4th year mucosal disease Flashcards
(133 cards)
1
Q
Define leukoplakia
A
White patch that cannot be classified as any other disease and is of questionable risk
2
Q
What is the prevalence of leukoplakia?
A
1-2%
3
Q
In smokers, how much does the prevalence of leukoplakia increase?
A
x6
4
Q
Define erythroplakia
A
Red patch that cannot be classified as any other disease and is associated with an increased risk of malignancy
5
Q
What is the malignant transformation rate of erythroplakia?
A
Greater than 80%
6
Q
List the 8 risk factors for progression of red/white patches
A
Female gender
Long duration of leukoplakia
Leukoplakia in non-smokers/drinkers
Located on the tongue or floor of the mouth
Greater than 200 mm²
Non-homogeneous type
Presence of Candida
Presence of epithelial dysplasia
7
Q
Define an ulcer
A
A break in the oral mucosa
8
Q
What should be done if an ulcer is not healing?
A
If >3 weeks create red flag referral to be seen within 2 weeks
9
Q
What are the 2 common locations for ulcers?
A
Edge of tongue
Buccal mucosa
10
Q
Name the 4 classifications of ulcers based on size
A
Minor (<1cm)
Major (>1cm)
Herpetiform (pin point ulcers)
Large erosive areas
11
Q
List 5 topical treatments for ulcers
A
Corsydyl
Difflam
Topical steroids
Antibiotics
Triple mouthwash
12
Q
What are 7 features of suspicious oro-mucosal lesions?
A
Solitary ulcer present for longer than 3 weeks
Rolled margins
Bleeding on light touch
Firm
Numbness
Red or speckled
Extensive ulceration
13
Q
What are 6 potential causes of oral ulceration?
A
Neoplasia (SCC)
Trauma
Recurrent aphthous stomatitis
Oral infection
Drugs
Systemic disease
14
Q
What is recurrent aphthous stomatitis (RAS)?
A
A condition characterised by recurrent, painful ulcers in the oral cavity
15
Q
Give 3 epidemiological features of oral lichen planus
A
Affects 2% of the population
More common in females
More common in older adults
16
Q
What are the 6 clinical forms of lichen planus?
A
Reticular
Papular
Plaque-like
Atrophic
Erosive
Bullous
17
Q
Describe the appearance of reticular oral lichen planus
A
Fine net-like lines
18
Q
Describe the appearance of papular oral lichen planus
A
Small elevated nodules
19
Q
Describe the appearance of plaque oral lichen planus
A
Broad area of mucosal thickening
20
Q
Describe the appearance of atrophic oral lichen planus
A
Reddened/hypervascular mucosa
21
Q
Describe the appearance of bullous oral lichen planus
A
Sub-epithelial fluid-filled blisters
22
Q
Describe the appearance of erosive oral lichen planus
A
Broad shallow ulcers covered by fibrinous slough
23
Q
What percentage of oral lichen planus cases transform to become malignant
A
1%
24
Q
What are the 3 management options for oral lichen planus?
A
No active treatment
Steroids
Immunomodulatory agents
25
What are 6 risk factors for OSCC?
Tobacco
Alcohol
UV-light/sun exposure
Malnutrition
Infections: syphilis, candida, HPV
Immunosuppression
26
What are 3 clinical features of OSCC?
Firm, not very mobile lump
Thickened warty white plaque
Ulcer with raised, rolled, everted edge
27
What is the survival rate for early-stage and late-stage OSCC?
Early: 80% three-year survival
Late: 50% three-year survival
28
Define potentially malignant oral lesions
Lesions that are not malignant but have a risk of developing into OSCC
29
What are 3 causes of white patches in the oral cavity?
Thicker keratin
Thicker epithelium
Fibrosis in the lamina propria
30
What is frictional keratosis?
A condition characterised by a thickening of the epithelium due to chronic friction or irritation
31
What is a candidal infection?
An infection caused by the overgrowth of Candida species, most commonly Candida albicans
32
Describe the appearance of homogeneous leukoplakia
Flat, possibly fissured
33
Describe the appearance of non-homogeneous leukoplakia
Nodular, speckled or both
34
What are 3 types of laboratory investigations for oral lesions?
