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Oral Disease > 2005/2006 > Flashcards

2005/2006 Flashcards

1
Q

How to manage an unerupted/partially erupted lower 3rd molar?

A

-SOCRATES/ take history, are they in pain?
- cheek biting/pain/pericoronitis/RESOPRTION/difficulty eating/cleaning -ASK
-EXAM: signs of ulceration,swelling,bleeding,occlusion fro opposing teeth, any plaque/debris/pus/lymphadenopathy,trismus
- sectional OPT to help diagnose
-look at x ray for depth of tooth within bone,impacted, distance from ID nerve, distance to ACJ of 2nd molar to caries, crow form,root form,root number, pathology,
-severity, does it recur,

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2
Q

When appropriate to prescribe antibiotics?

A

-fever malaise
- lymphadenopathy
- immunosuppressed individual
-spreading infection
-pericoronitis
-chronic infection

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3
Q

Benign lesion?

A
  • slow growing, well defined , corticated, asymptomatic, no loss of normal anatomy but can be displaced, uniform , maybe symmetrical,uni or multilocular
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4
Q

Malignant lesion?

A
  • fast growing, destruction of normal anatomy , bone RESOPRTION, ill defined, not well demarcated, symptoms like weight loss and pain swelling, assymetrical, irregular consistency,
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5
Q

What signs and symptoms to refer a pt to a specialist?

A
  • pain,swelling, loss of sensation, weight loss, persistent lymphadenopathy, unwell like malaise, pyrexia, dysphasia, dysarthria so difficulty speaking,
  • irregular borders, large, rolled margins, ulcer longer than 2 weeks, white and red patch, irregular swelling,assymetrical, facial swelling, loss of anatomy,not corticated, root resorption,
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6
Q

Maxillary sinus malignancy on a radiographs?

A
  • fast growing
  • destruction of normal anatomy like the 4 lines of hard palate not present
    -bone RESOPRTION,ill defined, rolled margins, not well demarcated, assymetrical, irregular consistency
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7
Q

Causes of burning mouth syndrome ?

A
  • anaemia, less b12,folate, diabetes, menopause, cancer, depression/anxiety,
  • bacteria, fungal,allergy, parafunction, reflux, geographic tongue, xerostomia,ace inhibitors,
    MANAGE- treat underlying cause ,oral swabs, oral rinse, patch test, observe and exam, FBC, check saliva flow,
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8
Q

Fibrous dysplasia?

A
  • benign
    -children and young adults same for both M/F, head and neck,
    -painless, bony swelling,displaces teeth, and malocclusion, posterior maxilla
    -starts radioliuscent , then mixed lesion, not well defined, orange peel appearance, blends into bone no end or beginnng,
    -mono static or poly so ore than 1 bone usual in less than 15 yrs, Around 50%
  • normal one replaced by loose fibrous tissue and abnormal bone placed down like woven bone fibrous stroma
    -MANAGE- stabilises overtim , debunk bone surgical removal,orthographic surgery,
    ALBRIGHTS syndrome poly static FD,pigmented macules on skin and endocrine abnormalities
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9
Q

What conditions involve treponema species?

A

ANUG
SYPHILIS

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10
Q

ANUG?

A

-young pts that are normally well
-erythema,gingivitis,sore sis,plaque and calculus,,Alice,fever,lymphadenopathy,loss of interdental papillae,ulceration,halitosis, pus which has metallic taste
-NO BONE LOSS,
-caused by anaerobes like fusobacterium,spiorchates,trep Vincentti
Can’t be passed on
-smoking,poor ohi,stress,immunocompromised can make it worse,
-treat by metronidazole 400mg 3xday for 5 days
3% hydrogen peroxide irrigation into pockets
Chlorhexidne,ohi,rsd,analgesia, antipyretics,

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11
Q

Gardeners syndrome?

A

-
Multiple osteomas of the jaw which are well circumscribes, round,radiopaque lesions
Impacted teeth,super numeracy teeth,missing teeth,abnormal roots

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12
Q

Odontomes?

