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Orthodontics > Oral Medicine > Flashcards

Oral Medicine Flashcards

1
Q

What do we need to know

A
  • History taking
  • Red patches
  • Ulcers
  • White patches
  • managing suspicious lesion
  • when to refer your patient
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2
Q

Pain history ? SOCRATES

A

Site- where is pain?
Onset- when/how did pain start ( sudden/gradual)
Character- describe the pain? Dull/sharpe
Radiation- Does pain move anywhere?
Associations- Any symtoms/ signs associated with pain?
Timing- How has pain changed over time?
Exacerbating/Relieving factors- does anything worsen/ relieve the pain?
Severity- How bad is the pain in scale 1-10 ?

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3
Q

History of lesion?

A
  • when did you notice it?
  • were they any predisposing events?
  • has it changed?
  • does it bother you?
  • are there any other lumps?
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4
Q

Past medical history ?

A
  • Current and previous illness
  • Previous operation
  • Previous investigation
  • Allergies
  • other
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5
Q

Drug History

A
  • Current and previous medication
  • Dosage and durations
  • Any allergies
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6
Q

Family history

A
  • Note any relevant conditions in immediate family members
  • Systemic illnesses, neoplasms etc
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7
Q

Social History

A
  • Smoking no. Per day and how long for
  • vaping
  • Alcohol intake in unit / single spirit 1 unit
  • Occupation
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8
Q

Red patches/ Erythema

A
  • Red patches appear red due to thinning/ ulceration / erosion of oral mucosa and increased
  • Most will cause a degree of discomfort (occasionally painless)
  • Some are pre- malignant
  • can be widespread in oral cavity.
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9
Q

Erythema

A
  • Trauma
  • Infection e.g Candida
  • Immune related disease
  • Idiopathic tongue - swelling of tongue
  • Neoplasia - uncontrolled , abnormal growth of cells or tissue in body
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10
Q

Type of Erythema

A

1- Painful and May ulceration-
Post radiotherapy mucositis
Hypersensitivity reaction
Erosive lichen planus

2- painful with no ulceration.
Acute candidosis
Geographic Tongue
Anemia ( iron , folate)

3- Painless with no ulceration
Erythroplakia
Chronic Candidosis

4- Painless with ulceration
Squamous cell carcinoma
Infectious mononucleosis

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11
Q

Contact hypersensitivity reaction

A

Cause by dental material/chemical I.e
Nickel , orthodontic wires

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12
Q

Acute Erythematous Candiosis

A

-May be painful
- steroid inhaler
- immunosuppression / HIV

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13
Q

Median Rhomboid glossitis

A

Caused by CANDIDA

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14
Q

Chronic Erythematous Candidosis

A
  • Seen under fitting surface of URA and nance buttons
  • caused by Candida albicas
  • management- OHI , appliance cleaning adv, soaking and leaving out at night
  • some cases - Tropical anti fungal paste-Miconazole 6hrs for 4 Weeks
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15
Q

Geographic tongue ( Erythema migrants)

A
  • Idiopathic condition
  • Typically involves tongue
  • increased sensitivity to certain foodstuffs
  • management- reassurance and symptomatic relief
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16
Q

Erythroplakia

A
  • Aetiology Tobacco, Alcohol, deficiency, Candida infection, chronic Trauma
  • Malignant 5-10 %
  • Require biopsy
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17
Q

Squamous cell Carcinoma

A
  • Variable clinical features
  • Present floor of mouth , tongue , retromolar region
  • 5yr survival rate ,40%
18
Q

Oral ulceration

A
  • Breach of Oral mucosa ( breaking into tissue) suqmous epithelium.
19
Q

Oral Ulceration - Erosion

A
  • Superficial break in epithelial continuity with underlying Lamina propria being intact
20
Q

Aetiology of Oral Ulceration

A
  • Trauma - ortho wires, sharp restoration
  • Immunological
  • Infection . HSV, TB
    -Immune related disease
  • Neoplatic lesions
21
Q

Trauma

A

Physical- Orthodontic appliance ,
Chemical - aspirin burn

22
Q

Recurrent Aphthous Stomatitis / Ulceration

A
  • often recurring
  • child / adult
  • Round / oval shape
  • painful
  • White/ yellow
  • can present in number of ways
  • 15-20 % population
  • someone smoke stop smoking experience RAS
  • idiopathic ( unknown)
  • Predisposing factor - Stress anxiety / Hypersensitivity (allergy), Deficiency, Hormonal
23
Q

RAS - types 1 . Minor RAS

A
  • unusually mobile
  • 2-6 per episode
  • last 7-14 days
  • heals with no scaring
24
Q

Type 2 - Major RAS

A
  • large >1 cm diameter
  • involve both keratinised and non keratinised mucosa
  • Month or longer
  • scar by healing
25
Q

Type 3 - HYPETIFORM RAS

A
  • Apthae grow and fuse
  • 7-14 days
  • heal without scarring
26
Q

Management of RAS/ RAU

A

Investigation :-
-Full blood count (B12, folate,Ferritin)
- clinical findings: coeliac disease screen, antibody, HIV

MANAGEMENT:
Beclometasone dipropionate: 2 puff directed onto ulcers 3x days

Betnesol Mouthwash: : 3 x day

Chlorhexidine M/W may help prevent secondary infection of RAU

27
Q

Ulcers - infective causes

A
  • Recurrent herpetic gingivostomatitis caused by Herpes simplex virus (HSV-1)
  • Herpes zoster virus (HHV- 3)

-HIV

28
Q

White patches / Lesions
When commonly developed?

A
  • Trauma
  • Infection
  • Immune related disease
  • Neoplasia
29
Q

Pattern of white patches with pain

A
  • often associated with pain
  • Chemical burn
  • lichen Planus
  • Lichenoid reaction
  • Lupus Erythmatosus
30
Q

White patches

A
  • usually painless, although discomfort can appear due to erosion and ulceration
  • Premalingnant - biopsy
  • may be localised or wide spread
31
Q

Trauma - Chemical burn

A
  • Painful injury to soft tissues
  • White sloughing due to necrosis
32
Q

Immune related - Hypersensitivity lichenoid reactions.

A
  • unilateral often adjacent to amalgam
33
Q

Acute Pseudomembranous candidosis

A
  • creamy path can be removed
  • caused by steroid inhalers use and broad spectrum AB’s
34
Q

What caused by orthodontic wire?

A
  • Frictional Keratosis
35
Q

Frictional keratosis

A
  • Thickening of mucosa due to persistent irritation eg smoking, heat, cheek biting, orthodontic wire.
36
Q

Leukoplakia

A
  • white thick patch in oral cavity
  • middle age or above
  • tongue
    -Retromolar region
  • lower lip
  • floor of mouth
37
Q

Smoking and smokeless tobacco

A
  • White keratosis , buccal tissue and on alveolar ridge
  • inflammed minor salivary glands
  • Nicotinic Stomatitis
38
Q

Alcohol

A
  • Oral cancer - high alcohol consumption
  • 38 times risk increase for drink and smoke heavily together
  • tooth erosion
  • accidental dental trauma
39
Q

Management of suspicious lesion

A
  • record in notes - visual exam
  • sign and symptoms - use open questions
  • Notes include MH, Social history, smoking and alcohol habit.
40
Q

DCP MANAGEMENT

A
  • Take a thorough history -
    -Take infra oral photos and measurement of suspicious lesions
  • Consult with orthodontist
  • Refer if in doubt
  • Review

Orthodontics (45 decks)

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