Microbiological
Haematological
Histopathological
35
Define dysplasia
Architectural and cytological changes in epithelium resembling cancer but without invasion of tissues
36
What are 6 histological features of epithelial dysplasia?
Distorted rete peg architecture
Dyskeratosis
Basal cell hyperplasia
Loss of adherence
Hyperchromatism
Abnormal mitotic figures
37
What is the risk factor increase for OSCC with the presence of dysplasia?
Increases the risk by a factor of 10
38
What are the 5 types of surgical treatments for dysplasia?
Scalpel excision
Laser excision
CO2 laser ablation
Photodynamic therapy
Cryotherapy
39
1 advantage of surgical treatment approaches for dysplasia?
The most abnormal-looking tissue can be removed or destroyed
40
What is 1 advantage of medical treatment approaches for dysplasia?
Topical drugs can be directed at abnormal tissues less overall destruction
41
What are 4 medical treatments for dysplasia?
Retinoids
EGFR inhibitors/antagonists
COX2 antagonists
p53 modulators
42
What are the 2 disadvantages of treatment for dysplasia?
Side effects: pain, infection, slow healing
Do not prevent new lesions or OSCC
43
Define fibrous hyperplastic nodules
Overgrowth of tissue
44
2 potential causes of fibrous hyperplastic nodules?
Chronic minor trauma
Chronic low-grade infection
45
3 common presentations of fibrous hyperplastic nodules
Fibroepithelial polyp (FEP)
Fibrous epulis at gingiva
Denture induced hyperplasia
46
What are 3 clinical features of papilloma?
Outwards growth with cauliflower-like appearance due to keratin
Usually painless
Occur at any oral site
47
2 managements of papilloma
Excision
Cryotherapy
48
What are the 3 clinical features of pyogenic granuloma?
Pedunculated lesion
Painless
Red and inflamed
49
Common site of pyogenic granuloma
Gingiva
50
3 causes of pyogenic granuloma
Local low-grade irritation
Hormonal changes
Trauma
51
3 managements of pyogenic granuloma
Excision
Remove causative factors
Improve oral hygiene as often calculus/plaque causative
52
Define giant cell granuloma
Uncommon benign lesion commonly at tooth bearing areas of unknown aetiology
53
2 classifications of giant cell granulomas and where they are found
Central: within bone
Peripheral: on gingiva
54
What are 4 clinical features of central giant cell granuloma?
Bony swelling
Loosening of teeth
Purple gingival swelling
Inflammation of overlying mucosa
55
What are the 4 radiographic features of central giant cell granuloma?
Large radiolucency, may have areas of trabeculation
Soap bubble appearance
Ill defined edges
Resorbed or displaced roots of adjacent teeth
56
3 management strategies for giant cell granuloma
Excision of soft tissue lesion and curettage underlying bone
Resection may be required in larger lesions
Corticosteroids, calcitonin, interferon alpha and bisphosphonates in children and patients unable to carry out surgery
57
Define hyperparathyroidism
Parathyroid hormone overproduction
58
3 epidemiological features of hyperparathyroidism
Uncommon
More common in females
Usually elderly
59
What is the management for hyperparathyroidism-related lesions?
Correction of the underlying lesion
60
Define vascular malformation
An abnormal growth and development of a vessel
61
What are 4 clinical features of vascular malformations?
Raised or flat
Soft but can become firm
Deep red/bluish color
Usually blanch with pressure
62
5 management strategies for vascular malformations
Excision if small
Laser surgery
Cryotherapy
Radiation therapy
Corticosteroids
63
Define haemangioma
A benign vascular tumour that usually presents in the first few months of life
64
3 management strategies for haemangioma
Leave as can regress with time
Cryotherapy
Excision
65
Define purpura
Small blood vessels bleeding into skin or mucous membranes
66
2 underlying causes of purpura
Underlying platelet or vascular disorders
67
Define herpes group viruses
DNA viruses characterised by latency
68
Define HHV-1
A herpes simplex virus that causes primary herpetic gingivostomatitis and may become latent and recur as a cold sore
69
Define HHV-3
Varicella-zoster virus that causes the primary infection chickenpox and the secondary reactivation causes shingles
70
Define HHV-4
Epstein-Barr virus that causes infectious mononucleosis and oral hairy leukoplakia
71
What are the 3 clinical features of herpes simplex virus infections?
