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Dentistry in a Nutshell > oral med > Flashcards

oral med Flashcards

1
Q

syphilis

A

sexually shared infection caused by t.pallidum
can be congenital / acquired
acquired is primary / secondary / tertiary

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2
Q

primary syphilis

A

painless round / ovoid lesion
lips common site
painless rubbery cervical lymphadenopathy may be a feature
highly contagious
resolves 2-3mths

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3
Q

secondary syphilis

A

1-4mths following healing of primary encounter
generalised macular skin rash
superficial ulcers
resolves 2-6wks although may enter latent phase

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4
Q

diagnosis of syphilis

A

serological tests i.e. TPHA / FTA

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5
Q

clinical features of candida (6)

A
  1. pseudomembranous (acute / chronic) - white / yellow plaques removed to reveal erythematous base which can bleed
  2. erythematous (acute / chronic) - commonly on dorsal surface of tongue, palate & buccal mucosa
  3. hyperplastic (chronic) - chronic discrete adherent white plaque like lesions, commonly at commissures
  4. denture induced stomatitis* - chronic erythema & oedema of mucosa in contact with fitting surface of denture
  5. angular cheilitis* - soreness, erythema, fissuring at angles of the lips
  6. median rhomboid glossitis* - papillary atrophy centrally placed anterior to circumvallate papillae
    * candida associated lesions
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6
Q

local factors predisposing to candida

A

trauma / denture wearing / poor denture hygiene / xerostomia

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7
Q

systemic factors predisposing to candida

A

radiotherapy / AB therapy / diabetes / nutritional deficiency / immunosuppression / smoking

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8
Q

investigating candida

A

swab & smear from palate & denture for everything except chronic hyperplastic
only 2 to biopsy is chronic hyperplastic & median rhomboid glossitis
screen for deficiencies & diabetes
FBC, ferritin, folate, b12 & glucose

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9
Q

tx of candida

A
  1. fluconazole capsules 50mg 1 x 7 days
  2. miconazole gel 20mg/g pea size x 4 daily continue to use for 7 days after lesions healed
  3. nystatin oral suspension 100,000 units/ml rinse after food x 4 daily & use for 48hrs after lesions healed
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10
Q

contraindications of azole antifungals

A

warfarin
statins

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11
Q

PHG cause

A

HSV 1
sometimes HSV 2
transmission via direct contact with infected skin / saliva

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12
Q

PHG clinical features

A

pyrexia, malaise, painful mouth & throat, cervical lymphadenopathy
widespread IO vesicles which rapidly rupture to form small irregular superficial ulcers with erythematous halos
gingiva if infected appear inflamed & bleed readily
SELF LIMITING & resolve in 10-14 days

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13
Q

investigations for PHG

A

hx & clinical features
PCR / detecting virus in smear / viral culture

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14
Q

tx of PHG

A

mild - symptomatic i.e. analgesia & fluids, can also give
- CHX 0.2% 10ml rinse for 1 min x 2 daily until resolved
- H2O2 6% 15ml diluted for 2 mins x 3 daily until resolved
mod / severe / immunocompromised pts - aciclovir 200mg x5 for 5 days

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15
Q

recurrent herpetic infection

A

in form of herpes labialis (cold sores)
lies dormant in trigeminal ganglion
reactivated via:
- fever
- trauma
- sunlight exposure
- menstruation
- immunosuppression
tx = topical aciclovir 1% / 5% every 2hrs during prodromal stage

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16
Q

varicella zoster virus causes

A

varicella - chicken pox in children
zoster - shingles in adults
tx via aciclovir (higher dose) 800mg x 5 daily for 5 days

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17
Q

what is aciclovir

A

systemic anti viral inhibits DNA polymerase by acting as defective guanine molecule

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18
Q

coxsackie virus causes

A

herpangina
HFM disease
tx of both = control symptoms via soft diet, fluids, analgesia

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19
Q

HPV - squamous cell papilloma

A

common benign tumour found on soft palate but also may affect dorsum / lateral surfaces of tongue
3rd-5th decade
pedunculated or sessile cauliflower like swelling

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20
Q

causes of ulceration

A

traumatic
idiopathic
infection - viral / fungal / bacterial
systemic disease association
dermatological diseases
neoplastic
drug induced i.e. nicorandil (K channel activator)

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21
Q

3 types of recurrent aphthous stomatitis

A
  1. minor <10mm, last <14 days, scarring uncommon
  2. major >10mm, last >30 days, scarring common
  3. herpetiform F>M, 1-2mm, larger if ulcers coalesce, >30 days, scarring possible if ulcers coalesce
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22
Q

investigation & diagnosis of RAS

A

FBC, haematinics (folate, ferritin, B12), coeliac screen (TTG tissue transglutaminase antibodies), allergy

