to discover area of erythema underneath

67
Q

what is the most frequently seen local predisposing factor for pseudomembranous candidosis

A

inhaled steroids

68
Q

what is chronic hyperplastic candidosis

A

occurs bilaterally in the commissure regions
speckled lesions

69
Q

what is prescribed when fungal hyphae are found in chronic hyperplastic candidosis

A

antifungal - fluconazole

70
Q

what are the five subtypes of lichen planus

A

reticular
erosive
plaque like
atrophic
bullous

71
Q

what is lichen planus

A

white patches that affect buccal mucosa, lips, tongue and attached gingivae giving symmetrical and bilateral pattern

72
Q

what is a lichenoid reaction

A

white patch almost indistinguishable from lichen planus expect occurs unilaterally and is asymmetrical and often involves palate

73
Q

what drugs are associated with lichen planus

A

ACE inhibitors
NSAIDs
beta blockers

74
Q

what are the two forms lupus erythematous (LE) occurs as

A

discoid
systemic

75
Q

what will patients with SLE have high titres of

A

circulating anti-nuclear factor

76
Q

where do lesions from discoid lupus erythematous present

A

any area of the skin
ear
areas exposed to sunlight
oral lesions consist of white patches similar to lichen planus

77
Q

how are oral lesions in discoid lupus erythematous treated

A

topical steroid

78
Q

how should you class a white term lesion of no known cause

A

leukoplakia like plaque lesion

79
Q

what investigations are done for leukoplakia

A

biopsy for histopathological investigation
punch biopsies not acceptable

80
Q

what is hairy leukoplakia

A

occurs bilaterally on lateral margins of the tongue
associated with EBV
managed by sucking peach stones or tongue scraping

81
Q

how does submucous fibrosis present

A

irregular flat white patches with fibrous bands that can be palpated like harp strings

82
Q

what is fibrous submucous fibrosis associated with

A

chewing betel

83
Q

name four topical steroid preparations for management of lichen planus

A

beclomethasone MDI (0.5 micrograms per puff, 2 x puffs twice daily)
clobetasol 0.05% ointment applied twice daily
prednisolone soluble 5mg tablet dissolved in 10ml water as mouthwash rinse 2 mins TID
betamethasone 0.5mg tablet x2 in 10ml water rinse for 2 mins TID

84
Q

what should be considered when prescribing topical steroids to treat disease

A

antifungal treatment to eradicate secondary candidosis
fluconazole 50mg daily for 7 days

85
Q
A

SCR Revision (4 decks)

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