Mouth and gum conditions

Question 1

Leukoplakia

Answer 1

White patches in the mouth

Often on the tongue or buccal mucosa

Question 2

Which cancer can leukoplakia be a precursor for

Answer 2

Squamous cell carcinoma

Question 3

Features of leukoplakia

Answer 3

Asymptomatic, irregular and slightly raised.

Fixed - cannot be scraped off

Question 4

Investigations for leukoplakia

Answer 4

Biopsy - exclude dysplasia

Question 5

Management of leukoplakia

Answer 5

Smoking cessation

Reducing alcohol intake

Close monitoring

Potentially laser removal or surgical excision.

Question 6

Erythroplakia

Answer 6

Red patches in the mouth

Question 7

Erythroleukoplakia

Answer 7

Lesions that are a mixture of red and white

Question 8

Which cancer is erythroplakia associated with

Answer 8

Squamous cell carcinoma

Question 9

Management of erythroplakia

Answer 9

Refer urgently to exclude cancer

Question 10

Lichen Planus

Answer 10

Autoimmune condition that causes localised chronic inflammation of the skin

Question 11

Presentation of lichen planus

Answer 11

The skin has shiny, purplish, flat-topped raised areas with white lines across the surface called Wickham’s striae

Can also affect the mouth

Question 12

Who normally gets lichen planus

Answer 12

Over 45 yo

Women

Question 13

Patterns of lichen planus in the mouth

Answer 13

Reticular
Erosive
Plaque

Question 14

Reticular lichen planus

Answer 14

Net-like web of white lines called Wickham’s striae

Question 15

Erosive lichen planus

Answer 15

Surface layer of the mucosa is eroded, leaving bright red and sore areas of mucosa

Question 16

Plaque lichen planus

Answer 16

Larger continuous areas of white mucosa

Question 17

Management of lichen planus

Answer 17

Good oral hygiene

Smoking cessation

Topical steroids

Question 18

Gingivitis

Answer 18

Inflammation of the gums

Question 19

Presentation of gingivitis

Answer 19

Swollen gums

Bleeding after brushing

Painful gums

Bad breath (halitosis)

Question 20

Complication of gingivitis

Answer 20

Periodontitis

Question 21

Periodontitis

Answer 21

Severe and chronic inflammation of the gums and the tissues that support the teeth.

This often leads to loss of teeth

Question 22

Acute necrotising ulcerative gingivitis

Answer 22

Rapid onset of severe inflammation in the gums.

Painful

Question 23

What causes acute necrotising ulcerative gingivitis

Answer 23

Anaerobic bacteria

Question 24

Risk factors for gingivitis

Answer 24

Plaque build-up on the teeth (inadequate brushing)

Smoking

Diabetes

Malnutrition

Stress

Question 25

Tartar

Answer 25

Hardened plaque

Question 26

Management of gingivitis

Answer 26

Managed by dentist

Good oral hygiene

Smoking cessation

Remove plaque and tartar

Chlorhexidine mouth wash

Antibiotics for acute necrotising ulcerative gingivitis (e.g., metronidazole)

Dental surgery if required

Question 27

Causes of gingival hyperplasia

Answer 27

Gingivitis

Pregnancy

Vitamin C deficiency (scurvy)

Acute myeloid leukaemia

Medications

Question 28

Which medications can cause gingival hyperplasia

Answer 28

• CCBs
• phenytoin
• ciclosporin

Question 29

Aphthous Ulcers

Answer 29

Very common

Small, painful ulcers of the mucosa in the mouth

Question 30

Appearance of aphthous ulcers

Answer 30

Well-circumscribed, punched-out, white appearance

Question 31

Triggers for aphthous ulcers

Answer 31

Emotional or physical stress

Trauma to the mucosa

Particular foods

Question 32

Conditions associated with aphthous ulcers

Answer 32

Inflammatory bowel disease

Coeliac disease

Behçet disease

Vitamin deficiency (iron, B12, folate and vitamin D)

HIV

Question 33

How long do aphthous ulcers take to heal

Answer 33

Usually within 2 weeks

Question 34

Management of aphthous ulcers

Answer 34

Normally self resolve

If persist:

• Choline salicylate (e.g. Bonjela)
• Benzydamine (e.g., Difflam spray)
• Lidocaine

Question 35

Management of severe ulcers

Answer 35

Topical corticosteroids

Hydrocortisone buccal tablets applied to the lesion

Betamethasone soluble tablets applied to the lesion

Beclomethasone inhaler sprayed directly onto the lesion

Question 36

2 week wait referral for mouth lesion

Answer 36

Unexplained ulceration lasting over 3 weeks