Ulcers
Cervical lymphadenopathy
Pyrexia
72
What is the 3 managements for herpes simplex virus infections?
Supportive
Topical acyclovir
Systemic acyclovir in severe cases
73
4 clinical features of herpes labialis
Initial prodrome
Clusters of tiny blisters, which ulcerate
Crusting and healing
Usually effects function vermillion border lip
74
1 management for herpes labialis
Topical 5% acyclovir cream in prodromal phase
75
Clinical features of shingles
Unilateral painful vesicular eruption localised to a single dermatome
76
Management of shingles
High dose systemic acyclovir for 7-10 days, 800mg x5 day
77
What are the 4 clinical features of measles virus infections?
Respiratory symptoms: cough, runny nose
Pyrexia
Rash
Koplik spots: intra-oral may form before skin rash
78
What are the 2 clinical features of mumps virus infections?
Enlarged salivary glands
Flu-like symptoms
79
Define hand foot and mouth disease
A common infection that usually effects children causes mouth ulcers plus spots and blisters on the hands and feet
80
What are the 3 transmission methods for herpes simplex virus
Direct contact with infective lesion
Contact with infected saliva from individual shedding the virus
Transfer via inanimate objects
81
Define actinomycosis
A rare, chronic suppurative granulomatous disease caused by filamentous anaerobic Gram-positive bacilli
82
What are 6 predisposing factors for Actinomycosis?
Poor oral hygiene
Trauma
Poorly controlled diabetes mellitus
Immunosuppressed
Alcoholism
Malnutrition
83
What are 3 features of the clinical presentation of Actinomycosis?
Painless undurated swelling with sinus tracts
Discharge containing visible sulphur-like granules
Pain and trismus in advanced stages
84
What are 3 diagnostic methods for Actinomycosis?
Imaging
Aspiration and culture
Histopathology
85
3 management strategies for Actinomycosis
Removal of dental focus
Antimicrobials
Surgical debridement
86
Define Cat Scratch Disease
Regional lymphadenopathy and fever resulting from the scratch or bite of an infected cat caused by Bartonella henselae
87
What are 3 clinical features of Cat Scratch Disease?
Papule/pustule at site of inoculation
Regional lymphadenopathy
Suppuration
88
Define impetigo
Common contagious superficial bacterial skin infection caused by Staphylococcus aureus, Streptococcus pyogenes
89
What is the most common form of impetigo?
Non-bullous impetigo
90
3 clinical features of non-bullous impetigo
Erythematous macule/papule
Becomes pustuler before rupture
“Honey-coloured” yellow crust on skin after rupture
91
4 clinical features of bullous impetigo
Vesicles or bullae
Blister formation
Rupture and shed to produce an erythematous moist base that oozes serum
Systemic symptoms
92
2 managements of impetigo
Supportive
Antimicrobial agents
93
Define Lyme disease
Bacterial infection caused by Borrelia burgdorferi
94
What is the characteristic rash of Lyme disease called?
Erythema migrans, a red rash that increases in size may have a central clearing and presents at site of bite
95
Define Syphilis
Common sexually transmitted infection caused by Treponema pallidum
96
What are the four main clinical stages of Syphilis?
Primary syphilis
Secondary syphilis
Latent syphilis
Tertiary syphilis
97
What is a common manifestation of primary syphilis?
Solitary chancre that develops at site of inoculation, usually lips which heals within 8 weeks
98
What are 3 symptoms of secondary syphilis?
'Flu-like' constitutional symptoms
Mucocutaneous manifestations: skin rash, mucous patches
Generalised lymphadenopathy
99
What is a common manifestation of tertiary syphilis?
Gummata, an indurated, nodular or ulcerated lesion that may produce tissue destruction, often found at multiple sites
100
Common site of tertiary syphilis
Hard palate
101
What are common complications of tertiary syphilis?