A

Ages 10-25
Benign hamartomas

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13
Q

Difference between paradental cysts and lateral perio cyst?

A

Lateralis vital teeth,between teeth,may displace teeth, unilocular,deep pockets
paradental is 3rd molars, from perio pockets, Odontogenic,

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14
Q

How to manage pt on alendronic acid- bisphosphonates

A

A traumatic technique, avoid bone removal,pack and suture
Under 10mgnothingnn
10-40mgdoubledosemorning beforehand rest of day
Over 40mg standby IV hydrocortisone

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15
Q

Amelobastoma

A

-benign Odontogenic neoplasms low growing locally destructive
-females10-30 yrs
Asymptomatic swelling
Posteriormandible80%
Buccolingual expansion
Root RESOPRTION and tooth displacement
Soap bubble appearance
-columnar a Lo last like cells on periphery Stella te reticulum like cellsin middle- conventional follicular type
-columnar amelobalsts like cell sand little or no Stella te reticulum cyst in stroma- Plexiform
-excision, enunciate if unilytic

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16
Q

Pleomorphic adenoma?

A
  • islands strands of epithelium
    -ducal structures are common
    -mucoid stroma
    -encapsulated
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17
Q

Cysts I midline of anterior palate?

A
  • nasopalatine cyst
    -radicular cyst-
  • dentigerous cysts
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18
Q

Ameloblastoma

A

-asymptomatic swelling
-Angle of mandible , well demarcated, root resoption and displacement of teeth ,buccolingual expansion
-plexiorm, and follicular,
-excision and enunciate if uni cystic . Reconstruct if large

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19
Q

Odontogenic keratocyst

A

—asymptomatic, can cause swelling, related to gorlin goltz
-uni or multilocular radioluscency ,no buccolingual expansion corticated
-can be associated with unerupted tooth
-fibrous walls ,parakeratinised epithelium , SSE lining loss of rete ridges
-fixation of nerve and enucleation and cryotherapy

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20
Q

Dentigerous cyst?

A

-10-30 displace adjacent structures , asymptomatic ,3rd molars, premolars and canine associated with cherubim
- unilocular, circumscribed corticated at CEJ of unerupted tooth
- can displace ID nerve and teeth
-comes from reduced enamel epithelium
-enucleate

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21
Q

Trigeminal neuralgia?

A

-SOCRATES
-will look scruffy, dont want u touch them,unilateral,sharp electric shock,non painful stimuli cause pain
-lasts seconds,10/10 severity ,can’t wake up from sleep,analgesia doesnt work,over 50’s,
-carbamazepine, 2x daily not for warfarin pts tho,gabapentin
-ganglion procedure , micro vascular depression, cryoanalgesia

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22
Q

Coeliac disease?

A

-ulcers , glossitis,angular Chelitis,dermatitis hermetiformis so gluten free diet
Intolerance. To alpha gliadin

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23
Q

Fracture of zygomatic complex?

A

-history of trauma,palpate bony step,flattening of cheek,peri orbital hematma, parathesia of infra orbital nerve and cheek,Diplopoda, pain,nasal bleed,trismus,
-TX by analgesics, soft diet, antibiotics, ORIF so open up face and move fragments to right position, gillies approach so incision made over infratemporal fossa and elevator passed deep into the fascia and depression lifted upwards and outwards

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24
Q

Treatment of zygomatic complex?

A

-analgesia,soft diet,antibiotics,
-ORIF open reduction and internal fixation so open face and move things into right position
-try gillies approach - incision made over infra temporal fossa and elevator passed deep into fascia and depression lifted upwards and outwards

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25
Q

Where do radicular cysts enamel come from?

A
  • her twigs root sheaths /cell rests of malassez
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26
Q

What’s cysts fro reduced enamel epithelium ?

A

Follicular cysts/dentigerous cysts,eruption cysts

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27
Q

Cysts from epitlium fro dental lamina

A

-so from cell rests of serres
-gingival cysts,Odontogenic keratocys ,lateral periodontal cysts

28
Q

Antibodies for DIF. For pemphigus

A

IgG igM

29
Q

What do u call a rupture of salivary gland on FOM

A

Ranula

30
Q

Mucous retention cysts?

