Oral Med

Question 1

what is atypical odontalgia

Answer 1

pain without dental pathology
presents like acute pulpitis but pattern is that it comes and goes - pulpitis would get worse until nerve necrotic and then no pain
no disease present
caused by damage to pathway that supplies tooth - patient relates this to toothache

Question 2

how is atypical odontalgia treated

Answer 2

referral to oral med
reassure patient that no dental disease so nothing to treat but that you believe them
analgesic advice in meantime

Question 4

how can each cranial nerve be tested

Answer 4

1 - olfactory - can they smell
2, 3, 4, and 6 - visual acuity and eye movements
5 - trigeminal - test sensitivity at each branch
7 - facial - movement of facial muscles
8- vestibulococchlear - can patient hear
9 + 10 - can patient move uvula to side and say ah
11 - accessory - shrug shoulders
12 - hypoglossal - move tongue

Question 5

what are symptoms of trigeminal neuralgia

Answer 5

intense sharp pain lasting 2-3 seconds, happening in cluster of attacks
happens along course of nerve, normally maxillary or mandibular
caused by vascular compression of the nerve or secondary to MS

Question 6

what triggers trigeminal neuralgia

Answer 6

wind, cold, touch, chewing
normally mask like face to avoid bringing pain on

Question 7

how is trigeminal neuralgia treated

Answer 7

carbamazepine first line - referral to oral med, needs careful monitoring due to effects on blood

Question 8

what is chronic hyperplastic candidiasis

Answer 8

fungal infection of the mouth, normally white patches on cheeks
cannot be scraped off - deeper into tissue
has potential to become more sinister - need to take incisional biopsy - OM

Question 9

how is chronic hyperplastic candidiasis treated

Answer 9

risk factors - rinse mouth after inhaler, check blood for diabetes and anaemia, immunocompromised
oral hygiene instruction
smoking cessation
systemic antifungal - fluconazole 50mg - 1 a day for 7 days - review after a week

Question 10

explain lichen planus to a patient

Answer 10

it is a relatively common condition and is a type of allergic reaction - the body percieves something harmless as a threat and works to try to remove it. in doing so it makes more keratin - which is a protein in the body, on skin and nails and responsible for these white marks you can see in your mouth.
the cause of this is commonly a silver filling or medications. can happen after trauma - tissue healing itself
this has the potential to turn malignant, into something more sinister - around 1% in 10 years so it is important for us to keep this under observation and monitor for any changes - every 4-6 months

Question 11

how is lichen planus treated

Answer 11

if asymptomatic - kuo
if symptomatic - treat symptoms, benzydamine mouthwash, chx mouthwash
check blood for haematinics
sls free toothpaste
if still persisting - topical steroids, beclomethasone mouthwash but referral to OM

Question 12

if a patient is presenting with dry mouth, what is important to gain from history?

Answer 12

how much it is effecting patient - effecting eating, talking, uncomfortable
what medications is the patient on and what for - amitryptiline antidepressant and used for pain
does the patient smoke or drink alcohol
any other conditions - diabetes, anxiety, stroke, sjorgens

Question 13

what advice should be given to a patient complaining of dry mouth

Answer 13

improve hydration - amitryptaline reduces fluid in body so need to increase fluid intake
improve diabetes control
manage symptoms - saliva replacements - lozenges, gel, sugar free chewing gum
high prevention - high strength toothpaste, oral hygiene instruction
if candida - CHX MW

Question 14

why does facial palsy occur after giving IDB and how does this appear

Answer 14

injecting too far back - into parotid gland where facial nerve runs through - temporary paralysis of facial muscles
ipsilateral paralysis of facial muscles, including forehead, drooping of corner of mouth, unable to close eyelids
in stroke - forehead spared so able to wrinkle forehead

Question 15

how is facial palsy treated

Answer 15

reassurance - temporary, will wear off once anaesthetic worn off
cover eye until blink reflex returns to protect cornea of eye

Question 16

explain OFG to a patient

Answer 16

over reaction, allergic reaction, to a perceived threat. causes build up in immune cells as they try to remove the cause, this blocks the drainage ducts and causes a build up in fluid
can be a reaction to many things - normally benzoates (in carbonated drinks and tomatoes), chocolate, cinnamon, sorbic acid

