oral health problems in older people Flashcards

Question

issue here

Answer 1

denture stomatitis likely the denture was stabilised with mucosa – hard to deal with

Answer 2

Common Often people unaware they have it as generally painless Need to remove denture on examination * See area of erythema corresponds exactly to where the denture fits * Due to candida infection (e.g. candida albicans, can be multiple) * Hyphae burrow into surface of mucosa and plastic of denture Do they wear denture continuously? Denture hygiene? * Soak in dilute solution of sodium hypochlorite 20-30mins, rinse and leave in water for another 30mins – bare minimum

Answer 3

Candida, bacterial or mixed Cracks and masserations at corner of mouth Hard to heal Common reservoir of infection intra-oral (denture) * Staphylococcal element common Deal with problem before medicating – check if problem Making drool? Take bloods – iron levels? Skin folds in elderly – moist painful area as face not cleaned and dried properly – uncomfortable

Answer 4

*Use mirror, place on tongue -\>* *sticks* ## Footnote *indication saliva not of right quality*

Answer 5

* Sjogren’s syndrome,* * polypharmacy (culmulative effect),* * drug side effect (right)* * radiotherapy of head and neck (left)*

Answer 6

* Change medication * Primary cause – often hard to change * Salivary replacement – shortlived effects * Salivary stimulants * Chewing gum * Beware strain on TMJ * Glycerine and lemon * Acidic Historically popular

Answer 7

**Saliva Orthana** * pH neutal * has F GlandosanepH 5 ish * Acidic - no Biotene Oral Balance BioXtra

Answer 8

xerostomia * Floor of mouth should be delicate – thin mucosa see BV through it* * *But here quite meaty floor of mouth with horizontal keratotic lines (heavy smoker) – protective* * Dry – medication* * Abrasion by 35 as stuck and torn when speaking – portal of entry for microbes (plentiful as there is reduced clearance*

Answer 9

aspirin and iron tablets mainly ## Footnote *other drugs can cause lichenoid reactions*

Answer 10

* often put next to tooth to try and help pain but actually just burns mucosa take with water

Answer 11

if they are left in contact with mucosa for length of time will burn mucosa * difficult to swallow -\> liquid iron (messy but not dangerous)

Answer 12

mucosubcutaneous disorder affecting 1-2% of UK population dermatological condition * 2 types lichen * Skin * Oral *can be all the way through digestive tract - pain* * If you have oral lesions – may not have skin lesions* * If you have skin lesions – likely to have oral lesions* **Characterised by white striae**

Answer 13

characterised by white striae Mainly effective: buccal mucosa, lips, tongue, attached gingiva Rare on palate – more likely to be lichenoid reaction than true lichen planus

Answer 14

more common than lichen planus ## Footnote mimic lichen planus but not a result of autoimmune condition, they are a direct reaction to drugs

Answer 15

* NSAIDs * β-blockers * Diuretics * Oral hypoglycaemics * Statins * Antialarials * Sulphonamides Many drugs cause lichenoid reaction

Answer 16

skin get purple, polygonal almost patches with white lines across itchy

Answer 17

charcterised by white striae many subtypes, can have more than one * reticular (left) – roughness to cheek but generally asymptomatic * erosive – painful * plaque, * atrophic cannot be managed in high street – need oral medicine

Answer 18

Inhibit osteoclast formation, migration and osteolytic activity * Incorporated in skeleton * Inhibit bone turnover * No repair of microdamage * Tooth extraction – break cancellous bone supporting the tooth, not repaired * Anti-angiogenic

Answer 19

* Non-malignant * Osteoporosis * Paget's disease * Osteogenesis imperfecta * Fibrous dysplasia * Primary hyperparathyroidism * Osteopenia * Malignant * Multiple myeloma * Breast cancer * Prostate cancer * Bony metastatic lesions * Hypercalcemia of malignancy

Answer 20

they are very common good drugs that pts need to be on however complications in extractions * Inhibit bone turnover * No repair of microdamage * Tooth extraction – break cancellous bone supporting the tooth, not repaired