A

-blockage of salivary duct causing a swelling ,15% 50-60 years ,FOMand buccal mucosa
-sialogram, lined by ductal epithelium and not many inflammatory cells filled with mucin

31
Q

Mucous extravasation cysts?

A

-ruptured duct causing spillage of mucous into surrounding connective tissue 85%,lowerlipmost common
-cysts lies in mucosa,lined by fibrous and granulation tissue and fill Edith mucous

32
Q

Possible causes of localised buccal gingival swelling?

A

-fibroepithelial polyp ( firm, mucosa coloured, due to from trauma, sessile)
-pyogenic granuloma ( red, soft swelling, vascular,BOP, from pregnancy or puberty or plaque, recurs,)
-peripheral giant cell granuloma ( red, soft, blueish tinge, vascular stroma, multinucleated giant cells)
-dental abscess ( SOCRATES, painful tooth, yellow pus, tinge,drain, facial swelling, x ray, fever)
-mucocele ( blueish swelling can rupture, lower lip,

33
Q

Special investigations to distinguish between different gingival swellings?

A
  • biopsy
    -refer to max fax or oral surger
  • ct scans, mri scans, CBCT, PA, OPT
    -palpate,
    -FBC,
34
Q

How can bisphosphonate medication lead to complications with extractions?

A

So if pt has osteoporosis then that means that bones are being broken down more than they are being repaired. Medication like alendronic acid inhibits these cells that break down the bones-osteoclasts.
With an extraction more likely to get BRONJ. So after extraction your socket doesnt heal well and the bone exposed can be painful. Can get infected. Bone can then die so risk of osteonecrosis of the jaw.
Inform pt of risk,obtain full consent , discuss other tx like rct, coronectomy, . OHI, prevention.
Before pt starts bisphosphonated do full dental assessments and XLA any poor prognosis teeth, stop smoking, alcohol and prevention

35
Q

How would you do extraction procedure for a pt on bisphonates?

A

Refer to hospital , atraumatic technique so avoid bone removal. Pack and suture using surgicel.
Steroid cover so below 10mg do nothing. 10-40mg double dose in morning and for rest of day. Over 40mg no doubling but have IV hydrocortisone. Review pt periodically so 1 week, 1 month 3 month

36
Q

Effect of bisphosphnates on bone?

A

Osteoclast inhibitor so less bone destruction and less bone turnover. May also effect osteoblasts so promotes bone formation. Stays in bone for many years

37
Q

Clinical and radiographical signs of an ameloblastoma?

A

Benign odontogenic neoplasm.
Slowly growing but locally destructive. 10-30 years. F>M. Asymptomatic unilateral swelling in jaws. Uni or multilocular radiolucency. 80% posterior mandible. Buccolingual expansion. Root RESOPRTION and displacement. Soap bubble appearance.
Differential: dentigerous cyst, odontogenic keratocyst, myxoma , giant cell lesions.

38
Q

Histological signs of ameloblastoma?

A

2 types . Follicular and plexiform

Follicular: columnar amelobalsts like cells on periphery. Stellate reticulum like cells in middle. Cysts form in the Stellate reticulum. Epihlieum resembles EO. Soap bubble appearance

Plexiform:columnar amelobalsts like cells forming strands. Little or no Stellate reticulum. Cystsform in stroma. Resembles dental lamina.

39
Q

Management of ameloblastoma?

A

-excision with margins , enucleation if unicystic. May lose posterior teeth as part of excision. Chance of nerve damage. If large may need bone substitute. Refer to max fax. Reassure pt.

