Oral Cavity

Question 1

What causes oral candidiasis?

Answer 1

Candida albicans causes an opportunistic infection

Question 2

Which conditions are required for candida albicans to cause an infection?

Answer 2

Oral cavity flora change

Immunocompromised

Question 3

How does candida albicans present?

Answer 3

White plaques on oral mucosa that can be rubbed off with a painless, red base underneath

Question 4

How do you treat candidiasis?

Answer 4

Miconazole or Nystatin (anti-fungals)

Question 5

How do you identify leukoplakia and erythoplakia and how do you distinguish between them?

Answer 5

Raised, sharply defined edges
Cannot be rubbed off
Leuko = white patches
Erythro = red patches

Question 6

What is the significance of leuko- and erythroplakia?

Answer 6

They are pre-malignant

Question 7

Which, between leukoplakia and erythroplakia, is at higher risk of malignancy?

Answer 7

Erythroplakia

Question 8

How do you investigate leuko- and erythroplakia?

Answer 8

Biopsy

Question 9

What is the management plan for leukoplakia and erythroplakia?

Answer 9

Frequent clinical exam with photographic records

Question 10

> 90% of oral tumours have which histological cell type?

Answer 10

Squamous cell carcinomas

Question 11

What are oral SCCs?

Answer 11

Invasive oral cancers that end to have granular or smooth texture

Question 12

What is the macroscopic appearance of oral SCCs?

Answer 12

20% have elevation of approx. 1 mm

Majority have no ulceration/bleeding and aren’t indurated (hardened)

Question 13

What are causes/risk factors of oral SCCs?

Answer 13

Tobacco
Alcohol
Diet and nutrition
HPV (risk increase with number of sexual partners and age)
UV-Light
Candida

Question 14

Where are high risk sites for oral tumours?

Answer 14

(soft non-keratinising site)
Ventral of tongue
Floor of mouth
Lateral tongue
Soft palate
Retro-molar pad
Tonsillar pillars

Question 15

Where are rare sites of oral tumours?

Answer 15

Hard palate

Dorsum of tongue

Question 16

What are potentially malignant lesions of the mouth?

Answer 16

Erythroplakia 
Erythroleukoplakia
Leukoplakia
Erosive lichens planus
Submucous fibrosis
Dyskeratosis congenita

Question 17

Histopathologically, oral SCCs show considerable variation but are cytologically _________________ and all show ______?

Answer 17

Malignant squamous epithelium

invasion and destruction of local tissue

Question 18

How do oral tumours present?

Answer 18

Red, white (or both) lesions
Ulcer
Numb feeling
Unexplained pain in mouth or neck (late-stage cancer or benign ulcer)
Change in voice
Dysphagia
Drooping eyelid or facial palsy, fracture of mandible, double vision, blocked or bleeding nose/fascial swelling

Question 19

What are investigations for oral tumours?

Answer 19

Refer for biopsy

Question 20

How do you treat oral tumours?

Answer 20

Radiotherapy
Chemotherapy
Surgical resection

Question 21

The majority of salivary gland tumours are?

Answer 21

Pleomorphic adenomas

Question 22

What are pleomorphic adenomas?

Answer 22

Benign tumours of glandular tissue

Question 23

Is a tumour more likely to be malignant if its in a small or large salivary gland?

Answer 23

Small

Question 24

What are the risk factors for salivary gland tumours?

Answer 24

Smoking
Radiation exposure
Hx of previous cancer

Question 25

How do salivary gland tumours present?

Answer 25

``` Facial nerve weakness Facial lump Ulceration of overlying skin Paraesthesia or anaesthesia of the skin Pain ```

Question 26

How do you investigate salivary gland tumours?

Answer 26

Refer for USS +/- FNA

Question 27

FNA gives you the _____ of the tumour

Answer 27

cytology

Question 28

Biopsy gives you the _______ of the tumour

Answer 28

Architecture

Question 29

How do you treat salivary gland tumours?

Answer 29

Local ablation Radiotherapy Surgical resection

Question 30

How do you treat salivary gland tumours?

Answer 30

Local ablation Radiotherapy Surgical resection

Question 31

Where do salivary gland stones form?

Answer 31

Typically in the major salivary glands and block associated ducts

Question 32

How do salivary gland stones present?

Answer 32

Colicky post-prandial pain | Swelling

Question 33

How do you investigate Salivary gland stones?

Answer 33

USS

Question 34

How do you treat salivary gland stones?

Answer 34

``` Oral analgesics Abx if infection Good hydration Massage Endoscopic or surgical removal ```

Question 35

Where are lichen planus found?

Answer 35

``` Oral mucosa Skin Scalp Nails Genitals Oesophagus ```

Question 36

What causes lichens planus?

Answer 36

Unknown - potential link to ACEI treatment

Question 37

What is the danger of lichen planus?

Answer 37

Potentially malignant

Question 38

What are macroscopic features of lichen plans?

Answer 38

+/- erosive | +/- ulceration

Question 39

What is angular chelitis?

Answer 39

Cracking at the corner of the mouth | Bleeding when mouth open

Question 40

What are causes of angular chelitis?

Answer 40

Anaemia or haematinimic deficiencies | Often related to bacteria like Staph aureus

Question 41

What is aphthous stomatitis?

Answer 41

Mouth ulcers Oval Yellow base + red periphery

Question 42

Aphthous stomatitis can persist up to?

Answer 42

4 weeks

Question 43

What are herpetiform?

Answer 43

Yellow base + red periphery

Question 44

How many herpetiform ulcers are usually found?

Answer 44

Hundreds

Question 45

Herpetiform ulcers can be caused by?

Answer 45

Anaemia Vitamin B12 Coeliac's Disease Folic Acid

Question 46

What is hairy leukoplakia?

Answer 46

Shaggy white patch on the side of the tongue seen in HIV | Caused by EBV

Question 47

What are causes of aphthous ulcers?

Answer 47

Crohns and coeliac's disease | Infections

Question 48

What are therapy options for minor aphthous ulcers?

Answer 48

Avoid oral trauma and acidic foods or drinks | Tetracylcine or antimicrobial mouthwashes

Question 49

How do you treat severe aphthous ulcers?

Answer 49

Prednisolone or thalidomide