Answer 21

SDCEP Guidance induced osteonecrosis MRONJ

Answer 22

* Extremes of age * Concurrent use of corticosteroids * Systemic conditions affecting bone turnover * Osteopenia, osteoporosis * Malignancy * Myeloma, breast cancer etc * Coagulopathies, chemotherapy, radiotherapy * Duration of therapy * Reduced recently – 3 years max * Previous diagnosis of BRONJ * Potency of drug * As well as delivery – IV greater risk over oral * Invasive dental procedures * Surgery – extraction, flap * Denture trauma * Fine mucosa and denture rubs on bone * Consider soft base on denture * Poor oral hygiene * Periodontal disease * Alcohol or tobacco use * Thin mucosal coverage – link to denture

Answer 23

Old lady with myeloma * Broke wisdom tooth MxH and drugs not disclosed * Went back multiple times as bone coming out ??? * But she had medical related osteonecrosis of jaw More common in mandible Get sequestrian of bone * Bone dies away and gum doesn’t heal – get open area in mouth – needs clean at all time

Answer 24

* Advise patient of BRONJ risk * Informed consent * Emphasise rarity of condition e.g. oral palindromic acid (IV hgher) * Don’t discourage from taking medication CHECK SDCEP

Answer 25

* Regular dental checks * Maintain good oral hygiene * Limit alcohol and stop smoking * Report any symptoms (e.g. loose teeth, pain, swelling)

Answer 26

Herpes Zoster (shingles) * Any branch of CNV* * Prodroma pain then unilateral rash* * *Often ask for tooth extracted as pain but tooth is healthy* * Painful*

Answer 27

*not that common in practice* * Previous episode of shingles * Constant burning sensation in dermatomal distribution * Any part body, face * Resolves within 2 months in 50% * May persist for two years or longer * _Suicide risk – unremitting pain_ * Psychological effect * Incidence possibly reduced by antiviral therapy ± steroids

Answer 28

* Antidepressants * Gabapentin * Carbamazepine * Topical capsaicin 0.025% * Transcutaneous electrical nerve stimulation (TENS)

Answer 29

* any of the 3 branches * Mandibular most * More women\> men * “10/10” “electric shock pain” excruciating * Not constant * Just comes on

Answer 30

* Carbamazepine * Only drug licenced for this currently - on dental list * Base line bloods, liver function * Low and build until pain free * Oxcarbazepine * Gabapentin * Pregabalin * Lamotrigine * Sodium valproate * Phenytoin

Answer 31

* request surgical opinion* * Presents with new trigeminal neuralgia – request MRI – look for impingement of nerve*

Answer 32

* Peripheral Procedures * Cryotherapy * Injection of alcohol or glycerol * Neurectomy * Avulsion of nerve * Ganglion procedures * Balloon compression * Radiofrequency thermocoagulation * Alcohol or glycerol injection * Microvascular decompression * Gamma knife radiosurgery *only 1 site in England*

Answer 33

yes less likely to have to constantly take pills

Answer 34

* *esp if younger* * Multiple sclerosis * Space occupying lesion MRI scan

Answer 35

* More common in females (F:M = 3:1) * **+/- anxiety, stress** * +/- depression

Answer 36

No cause identified in 50% patients * Psychogenic in 20% * Drugs (ACE or protease inhibitors) * Dry mouth * Candidosis * Haematinic deficiencies – FBC, folate, ferritin, B12, blood sugar * Diabetes * Parafunctional activity – clenching, grinding * Denture factors * Hypothyroidism * Allergy Reassure not cancer

Answer 37

* May lead to malnutrition * Don’t want to eat * Slow rehabilitation * Slow recovery * Reduce quality of life need conservative management (tricyclic, antistress, mindfulness) Any ‘burning mouth remedies’ don’t help * just make worse if anything, chemicals  irritate mucosa

Answer 38

should be detected in oral mucosal screen an regular appointments * anything abnormal -\> refer * *Better to be safe then sit and wait and monitor* * Never examine mouth with denture in place and move tongue to see all areas of mucosa* * *Carcinoma can be tucked into denture* **exam in systematic way** * less likely to miss something

Answer 39

oral cancers advanced treatment not pleasant

Answer 40

oral cancers * Speckled lesion, slightly exophytic buccal mucosa (carcinoma)* * *Can be missed – hurry, poor light – TAKE TIME*

Answer 41

* A large exophytic lesion with an ulcerated base and heaped up margins.* * Neglected mouth – a not atypical presentation*

Answer 42

oral cancer carcinomas can be tucked into denture

oral health problems in older people Flashcards

(66 cards)