40
Q

Likely diagnosis for pt being assaulted, luxated incisor , teeth meeting funny and numb lip

A

Fractured mandible as:
- displacement of teeth
-numbness
-trismus
-altered occlusion
-mobility of teeth
-pain and teeendernes
-lacerations, swelling, bruising

41
Q

Investigations for fractured mandible

A

PA, CT, OPT

42
Q

How to re implant a tooth

A

Clean any blood or debris
Irrigate socket to remove blood clot
Irrigate tooth with saline
Handle tooth via crown not root
LA
Reimpalnt with gentle pressure
Use flat plastic to remove any bony fragments
Check pt has had tetanus injection
Splint for 2 weeks

43
Q

What factors effect prognosis of tooth being reimpanted

A

How long tooth has been out of mouth . If more than 90 mins poor
Age of pt
Apex of tooth
Tooth morphology
Any lacerations
Cleanliness of tooth
Medical history like risk of endocarditis, learning difficulties,
Denta history- occlusion, crowding

44
Q

Surgeries for class 3 skeletal pattern

A

-BSSO( bilateral Sagittal split osteotomy)
-le fort 1 osteotomy

45
Q

Complications of surgeries for a class 3?

A

Nerve damage,infection, long term swelling,pain, bleeding,bruising

46
Q

What are the differential diagnosis for a painless parotid swelling?

A

-chronic sialadentitis or sjogrens ( fever and lymphadenopathy )
-pleomorphic adenoma (biopsy, ultrasound in 30-50 years)
-recurrent parotitis ( ultrasound)
-parotid duct stricture (mealtime syndrome )
-warthins tumour (only in parotid )
-mucoepidermoid carcinoma , adenoid cystic carcinoma

47
Q

Histology of pleomorphic adenoma?

A

Island or strands of epithelium
Ductal structures
Myxoid , chondroid, mucoid stroma
Encapsulated

48
Q

Differential diagnosis for a cyst in midline of anterior palate

A

Nadopalatine duct cyst
Radicular cyst
Dentigerous cyst

49
Q

Histology of radicular cyst

A

Fibrous CT wall with cholesterol clefts and fibroblasts and endothelial cells
NKSSE lining
Chronic inflammatory cells
Lumen
Mucous meta plasma, keratiusation but 2%, cilia, hyaline

50
Q

Histology of nasopalatine cyst

A

Lined by pseudostratified columnar epithelium with goblet cells and cilia
SSE

51
Q

If extraction of lower tooth and 3 months of history of pain and swelling . What is the spread of infection?

A

Depends on relationship of mylohyoid and buccinator to the apex of the tooth
Above mylohyoid: sublingual space
Below mylohyoid : submandibular space
Above buccinator:buccal sulcus in the mouth
Below buccinator : buccal space/skin
If goes posteriorly goes into retropharyngeal space which can cause obstruction and pus into chest

52
Q

How to take a sample from an extracted tooth and send to lab

A

If pus put into tube with transport medium
Paper point into tube with transport medium
Aspirate but don’t take needle off
Transport medium is water, isotonic salt, racing agent, activated charcoal
Screw jar/tube in leak proof container
Name , consultant , next appt, what is sample and where from, provisional diagnosis,refrigerate
Label as substance category B

53
Q

Syphilis ?

A

STI caused by treponema pallidum
Stage 1: 3-4 weeks after infection, oral chancre appears on lower lip which forms an ulcer . Lymphadenopathy
Stage 2: 6 weeks after infection. Causes mild fever, lymphadenopathy, headache sore throat,flat ulcers with grey membrane,on lateral border of lip or tongue, rash is coppery and lasts weeks
Stage 3: 3 years after infection, gumma seen on palate tongue or tonsils, swelling with a yellow centre which necroses to form a hole. Syphilictic leukoplakia may also be seen as a premalignant lesion,
Treat using antibiotics particularly penicillin

54
Q

What is ortho camouflage?

A

Treating ortho malocclusion without surgery
Advantages; no surgery, simple, shorter tx , good outcome,good for medically compromised patients, good for class 2/3classes as can retrocline lower incisors and pro line upper incisors.
Disadvantages: need to wear life long retainers can’t correct skeletal pattern,not suitable for severe malocclusions,

55
Q

What is surgical ortho?

