Flashcards in Oral Health 1 - Oral Manifestations of systemic Disease Deck (52):
Where are the lingual tonsils located?
At the postural lateral side of the tongue (key site where oral cancer can present)
What is the torus mandibularis?
A bony growth in the mandible along the surface nearest to the tongue
What is anaemia?
A decrease in the amount of red blood cells
What is a haematinic?
A hematinic is a nutrient required for the formation of blood cells in the process of hematopoiesis. The main hematinics are iron, B12, and folate
How can anaemia/ haematinic deficiencies present in the oral cavity?
Angular chelitisRecurrent oral ulceration
What is angular chelitis?What causes it?
Cracking at the side of the mouth that may extend around the lips (painful and can crack and bleed)Caused by candida, staph coccus, strep cocci or staple aureus infection (can be a combination of these)It is therefore an infection however a haematinic deficiency is a predisposing factor
What are the most common type of recurrent mouth ulcers?
Aphthous stomatitis (ulceration)
What are the 3 different types of aphthous ulcers?
Minor (most common) = small (less than 10mm across), pale yellow with a red swollen area around them, usually come in about groups of 5 and disappear in 7-10 days without leaving a scarMajor = usually 10mm or larger across, get one or 2 at a time, lasts from weeks to months and leaves a scar, can be very painfulHerpetiform = tiny pin-head size ulcers, get multiple at the one time and some may join together, lasts a week to 2 months, usually very painful
When should mouth ulcers be investigated further?
When they suddenly start or if they become a lot worse than normal
What are 3 examples of GI diseases that manifest with recurrent oral ulceration?
Is Crohns or UC granulomatous?
Symptoms/ signs of oral Crohns disease? (4)
Oral ulcerationLip swelling (usually fluctuates initially, swelling is soft and not painful usually, swelling can lead to cracking)GingivitisCobble-stoning
Oral manifestation of type II diabetes?
Acute pseudomembranous candidiasis - candida yeast infection in the mouth - thrush (yeast feeds on high levels of salvia sugar) - also caused by anything that lowers your immune system
What is an adverse side effect of nicorandil (used to treat angina)?
Oral ulceration - patient can be taking the drugs for many years before they develop a problem (patients should stop the drug as soon as they develop ulcers if got them in mouth, likely to have them somewhere else)
What is an adverse side effect of ACEI?
What side effect in the mouth do NSAIDs have?
Can cause recurrent mouth ulcers
What oral symptom do many drugs have?
A dry mouth (mainly anti-muscarinic medications)
What is lichen planus?
A non-infectious rash that affects many areas of the body e.g. oral mucosa, skin, scalp, nails, genitals
Is lichen Planus related to cancer?
Yes, it is a potentially malignant condition
Where does lichen plans most commonly affect?
The tongue and buccal mucosae
Symptoms of oral lichen planus?
Sometimes asymptomatic, can cause sensitivity to sour/ spicy food, can cause atrophy of the oral mucosae and blister and white plaquesIf erosive lichen planus, it can cause painful ulcers to develop
What is a cause of lichen planus?
Usually unknown cause but can be due to a type 4 hypersensitivity reaction to the likes of dental filling materials
What is another name for mucous membrane pemphigoid?What is it?
Cicatricial pemphigoidRare condition that causes blisters and vesicles to form in mucosal membrane (most commonly the eyes and mouth) leading to ulcer formation
What is an autoimmune disorder which can cause a severe dry mouth?
What are the 2 different types of Sjogrens syndrome?
primary – when the syndrome develops by itself and not as the result of another conditionsecondary – when the syndrome develops in combination with another autoimmune disorder, such as lupus or rheumatoid arthritis
What are the symptoms of Sjogren's syndrome?
Dry mouth and/ or eyes
What are 3 signs of a dry mouth?
Very sticky oral mucosaShiny appearanceIncreased tooth decay
What are the 3 ways in which HIV/ AIDs can manifest in the mouth?
Hairy leukoplakiaKaposi's sarcomaCandiditis (usually chronic)
What is Kapok's sarcoma?
A type of cancer that forms from the cells lining the blood vessels or lymph vessels (most common develops in a patient with HIV/ AIDs)
What is oral leukoplakia?
An oral mucosal white patch that will not rub off and is not attribute to any other disease - it is pre-malignant (e.g. not candidiases, oral lichen planus, etc.)
What is oral hairy leukoplakia?
A shaggy white patch on the side of the tongue seen in HIV patients cased by EBV (not pre-malignant)
What are the risk factors for leukoplakia formation?
AlcoholSmoking(repeated candidiasis is also a cause)
What is the annual rate of transformation of leukoplakia into squamous cell carcinoma?
Is leukoplakia painful?
What is the most common site for leukoplakia formation?
The buccal mucosa (the floor of the mouth is the highest risk site)
What feature of leukoplakia should make you more concerned?
Speckled to a homologous white patch
What are the main risk factors for leukoplakia malignant transformation?
Female genderlong durationnon-homogenous appearanceon the tongue/ floor of mouthgreater than 200mm sizepresence of dysplasia
Diagnosis of leukoplakia?
Careful clinical examinationExclude other disorders or causesRefer to dentist and if they are not registered refer to oral medicine or maxofacial surgeonsMay me biopsied
Management of leukoplakia?
If at an increased risk of mouth cancer, it cane removedIf not it is carefully monitoredAppropriate counselling regarding smoking cessation and alcohol moderation is also given
What is erythroplakia?
a fiery red patch that cannot be characterized either clinically or pathologically as any other definable lesion
What is sub-mucous fibrosis?
A condition where patients develop fibrous bands in the mouthAssociated with ereca nut
What are the most common potentially malignant conditions of the oral cavity?
leukoplakiaLichen planusErythroplakiaPlatal lesions in reverse smokersChronic candidiasisSub-mucous fibrosisActinic keratosis
What are common benign epithelial tumours of the oral cavity?What causes these?Are they are risk of malignant transformation?
Squamous cell papillomasHPVNo
What type of cancer are most oral malignancies?
Squamous cell carcinoma
Where are the high risk sites for oral cancer?
Floor of the mouth and ventral and lateral aspects of the tongue
How does cancer of the lower lip typically present?
Non-healing ulcer or small lump
What type of cancer do patients tend to get on their lip?
Squamous cell carcinoma
What is the most frequent aetiological cause of lip cancer?
What are known risk factors for intra-oral cancer? (3)
Apart from squamous cell carcinoma, what are some of the rarer causes of oral malignancies?
Kaposi's sarcomaSalivary gland tumours e.g. adenoid cystic carcinomaLymphomaMalignant melanomaNeoplasms of bones and connective tissueMetastases
Symptoms of oral cancer?
Mainly asymptomatic unless it invades nerves earlyPainHalitosisParasthesia/ anaesthesiaMobility/ loss of teethTrismus (spasm of jaw)Restricted tongue movementWeight loss