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Oral disease > Diagnosis and management of oral medicine problems > Flashcards

Diagnosis and management of oral medicine problems Flashcards

1
Q

Why is past medical history important?

A

Oral disease may be a manifestation of systemic disease
Oral disease may be iatrogenic
Management of oral disease may be affected by systemic disease e.g. pregnancy

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2
Q

When do you take a biopsy?

A 
To confirm diagnosis 
To exclude other pathologies
When we are not sure of the diagnosis 
When we remove a lump 
When a lesion changes
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3
Q

What are the 4 types od biopsies

A

Incisional
Excisional
core
fine needle aspiration

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4
Q

When do you take blood tests to help diagnosis?

A

To check there’s no underlying condition e.g. anaemia leading to mouth ulcers or controlled hyperglycaemia leading to oral candidosis
To monitor condition e.g. Sjogrens pts developing lymphomas
To make sure it is safe for a pt to receive the treatment e.g prior to starting immunosupressants in lichen planus
To monitor if it is safe to continue treatment

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5
Q

What are other special investigations?

A 
Imaging 
Oral rinses/swabs
sialometry
Shrirmer's 
Dental 
Clincal
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6
Q

What is difflam?

A

benzydamine hydrochloride mouth rinse

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7
Q

what is the immediate aim for the consultation?

A

Make working diagnosis and arrange special test to confirm
Address pt’s concerns and reassure
consider pt’s discomfort and dysfunction e.g. pain relief
Educate - smoking, diet, OH
Can the problem be easily solved?

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8
Q

What is the short-term management?

A 
Reassure
Educate - condition and management
address risk factors
can it be managed with medications
more investigations needed?
Arrange follow up
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9
Q

What is the long-term management?

A

Reassure
Educate
Address risk factors
What can be done to control the condition? e.g. steroid mouth rinse for oral ulceration, immunosuppressants for erosive oral lichen planus

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10
Q

What is a biopsy?

A

Removal of tissue for histological examination

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11
Q

What are incisional biopsies for?

A

For large lesions to establish diagnosis or where treatment depends on diagnosis.
When pre-malignant or malignant

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12
Q

How do you take an incisional biopsy?

A

take of part of the lesion and normal mucosa too.

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13
Q

Why do you not remove it all?

A

Differential diagnoses

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14
Q

Examples where incisional biopsies are used?

A

SCC, pre-cancer, dysplasia, candida

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15
Q

What is an excisional biopsy?

A

Entire lesion is removed

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16
Q

When do you use excisional biopsy?

A

Small or certain it is not precancer or cancer.

For small lesions, used to confirm the diagnosis or for large lesions to establish the completeness of excision

17
Q

When do you do fine needle aspiration?

A

to obtain cells from deep lesions.
suspected malignancy or cystic lesions.
NOT for oral cavity

18
Q

What is core/needle biopsy used for?

A

obtain a small sample or core of the tissue from a deep lesion preserving the architecture.
(has a cutting edge)

19
Q

What are smears used for?

A

examination of cells

Generally for fungal infections

20
Q

Which lesions should be biopsied?

A

When confident of the diagnosis and able to carry out treatment

21
Q

What 2 things do you not biopsy?

A

Bone (unless apicectomy)

Any lesion you suspect is malignant - send via hospital pathway

22
Q

How do you send of tissue for histopathological diagnosis?

A

10% formol saline: screw top jar

23
Q

What do you include on form for the tissue?

A 
Clinical details
Description of lesion 
Site, size
duration
Associated lesion
systemic disease
incisional biopsy
hard or soft tissue
24
Q

What must the carriage of specimens in the post comply with?

A

IATA 650 packaging instructions UN3373

25
Q

What is good sampling practice for micro-biological tests

A

Collect prior to anti-microbial therapy
Specimens must be from the actual infection site e.g. deeper into the site
sample collection and transportation critical

26
Q

How would you collect a sample from a cyst?

A

Aspirate
take 1ml
sheath on needle and tape up to send off

27
Q

Why is the black top swab sample better than red top?

A

Helps keep the microbes alive
Has minerals and isotonic salts
charcoal absorbs secondary metabolites
Soft agar jelly - keeps culture alive, does not culture

28
Q

What is the transport medium used for?

A

No growth supporting nutrients, objective is to maintain vitality
Want to maintain vitality but not support growth as commensals would out-compete and kill pathogens

29
Q

What are the special additives in the transport medium

A

A reducing agent - thioglycolate - preserves anaerobes but allows aerobes to survive
CO2 support vitality of certain pathogens e.g. Neisseria gonorrhoea and streptococcus pneumoniae
Charcoal, gelatine or corn starch can be added to absorb toxic metabolic products of the host or the hosts normal microbes

30
Q

How would you collect/send off pus sample?

A

Swab
Clean mucosa
Send in transport medium - water, isotonic salts, reducing agent, activated charcoal

31
Q

How would you collect a potentially viral sample?

A

Need the viral transport medium
Protein stabiliser: salts, gelatin, water, sometimes antibacterial agent
Vesicle fluid: aspirate into tuberculin syrinige

32
Q

How to take an oral rinse sample?

A

10ml Sterile saline
rinse mucosa 30 secs
spit into sterile bottle/tube

33
Q

What is in the viral transport medium?

A

modified Hank’s balanced salt solution supplemented with bovine serum albumin, cysteine, gelatin, sucrose, glutamic acid
pH buffered with HEPES
Antibiotics inhibit growth of competing bacteria and yeast

34
Q

What is written on the specimen request form?

A 
Type of sample
where it is taken from
Clinical signs and symptoms
Provisional diagnosis 
Ask for culture and sensitivity]
35
Q

How do you post the sample?

A

Label as diagnostic specimen or biological substance category B
Place leak proof, rigid container conforming wit p:650-UN3373
White aspirates in absorbent material in case of leakage
Itemise list of contents enclosed between the secondary and outer packaging

36
Q

What are category A substances?

A

Infectious substance:
when exposed to it is capable of causing permanent disability, life threatening or fatal disease to humans of animals
examples: HIV, HEP B or C, mycobacterium TB, only cultures or concentrates not swabs or aspirates taken for diagnosis

37
Q

What do you expect back from the lab?

A

at least 48 hours required
Microscopy, culture
Results will not give species, will tell you what antibiotics it is sensitive to,

Oral disease (3 decks)

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