A

For severe ortho malocclusions
Adabtanges: severe malocclusions, predictable outcome, high degree of success, pt satisfied, can change facial features too
Disadvantages: high morbidity, 10% nerve symptoms,long tx, motivated pt, requires GA, side effects can be irreversible

56
Q

Examples of mucosal changes caused by systemic disease?

A

-ulcer : by herpetic gingivostomatitis, herpes, EBV, HIV, anaemia, crohns, UC, malignancy, erythema multiforme, syphilliis,
-bullae ; pemphigoid, pemphigus,
- radiation induced mucositis: after malignancy

57
Q

Oral features of HIV

A

Perio, ANUG , non Hodgkin’s lymphoma,Kaposis sarcoma, candida, hairy oral leokoplasia

58
Q

Oral features of coeliac

A

Intolerance to a-gliadin found in gluten
- oral ulceration, glossitis, angular chelitis, RAS, dermatitis herpetiformis

59
Q

Oral features of crohns

A

Aphthous ulceration, lip swelling, cobblestone mucosa, fissures and ulcers, angular Chelitis, mucosal inflammation

60
Q

Oral features of oral facial granulomatitis

A

Ulcerations, lip swelling, cobbblestone mucosa

61
Q

Ora features of anaemia

A

Ulcers, mucosa atrophy, altered taste, oral candidiasis, dysphagia

62
Q

What are Odontomes?

A

Hamartomas so benign malformations
Ages 10-25. Can erupt and become infected or block teeth and prevent infection
2 types complex and compound
Complex; mandible posterior area, irregular mass of calcified dental tissue, may miss a tooth in arch, dont look like teeth, radiopaque mass in a follicle
Compound; maxilla , anterior maxilla, small and non aggressive, small radiopaque denticles,

63
Q

Central giant cell granuloma or browns tumour

A

Browns is related t hyperparathyroidism so blood test
Radiolucecy: radiolucent scalloped margins and multilocular, RESOPRTION roots,
Multinucleated giant cells, vascular tissue,
Tx by curatagge

64
Q

What are the MOM, their nerve supply,and their attachment

A

MOM supplied by the trigeminal nerve with the mandibular branch V3.
-masseter inserts at angle of mandible and zygoma, jaw elevator and closes mouth
-temporalis attaches to coronoid process of mandible and temporal fossa , closes the jaw
-medial pterygoid to pterygoid plate to lingual aspect of angle of mandible and closes jaw
-lateral pterygoid 2 heads greater wing of sphenoid and pterygoid plate to articulate disc and condyle. Opens jaw

65
Q

Favourable and unfavourable fractures

A

-favourable is when muscle pull and fracture line approximate/reduce the fracture
-unfavourable when fractures are displaced by the fracture line and muscle pull
Fractures at ramus are favourable and those anterior to angle are unfavourable
Unfavourable can be treated by ORIF so open reduction and internal fixation
Favourable treated by soft icier or closed reduction involving intermixallry fixation

66
Q

Pemphigoid?

A

Autoimmune vesicobullous disease . Type 2 hypersensitivity antibodies against hemidesmosomes BP180 AND BP230
-types: bulbous Pemphigoid, mucous membrane Pemphigoid, dermatitis herpetiformis
-features: desquamative gingivitis, on buccal mucosa and palate,well marginated ulcers and blisters, can affect eyes, nose, genitals
-incision biopsy, DIF with igM,IgG. Nikolsky sign positive
-histology: sup epithelial bullae, Detachment of lamina Propria from basement membrane,, clear loss of entirety of epithelium at basement membrane level including basal cell layer. Some inflammatory infiltrate

67
Q

2 types of biopsies

A

-incisional so part of lesion is removed for histologically analysis. Full thickness with adjacent healthy normal tissue. For SCC, OLP,dysplasia, lichenoid reaction, pemphigus and Pemphigoid
-excisional so all of lesion is removed , when unsure of diagnosis , smaller lesions, include margin of normal tissue. For mucoceles, FEP, pyogenic granuloma

Oral Disease (9 decks)

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