red and white patches

Question 1

What contributes to the colour of the oral mucosa?

Answer 1

Epithelial thickness
Keratinisation
Inflammation
Melanin
Candida
Exogenous factors eg - strawberry lolly would make it red

Question 2

Give some reasons for white patches

Answer 2

Abnormal or increased keratin
Increased epithelial thickness
Candida infection

Question 3

Name 4 risk factors for oral candida infection

Answer 3

Any from:
- immunocompromised
- dentures
- smoking
- inhaler use
- dry mouth
- antibiotics

Question 4

How is oral candidiasis managed?

Answer 4

Antifungal therapy - fluconazole, miconazole, nystatin
Local measures - rinse after inhalers, use a spacer, denture hygiene, smoking cessation

Question 5

What common drugs interact with -azoles?

Answer 5

Warfarin
Statins

Question 6

What are the different types of oral candidiasis?

Answer 6

Pseudomembranous
Erythematous
Hyperplastic
Angular cheilitis

Question 7

Describe pseudomembranous candidosis

Answer 7

White, curd like patches
Can be wiped away, leaving red/bleeding underneath
Seen in immunocompromised, inhalers and infants

Question 8

Describe erythematous candidosis

Answer 8

Red, atrophic areas
Burning sensation
Bleeding areas
Seen in immunocompromised, denture wearers and people with xerostomia

Question 9

Describe hyperplastic candidosis

Answer 9

Chronic, persistent white patches
Cannot be wiped away
Found in immunocompromised and those with poor fitting dentures

Question 10

Describe angular cheilitis

Answer 10

Found on the corners of the mouth
Erythema and fissuring
Due to poor fitting dentures, immunocompromised and nutritional deficiencies

Question 11

What is traumatic keratosis and how is it treated?

Answer 11

Increased keratin deposition at the site of trauma as a protective mechanism
Give smoking cessation and take a photograph

Question 12

How can oral lichen planus and oral lichenoid reactions be classified?

Answer 12

Reticular
Atrophic
Papular
Erosive
Plaque like
Bullous

Question 13

What is lichen planus?

Answer 13

A chronic inflammatory condition where T cells cause destruction of basal keratinocytes
A white patch
Most patients are asymptomatic but some have burning/stinging sensation to hot/spicy foods and fizzy drinks
1% malignant potential over 10 years

Question 14

What are the causes of oral lichenoid reactions?

Answer 14

Drugs:
- antihypertensives
- NSAIDS
- lithium
Materials:
- metals
- amalgam

Question 15

How are OLP/OLR managed?

Answer 15

Symptomatic relief
1. Mouthwash - hot, salty water
2. LA - benzydamine mouthwash
3. Avoid triggers eg - spicy foods, fizzy drinks
4. Steroid mouthwash - betamethasone
5. Change restorations
6. Onwards referral - biopsy for histopathology

Question 16

What is hairy leukoplakia?

Answer 16

A non-removable white patch found mostly on the lateral borders of the tongue
Acanthotic and parakeratinised tissue
Triggered in EBV
Found in patients with HIV due to being immunocompromised

Question 17

What is leukoplakia and how is it managed?

Answer 17

A clinical diagnosis of exclusion
No obvious cause for white patch but potential to become malignant
Needs biopsy for histopathological examination

Question 18

Give 4 examples of red patches?

Answer 18

Erythematous candidiasis
Granulomatosis with polyangiitis
Erythroplakia
Orofacial granulomatosis

Question 19

Describe granulomatosis with polyangiitis and how it is managed

Answer 19

Systemic vasculitis
Patient may have fever and weight loss
Potentially fatal
Managed with immunosuppressants

Question 20

What is erythroplakia?

Answer 20

Clinical diagnosis of exclusion
Velvety, fiery, red patch
Most will have dysplasia or malignancy
Very high malignant transformation
Urgent referral indicated

Question 21

What is OFG and oral Crohn’s and how is it managed?

Answer 21

Non-necrotising granuloma formation
Consider GI investigation
Manage with topical steroids, avoidance diets and biologics for Crohn’s disease

Question 22

What are speckled white and red patches and how is it managed?

Answer 22

Erythroleukoplakia
High risk, refer to secondary care urgently
Biopsy needed

Question 23

What 8 things should be assessed in a white patch?

Answer 23

Location
Colour
Homo/heterogeneity
Induration (soft or hard)
Raised or flat
Texture
Is it wipeable
Symmetry

Question 24

Which oral tissues are keratinised?

Answer 24

Gingiva
Hard palate
Dorsum of tongue

Question 25

Which oral tissues are non-keratinised?

Answer 25

Buccal and labial mucosa
Soft palate
Floor of mouth
Inner lining of lips

Question 26

Which systemic conditions are often mistaken for lichen planus?

Answer 26

Lupus
Graft versus host disease