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23
Q

RAS tx

A

no specific
antiseptic MW - CHX 0.2% / benzydamine MW 0.15% rinse using 15ml every 1.5hrs as required (or use 0.15% spray)
topical corticosteroids - beclomethasone MDI 50mcg 1-2 puffs directly onto ulcers x2 daily // betamethasone MW 500mcg 1 tablet dissolved in 10ml water x 4 daily // hydrocortisone oromucosal tablets 2.5mg 1 tab dissolved next to lesion x 4 daily for 5 days
systemic corticosteroids - prednisolone
other = azathioprine, dapsone etc

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24
Q

behcets syndrome

A

comprises triad of RAS, genital ulceration & posterior uveitis
diagnosis essentially clinical
tx - via immunosuppressive agents e.g. corticosteroids / azathioprine / topical tacrolimus
oral ulceration managed as for RAS

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25
Q

intraepithelial vesiculobullous disease

A

pemphigus vulgaris
viral infections (HSV / HZV / CXS)

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26
Q

subepithelial vesiculobullous disease

A

angina bullosa haemorrhagica
mucous membrane pemphigoid
lichen planus
erythema multiforme

27
Q

direct immunofluorescence in vesiculobullous diseases

A

pemphigus = intercellular IgG & C3, basket weave pattern
mucous membrane pemphigoid & bullous pemphigoid = linear IgG & C3 at basement membrane zone

28
Q

angina bullosa haemorrhagica

A

older people
rapid formation of blood filled blister
usually soft palate
ruptures to leave superficial ulcer which is self limiting
unknown aetiology
tx - reassure & antiseptic MW for symptomatic relief

29
Q

pemphigus vulgaris

A

autoimmune skin disease
clinical - widespread bullous lesions, oral lesions in almost all pts, positive nikolsky sign, INTACT IO BULLAE ARE RARE, tend to rupture shortly after they form, pain, scarring uncommon
failure to tx may be fatal

30
Q

pemphigus vulgaris investigation & diagnosis

A

routine histopathological exam of perilesional tissue
with direct / indirect immunofluorescence
IgG & C3 bind to component of desmosomes (predominantly desmoglein 3)
circulating antibody titre reflects severity of disease & can be used as marker of disease acitivty

31
Q

pemphigus vulgaris tx

A

immunosuppressive therapy & corticosteroids +/- azathioprine

32
Q

mucous membrane pemphigoid

A

chronic subepithelial bullous disorder principally affecting the elderly
lesions on oral / genital mucosa
heals with scarring
clinical - bullae thick walled, intact for days before rupturing to leave superficial areas of ulceration, may also present as desquamative gingivitis

33
Q

mucous membrane pemphigoid investigation & diagnosis

A

histopathological examination shows subepithelial bulla formation
immunofluorescence shows IgG & C3 at basement membrane

34
Q

erythema multiforme

A

self limiting vesiculobullous disease affecting skin +/- mucous membranes
usually young adult males
precipitating factors = HSV / thiazide diuretics / carbamazepine
clinical - skin lesions, erythematous maculopapular rash, target lesions, haemorrhagic crusting of lips with extensive bullous lesions which rapidly rupture to form widespread painful erosions, ocular involvement may lead to conjunctival scarring & blindness
usually subside within 2wks but can recur

35
Q

erythema multiforme investigation, diagnosis & tx

A

clinical picture but can confirm with biospy
tx = identify & eliminate precipitating factor if possible e.g. aciclovir if HSV, prevent dehydration, systemic corticosteroids +/- azathioprine

36
Q

white sponge naevus

A

benign keratin defect
autosomal dominant
genetic
biopsy will confirm
reassure
no tx

37
Q

other white patches

A

chemical burn - resolves following removal of irritant
smoker’s keratosis - typically palate, tongue. commissures
frictional keratosis - in response to chronic low grade trauma e.g. cheek biting - will resolve when irritation removed

38
Q

leukoplakia

A

white patch that cannot be wiped off or characterised clinically or pathologically as any other disease essentially a diagnosis of exclusion

39
Q

erythroplakia

A

bright red patch that cannot be attributed to any other cause

40
Q

factors associated with increased rate of malignant transformation (3)

A

site of lesion - FoM, ventral surface of tongue, lingual alveolar mucosa
presence of epithelial dysplasia
clinical nature - nodular / speckled leukoplakia

41
Q

chronic hyperplastic candidiasis

A

aka candidal leukoplakia
persistent white / speckled red/white lesion
predisposing factors:
- tobacco usage
- nutritional deficiency
- poor denture hygiene
- corticosteroid inhaler use
mx - biopsy of all red / white lesions, eliminate predisposing factors, antifungal therapy

42
Q

oral submucous fibrosis

A

increased risk with chewing betel quid / areca nut
epithelial dysplasia common finding histological evidence of carcinoma in 5-6%
progressive fibrosis

43
Q

aetiological factors of mouth cancer

A

tobacco
alcohol *
diet
UV
chronic candida i.e. chronic hyperplastic candidosis (premalignant condition)
HPV
immunosuppression
syphilis *
* causes mucosal atrophy which in turn thins epithelium making it more susceptible to carcinogens