Cardiovascular syphilis
Neurosyphilis
102
What are 3 dental manifestations in the primary dentition associated with Congenital Syphilis?
Mulberry molars
Hutchinson's incisors
Anterior open bite
103
Define Tuberculosis
Chronic infectious disease caused by Mycobacterium tuberculosis
104
What is the oral manifestations of Tuberculosis?
Single, painful ulcers on the dorsum of the tongue
105
Describe the management of tuberculosis
Quadruple antimicrobial therapy
106
Define oral candidosis
Infection of the oral/perioral tissue with candida fungal species
107
What is the most common species causing oral candidosis?
C. albicans
108
4 local predisposing factors to oral candidosis
Xerostomia
Broad spectrum antimicrobials
Corticosteroids
Dental appliances
109
Classification of oral candidosis
Primary: confirmed to oral and perioral tissues
Secondary: distributed in other parts of the body as well as the oral cavity
110
What is the clinical presentation of Pseudomembranous candidosis?
Semi adherent white/creamy patches, wiped off to reveal an erythematous base, with a tendency to recur
111
3 common sites of acute pseudomembranous candidosis
Palate
Dorsum of tongue
Buccal mucosa
112
What is the clinical presentation of erythematous candidosis?
Painful, localised red areas
113
What is the clinical presentation of Candidal leukoplakia?
Persistent, adherent white/speckled lesions
114
What is the clinical presentation of Angular cheilitis?
Inflammation, fissuring and pain of the skin at the commissure of the mouth
115
What is the clinical presentation of median rhomboid glossitis
Elliptical or rhomboid papillary atrophy at midline of tongue
116
What is the clinical presentation of denture associated erythematous candidosis?
Erythema and oedema of oral mucosa in contact with a dental prosthesis
117
Define chronic mucocutaneous candidosis
Rare group of syndromes causing persistent, severe mucocutaneous candidal infections affecting skin, nails and mucous membranes
118
3 diagnostic investigations for oral candidosis
Swabs
Tissue biopsy
Blood tests
119
What is the management for oral candidosis?
Anti-fungal therapy
Topical: Nystatin, Chlorohexidine
Systemic: Fluconazole, Miconazole
120
What are the two forms of Candida as a dimorphic yeast-like fungus?
Blastospore
Hyphae
121
What is the risk associated with Azole antifungal drugs like Miconazole and Fluconazole?
Significant drug interactions
122
Define white sponge naevus
Hereditary condition present from birth/early childhood causing thick bilateral symmetrical white plaques mainly on the buccal mucosa
123
Define lichen planus
A clinically distinctive maculopapular mucocutaneous rash with a tendency to develop at sites of trauma
124
Define lichenoid reaction
Something that resembles lichen planus clinically and histologically but is caused by an identifiable agent, e.g. a drug
125
5 conditions that mimic oral lichen planus/lichenoid reaction
Frictional keratosis
Lupus erythematosus
Tobacco-related keratosis
Potentially malignant oral lesion
Chronic graft-versus-host disease
126
3 common sites for OSCC
Tongue: lateral border and ventral surface
Floor of mouth
Lower gum including retromolar pad
127
3 treatment options for OSCC
Surgery: remove all tumour with a 5mm periphery of non-tumour tissue
Radiotherapy
Chemotherapy
128
What are 3 causes of red patches
Thinner keratin
Thinner epithelium (atrophy)
Vascularity in the lamina propria
129
3 classifications of potentially malignant oral lesions
Homogeneous leukoplakia: lowest risk of OSCC
Non-homogeneous leukoplakia: higher risk of OSCC
Erythroplakia: highest risk of OSCC
130
What are the 3 clinical features of fibrous hyperplastic nodules
Usually well circumscribed
Solid and raised
Can form on mucosa close to line of occlusion
131
2 management strategies for fibrous hyperplastic nodules
Remove stimulus
Excisional biopsy under LA, can recur if causative factor not removed
132
3 epidemiological features OSCC
1-2% of all cancers worldwide
80% of patients aged 40+ years
More common in males 2M:F
133
2 classifications of leukoplakia
Homogenous
Non homogenous
