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Dentistry in a Nutshell > oral med > Flashcards

oral med Flashcards

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1
Q

syphilis

A

sexually shared infection caused by t.pallidum
can be congenital / acquired
acquired is primary / secondary / tertiary

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2
Q

primary syphilis

A

painless round / ovoid lesion
lips common site
painless rubbery cervical lymphadenopathy may be a feature
highly contagious
resolves 2-3mths

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3
Q

secondary syphilis

A

1-4mths following healing of primary encounter
generalised macular skin rash
superficial ulcers
resolves 2-6wks although may enter latent phase

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4
Q

diagnosis of syphilis

A

serological tests i.e. TPHA / FTA

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5
Q

clinical features of candida (6)

A
  1. pseudomembranous (acute / chronic) - white / yellow plaques removed to reveal erythematous base which can bleed
  2. erythematous (acute / chronic) - commonly on dorsal surface of tongue, palate & buccal mucosa
  3. hyperplastic (chronic) - chronic discrete adherent white plaque like lesions, commonly at commissures
  4. denture induced stomatitis* - chronic erythema & oedema of mucosa in contact with fitting surface of denture
  5. angular cheilitis* - soreness, erythema, fissuring at angles of the lips
  6. median rhomboid glossitis* - papillary atrophy centrally placed anterior to circumvallate papillae
    * candida associated lesions
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6
Q

local factors predisposing to candida

A

trauma / denture wearing / poor denture hygiene / xerostomia

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7
Q

systemic factors predisposing to candida

A

radiotherapy / AB therapy / diabetes / nutritional deficiency / immunosuppression / smoking

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8
Q

investigating candida

A

swab & smear from palate & denture for everything except chronic hyperplastic
only 2 to biopsy is chronic hyperplastic & median rhomboid glossitis
screen for deficiencies & diabetes
FBC, ferritin, folate, b12 & glucose

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9
Q

tx of candida

A
  1. fluconazole capsules 50mg 1 x 7 days
  2. miconazole gel 20mg/g pea size x 4 daily continue to use for 7 days after lesions healed
  3. nystatin oral suspension 100,000 units/ml rinse after food x 4 daily & use for 48hrs after lesions healed
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10
Q

contraindications of azole antifungals

A

warfarin
statins

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11
Q

PHG cause

A

HSV 1
sometimes HSV 2
transmission via direct contact with infected skin / saliva

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12
Q

PHG clinical features

A

pyrexia, malaise, painful mouth & throat, cervical lymphadenopathy
widespread IO vesicles which rapidly rupture to form small irregular superficial ulcers with erythematous halos
gingiva if infected appear inflamed & bleed readily
SELF LIMITING & resolve in 10-14 days

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13
Q

investigations for PHG

A

hx & clinical features
PCR / detecting virus in smear / viral culture

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14
Q

tx of PHG

A

mild - symptomatic i.e. analgesia & fluids, can also give
- CHX 0.2% 10ml rinse for 1 min x 2 daily until resolved
- H2O2 6% 15ml diluted for 2 mins x 3 daily until resolved
mod / severe / immunocompromised pts - aciclovir 200mg x5 for 5 days

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15
Q

recurrent herpetic infection

A

in form of herpes labialis (cold sores)
lies dormant in trigeminal ganglion
reactivated via:
- fever
- trauma
- sunlight exposure
- menstruation
- immunosuppression
tx = topical aciclovir 1% / 5% every 2hrs during prodromal stage

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16
Q

varicella zoster virus causes

A

varicella - chicken pox in children
zoster - shingles in adults
tx via aciclovir (higher dose) 800mg x 5 daily for 5 days

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17
Q

what is aciclovir

A

systemic anti viral inhibits DNA polymerase by acting as defective guanine molecule

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18
Q

coxsackie virus causes

A

herpangina
HFM disease
tx of both = control symptoms via soft diet, fluids, analgesia

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19
Q

HPV - squamous cell papilloma

A

common benign tumour found on soft palate but also may affect dorsum / lateral surfaces of tongue
3rd-5th decade
pedunculated or sessile cauliflower like swelling

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20
Q

causes of ulceration

A

traumatic
idiopathic
infection - viral / fungal / bacterial
systemic disease association
dermatological diseases
neoplastic
drug induced i.e. nicorandil (K channel activator)

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21
Q

3 types of recurrent aphthous stomatitis

A
  1. minor <10mm, last <14 days, scarring uncommon
  2. major >10mm, last >30 days, scarring common
  3. herpetiform F>M, 1-2mm, larger if ulcers coalesce, >30 days, scarring possible if ulcers coalesce
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22
Q

investigation & diagnosis of RAS

A

FBC, haematinics (folate, ferritin, B12), coeliac screen (TTG tissue transglutaminase antibodies), allergy