44
Q

black hairy tongue

A

benign
overgrowth of filiform papillae with lack of normal desquamation
overgrowth of bacteria / fungi cause discolouration
exacerbated by tobacco use
reassure, brush tongue, tongue scraper

45
Q

geographic tongue

A

irregular partially depapillated areas on anterior 2/3s of tongue often with distinct white margins
regress & reappear on other parts of tongue
asymptomatic but may show sensitivity to hot spicy food

46
Q

for pilocarpine to work

A

pts must have some residual functional salivary gland tissue

47
Q

sialadenitis

A

local e.g. calculus or systemic e.g. diabetes / sjogrens causes of reduced salivary flow invoke ascending infection from oral flora i.e. s.aures / s.viridans
pain & swelling of affected gland, pyrexia, malaise, cervical lymphadenopathy
tx - ABs / drainage by use of sialogogues

48
Q

burning mouth syndrome

A

chronic pain disorder (burning) in the absence of mucosal pathology
investigate - haematinics, diabetes control, psychological factors

49
Q

persistent idiopathic facial pain

A

diagnosis of exclusion
pain - persistent & present daily
confined to outset of 1 side of face
not associated with other signs
high incidence of depression / anxiety
tx via SSRIs e.g. fluoxetine / tricyclic antidepressant i.e. amitriptyline

50
Q

trigeminal neuralgia

A

classical ( compression of nerve)
secondary (to space occupying lesion i.e. tumour / MS )
idiopathic
severe paroxysmal pain, lasts secs, mandib > max branch of TN, older pts, electric shock like pain
investigate - MRI, cranial nerve testing, OPT to rule out dental cause
tx - carbamazepine, oxcarbazepine, gabapentin, phenytoin, valproate

51
Q

malignant transformation of lichen planus

A

1% chance over 10 year period

52
Q

aetiology of lichen planus

A

exogenous - dental materials / food allergens / drugs e.g. diuretics, beta blockers / infection i.e. bacterial plaque & candida / stress / tobacco / trauma
systemic - GVHD / nutritional deficiencies / diabetes mellitus / liver disease

53
Q

histological features of lichen planus

A

acanthosis
liquefaction degeneration of basal cell layer
inflammatory cell infiltrate in deeper layers of epithelium
dense subepithelial band of chronic inflammatory cells with well defined lower border

54
Q

tx of lichen planus

A

antiseptic MW - CHX 0.2% / benzydamine MW 0.15% rinse using 15ml every 1.5hrs as required (or use 0.15% spray)

topical corticosteroids - beclomethasone MDI 50mcg 1-2 puffs directly onto ulcers x2 daily // betamethasone MW 500mcg 1 tablet dissolved in 10ml water x 4 daily

systemic corticosteroids - prednisolone

azathioprine

topical tacrolimus
this is for tx of symptomatic lesions, asymptomatic don’t require active tx

55
Q

systemic lupus erythematous

A

autoimmune disorder of unknown aetiology, potentially drug induced i.e. phenytoin F>M 9:1
photosensitive erythematous rash (butterfly), arthritis, anaemia = main symptoms
oral lesions in 1/3 of pts, similar to those of lichen planus with erythematous lesions & superficial erosions
difficult to tx & may only respond to high dose systemic corticosteroids

56
Q

orofacial granulomatosis

A

if pt has crohn’s this is termed oral crohn’s
clinical - recurrent ulcers diffuse lip or cheek swelling cobblestone appearance of mucosa mucosal tags full width gingivitis granulomatous angular cheilitis vertical fissures of the lips

57
Q

upper v lower motor neurone lesions

A

upper -> affects only lower part of face on opposite side e.g. cerebrovascular accident, MS
lower -> affects whole face on same side e.g. Bell’s palsy, trauma, parotid gland tumour, otitis media

58
Q

bell’s palsy

A

acute onset over several hrs
recover spontaneously
protect cornea while palsy present

59
Q

oral features of anaemia

A

recurrent oral ulceration
atrophic glossitis
angular cheilitis
oral dysaesthesia

60
Q

oral features of leukaemia

A

bleeding, mucosal pallor, increased predisposition to infections e.g. candida / herpes, ulceration, gingival swelling

61
Q

lesions strongly associated with HIV infection

A

candidiasis
hairy leukoplakia
kaposi’s sarcoma
non hodgkin’s lymphoma
periodontal disease (ANUG/P)

62
Q

hairy leukoplakia

A

usually asymptomatic
bilateral vertically corrugated white patches on lateral margins of tongue
marker of underlying immunodeficiency
opportunistic infection of oral mucosa by EBV
marker of poor prognosis in HIV pts

63
Q

non hodgkin’s lymphoma

A

uncommon but well recognised complication of HIV infection
rapidly enlarging, firm, rubbery swelling
fauces / palate / gingivae
tx via radio/chemotherapy

Dentistry in a Nutshell (30 decks)

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