Question 17

what would a patient with OFG complain of

Answer 17

swollen, fissured lips
inflammation of peri-oral tissues
angular chelitis
ulceration of mucosa
gingivitis

Question 18

what advice should be given to patient with OFG

Answer 18

ask about bowel habits - if problems then suggest possible crohns as this is a similar condition
ask if pt happy for you to share information with GP - might require test faeces or colonoscopy
advise exclusion diet - would have to be strict for 3 months
tracolinmus ointment for lips
immune modulation - azthimyocin

Question 19

what is difference between minor and major aphthous stomatitis

Answer 19

minor - less than 10mm, heals within 2 weeks, responsive to topical steroids, only on non-keratinised epithelium

Question 20

what conditions can be associated with apthous stomatitis

Answer 20

anaemia - check iron, folate, b12
coeliac - check ttg

Question 21

how is aphthous stomatitis treated

Answer 21

treat symptoms - benzdamine mouthwash, CHX mouthwash
if doesnt work - topical steroid - betamethasone mouthwash
if still persisting - referral to OM
if ulcers persist for more than 3 weeks despite being treated - urgent referral
treat risk factors - anaemia, exclusion diet

Question 22

what diet advice should be given to people with anaemia

Answer 22

eat dark green leafy veg
increase meat intake or tofu
pulses, nuts
cereals fortified with iron

Question 23

explain epithelial dysplasia to a patient

Answer 23

the results show that although there have been some changes to the cells in your mouth - it is not cancerous, however, it has a high risk of turning into something malignant
you can reduce this risk by reducing your alcohol intake and smoking

Question 24

how can you give alcohol advice

Answer 24

ask - how much do you drink per week? what do you drink? are you or your family concerned about your drinking?
advise - alcohol is a risk factor for oral cancer, also has effects on general health - more at risk of stroke, effect on liver and cardiovascular disease
assess - ask if patient is interested in changing, inform fundamental to reduce risk of oral cancer
refer - to alcoholics annoymous

Question 25

what lymph nodes are around the face

Answer 25

pre auricular
parotid
submandibular
submental

Question 26

what lymph nodes travel down the neck

Answer 26

occipital
posterior auricular
juglo-digastric
jugulo-omohyoid
deep cervical
supra clavicular - look at anatomy

Question 27

if patient presenting with sinister ulcer what should you ask

Answer 27

how long has it been there
has it gotten worse
has it been sore, difficult to eat or swallow
medical history, smoking, alcohol

Question 28

explaint to a patient that you are concerned about an ulcer

Answer 28

the ulcer has a number of different things that it could be caused by, one of these possibilities is oral cancer. the area that the ulcer is, is a high risk area and as you smoke and drink alcohol, these two factors make you at a higher risk of devleoping oral cancer. i think it would be appropriate to refer you on to a specialist to have a look at this.

Question 29

explain to a patient what a biopsy is

Answer 29

taking a small sample of the lesion, and sending it to the lab for analysis, you will be numb for this and stitches will be used to close it back together
it will be sore afterwards - similar to having an ulcer and the stitches will dissolve on their own
they will give you more advice at this appointment

Question 30

explain to a patient why they have to be made dentally fit prior to chemotherapy

Answer 30

chemotherapy puts a toll on the body, including the mouth - make at more risk of infection
we want to make sure we remove any potential sources of infection before you start so that there is reduced need to interrupt treatment
it is also important you maintian oral health during treatment and we can support you in doing this

Question 31

explain why extraction must be carried out prior to chemotherapy starting

Answer 31

if xla done during treatment - higher risk of infection
if done after treatment - risk of MRONJ

Question 32

what pre-chemo prevention should be carried out

Answer 32

full mouth PMPR
smooth down sharp teeth
imps taken for soft splint
toothbrushing advice
fluoride toothpaste - 5000ppm
fluoride varnish
give trays to fill with toothpaste for through the night

Question 33

what are oral side effects of chemotherapy and how can we manage these

Answer 33

mucositis - inflammation of lining of mouth, really painful, impacts eating and oral hygiene
can be managed with analgesia, topical lidocaine, benzydamine, ice, caphasol
avoid smoking, spicy foods, spirits
oral candidiasis - thrush, fungal infection, mouth is dry and immune system low - fluconazole prescribed, CHX MW and miconazole
dry mouth - frequent sips of water, saliva replacement, lozenges, chewing gum