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23
Q

RAS tx

A

no specific
antiseptic MW - CHX 0.2% / benzydamine MW 0.15% rinse using 15ml every 1.5hrs as required (or use 0.15% spray)
topical corticosteroids - beclomethasone MDI 50mcg 1-2 puffs directly onto ulcers x2 daily // betamethasone MW 500mcg 1 tablet dissolved in 10ml water x 4 daily // hydrocortisone oromucosal tablets 2.5mg 1 tab dissolved next to lesion x 4 daily for 5 days
systemic corticosteroids - prednisolone
other = azathioprine, dapsone etc

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24
Q

behcets syndrome

A

comprises triad of RAS, genital ulceration & posterior uveitis
diagnosis essentially clinical
tx - via immunosuppressive agents e.g. corticosteroids / azathioprine / topical tacrolimus
oral ulceration managed as for RAS

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25
intraepithelial vesiculobullous disease
pemphigus vulgaris viral infections (HSV / HZV / CXS)
26
subepithelial vesiculobullous disease
angina bullosa haemorrhagica mucous membrane pemphigoid lichen planus erythema multiforme
27
direct immunofluorescence in vesiculobullous diseases
pemphigus = intercellular IgG & C3, basket weave pattern mucous membrane pemphigoid & bullous pemphigoid = linear IgG & C3 at basement membrane zone
28
angina bullosa haemorrhagica
older people rapid formation of blood filled blister usually soft palate ruptures to leave superficial ulcer which is self limiting unknown aetiology tx - reassure & antiseptic MW for symptomatic relief
29
pemphigus vulgaris
autoimmune skin disease clinical - widespread bullous lesions, oral lesions in almost all pts, positive nikolsky sign, INTACT IO BULLAE ARE RARE, tend to rupture shortly after they form, pain, scarring uncommon failure to tx may be fatal
30
pemphigus vulgaris investigation & diagnosis
routine histopathological exam of perilesional tissue with direct / indirect immunofluorescence IgG & C3 bind to component of desmosomes (predominantly desmoglein 3) circulating antibody titre reflects severity of disease & can be used as marker of disease acitivty
31
pemphigus vulgaris tx
immunosuppressive therapy & corticosteroids +/- azathioprine
32
mucous membrane pemphigoid
chronic subepithelial bullous disorder principally affecting the elderly lesions on oral / genital mucosa heals with scarring clinical - bullae thick walled, intact for days before rupturing to leave superficial areas of ulceration, may also present as desquamative gingivitis
33
mucous membrane pemphigoid investigation & diagnosis
histopathological examination shows subepithelial bulla formation immunofluorescence shows IgG & C3 at basement membrane
34
erythema multiforme
self limiting vesiculobullous disease affecting skin +/- mucous membranes usually young adult males precipitating factors = HSV / thiazide diuretics / carbamazepine clinical - skin lesions, erythematous maculopapular rash, target lesions, haemorrhagic crusting of lips with extensive bullous lesions which rapidly rupture to form widespread painful erosions, ocular involvement may lead to conjunctival scarring & blindness usually subside within 2wks but can recur
35
erythema multiforme investigation, diagnosis & tx
clinical picture but can confirm with biospy tx = identify & eliminate precipitating factor if possible e.g. aciclovir if HSV, prevent dehydration, systemic corticosteroids +/- azathioprine
36
white sponge naevus
benign keratin defect autosomal dominant genetic biopsy will confirm reassure no tx
37
other white patches
chemical burn - resolves following removal of irritant smoker's keratosis - typically palate, tongue. commissures frictional keratosis - in response to chronic low grade trauma e.g. cheek biting - will resolve when irritation removed
38
leukoplakia
white patch that cannot be wiped off or characterised clinically or pathologically as any other disease essentially a diagnosis of exclusion
39
erythroplakia
bright red patch that cannot be attributed to any other cause
40
factors associated with increased rate of malignant transformation (3)
site of lesion - FoM, ventral surface of tongue, lingual alveolar mucosa presence of epithelial dysplasia clinical nature - nodular / speckled leukoplakia
41
chronic hyperplastic candidiasis
aka candidal leukoplakia persistent white / speckled red/white lesion predisposing factors: - tobacco usage - nutritional deficiency - poor denture hygiene - corticosteroid inhaler use mx - biopsy of all red / white lesions, eliminate predisposing factors, antifungal therapy
42
oral submucous fibrosis
increased risk with chewing betel quid / areca nut epithelial dysplasia common finding histological evidence of carcinoma in 5-6% progressive fibrosis
43
aetiological factors of mouth cancer
tobacco alcohol * diet UV chronic candida i.e. chronic hyperplastic candidosis (premalignant condition) HPV immunosuppression syphilis * * causes mucosal atrophy which in turn thins epithelium making it more susceptible to carcinogens
44
black hairy tongue
benign overgrowth of filiform papillae with lack of normal desquamation overgrowth of bacteria / fungi cause discolouration exacerbated by tobacco use reassure, brush tongue, tongue scraper
45
geographic tongue
irregular partially depapillated areas on anterior 2/3s of tongue often with distinct white margins regress & reappear on other parts of tongue asymptomatic but may show sensitivity to hot spicy food
46
for pilocarpine to work
pts must have some residual functional salivary gland tissue
47
sialadenitis
local e.g. calculus or systemic e.g. diabetes / sjogrens causes of reduced salivary flow invoke ascending infection from oral flora i.e. s.aures / s.viridans pain & swelling of affected gland, pyrexia, malaise, cervical lymphadenopathy tx - ABs / drainage by use of sialogogues
48
burning mouth syndrome
chronic pain disorder (burning) in the absence of mucosal pathology investigate - haematinics, diabetes control, psychological factors
49
persistent idiopathic facial pain
diagnosis of exclusion pain - persistent & present daily confined to outset of 1 side of face not associated with other signs high incidence of depression / anxiety tx via SSRIs e.g. fluoxetine / tricyclic antidepressant i.e. amitriptyline
50
trigeminal neuralgia
classical ( compression of nerve) secondary (to space occupying lesion i.e. tumour / MS ) idiopathic severe paroxysmal pain, lasts secs, mandib > max branch of TN, older pts, electric shock like pain investigate - MRI, cranial nerve testing, OPT to rule out dental cause tx - carbamazepine, oxcarbazepine, gabapentin, phenytoin, valproate
51
malignant transformation of lichen planus
1% chance over 10 year period
52
aetiology of lichen planus
exogenous - dental materials / food allergens / drugs e.g. diuretics, beta blockers / infection i.e. bacterial plaque & candida / stress / tobacco / trauma systemic - GVHD / nutritional deficiencies / diabetes mellitus / liver disease
53
histological features of lichen planus
acanthosis liquefaction degeneration of basal cell layer inflammatory cell infiltrate in deeper layers of epithelium dense subepithelial band of chronic inflammatory cells with well defined lower border
54
tx of lichen planus
antiseptic MW - CHX 0.2% / benzydamine MW 0.15% rinse using 15ml every 1.5hrs as required (or use 0.15% spray) topical corticosteroids - beclomethasone MDI 50mcg 1-2 puffs directly onto ulcers x2 daily // betamethasone MW 500mcg 1 tablet dissolved in 10ml water x 4 daily systemic corticosteroids - prednisolone azathioprine topical tacrolimus this is for tx of symptomatic lesions, asymptomatic don't require active tx
55
systemic lupus erythematous
autoimmune disorder of unknown aetiology, potentially drug induced i.e. phenytoin F>M 9:1 photosensitive erythematous rash (butterfly), arthritis, anaemia = main symptoms oral lesions in 1/3 of pts, similar to those of lichen planus with erythematous lesions & superficial erosions difficult to tx & may only respond to high dose systemic corticosteroids
56
orofacial granulomatosis
if pt has crohn's this is termed oral crohn's clinical - recurrent ulcers diffuse lip or cheek swelling cobblestone appearance of mucosa mucosal tags full width gingivitis granulomatous angular cheilitis vertical fissures of the lips
57
upper v lower motor neurone lesions
upper -> affects only lower part of face on opposite side e.g. cerebrovascular accident, MS lower -> affects whole face on same side e.g. Bell's palsy, trauma, parotid gland tumour, otitis media
58
bell's palsy
acute onset over several hrs recover spontaneously protect cornea while palsy present
59
oral features of anaemia
recurrent oral ulceration atrophic glossitis angular cheilitis oral dysaesthesia
60
oral features of leukaemia
bleeding, mucosal pallor, increased predisposition to infections e.g. candida / herpes, ulceration, gingival swelling
61
lesions strongly associated with HIV infection
candidiasis hairy leukoplakia kaposi's sarcoma non hodgkin's lymphoma periodontal disease (ANUG/P)
62
hairy leukoplakia
usually asymptomatic bilateral vertically corrugated white patches on lateral margins of tongue marker of underlying immunodeficiency opportunistic infection of oral mucosa by EBV marker of poor prognosis in HIV pts
63
non hodgkin's lymphoma
uncommon but well recognised complication of HIV infection rapidly enlarging, firm, rubbery swelling fauces / palate / gingivae tx via radio/chemotherapy

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