Oral Med Flashcards
(277 cards)
1
Q
Name this lesion based off its clinical findings:
● Asymptomatic but can be sore with chronic irritation
● Normal overlying mucosa and fibrous centre
● Found usually at the gingival margin
A
Fibrous epulis
2
Q
What cases pyogenic granulomas?
A
Local irritation/trauma
3
Q
What is this lesion based of the clinical findings:
● Ulceration and necrosis of the soft tissues
● Area of exposed bone
● Typically in the mandible but can also occur in the maxilla
This patient has previously had cancer that was treated with radiation therapy
A
Osteoradionecrosis
4
Q
What is the treatment for white sponge naevus?
A
Just explain to the patient
5
Q
How does carbamazepine work?
A
It binds to voltage dependant sodium channels and inhibits action potential generation
6
Q
What percentage of erythroleukoplakia will have dysplasia (abnormal cells in the tissue)?
A
90%
7
Q
Why does osteoradionecrosis happen?
A
Because radiation affects the capacity of osteocytes, osteoblasts and endothelial cells to repair following an injury
8
Q
What is the treatment of osteoradionecrosis?
A
The primary treatment for ORN is prevention.
● Prior to radiotherapy, dental assessment and any teeth with poor prognosis extracted
● Topical fluoride trays
● Antibiotic cover for any extraction after radiotherapy
● Hyperbaric oxygen tx (to increase oxygenation of affected tissues)
9
Q
What is a pleomorphic adenoma?
A
A salivary gland tumour that accounts for around 75% of parotid tumours
10
Q
What are the clinical findings of sialadenosis?
A
● Painless
● Bilateral enlargement of parotid glands
11
Q
Name this idiopathic lesion based off its clinical findings:
● Asymptomatic
● Round/oval shape
● Brown/black
● Most common in lip but can be found on any mucosal surface
A
Melanotic macule
12
Q
Who should not be prescribed carbamazepine?
A
Han, Thai or Chinese - due to likelihood of Stevens-Johnson Syndrome (sever skin reactions)
- Caution in pregnancy and those with hepatic impairments
13
Q
What should you do if you see major aphthous ulcers?
A
● BIOPSY - as lesion may resemble neoplasia or deep fungal infection
● Blood test to check for any underlying causes
14
Q
What is the treatment for a polyp?
A
Surgical excision
15
Q
What is Sicca Syndrome?
A
A combination of dry eyes and dry mouth without the diagnosis of Sjogren’s syndrome
16
Q
What is the treatment for acute necrotising ulcerative gingivitis (ANUG)?
A
● Mechanical cleaning and debridement of teeth in affected area
● Metronidazole
● Long-term hygiene therapy
17
Q
What is the treatment for syphilis?
A
● Intramuscular procaine penicillin
● Follow-up for 2 years
18
Q
What are some predisposing factors of pseudomembranous candidiasis? (10)
A
● Dry mouth
● Steroid inhaler
● Anaemia
● Nutritional deficiency
● DM
● Immunosuppressed/immunocompromised
● Extremes of age
● Dentures
● Broad spectrum antibiotics
● Systemic/inhaled corticosteroid
19
Q
Name this viral lesion
A
Hairy leukoplakia
20
Q
What is the difference between chickenpox and shingles?
A
They are both caused by the Varicella Zoster Virus (VZV).
Primary infection with VZV = chickenpox
Later in life infection with VZV = shingles
21
Q
Who is most likely affected with proliferative verrucous leukoplakia?
A
Elderly women
22
Q
What is the treatment for lymphomas?
A
Depends on the extent of the disease
● Localised: radiation
● Widespread: radiation and chemo combination
23
Q
Name this lesion
A
Squamous cell carcinoma
24
Q
What is the treatment for mucoceles?
A
Surgical excision including the associated duct and surrounding minor glands
25
Name this tumour based on its clinical findings:
● Firm, painless swelling
● Palate
● Possible superficial ulceration
● If in parotid, fixed discrete swelling (often associated with facial nerve palsy)
Adenoid cystic carcinoma
26
What causes epitheliolysis?
Epitheliolysis occurs secondary to mucosal irritation - usually from toothpaste and mouthwash
27
What is the treatment for epitheliolysis (oral mucosal peeling)?
Avoid SLS containing products
28
Name this traumatic lesion
Denture-induced hyperplasia
29
Name this lesion based on its clinical findings:
● Painful mucosal ulceration
● Desquamative gingivitis
● Vesicles and bullae may be blood filled
● ‘The lining of the mouth peeling off’
Mucous membrane pemphigoid
30
What is a ranula?
A mucocele of the sublingual gland and its draining ducts
31
What are the clinical features of shingles?
● Vascular eruption (unilateral)
● The infection heals but with scarring
● Skin or palate
32
What is the treatment for shingles?
● Antiviral therapy in cases that present within 48 hours of onset symptoms
● Acyclovir, valacyclovir, famciclovir
33
Where would glossophayngeal neuralgia be experienced?
The ear, base of the tongue, tonsillar fossa and/or beneath the angle of the jaw
34
Name this lesion
Angular cheilitis
35
Name this lesion based on its clinical findings:
● Sore/sensitive when eating spicy or sour foods
● Can move around the tongue (erythema migrans)
● Map looking
● Irregular outlined red patches
● Red areas surrounded by white/yellow/cream border
● Can disappear and return after some time
● On the tongue
Geographic tongue (inflammatory)
36
What are the three types of trigeminal neuralgia?
1. Classical trigeminal neuralgia
2. Secondary trigeminal neuralgia
3. Idiopathic trigeminal neuralgia
37
What can a GDP prescribe for replacement of saliva in cases of dry mouth?
- Artificial saliva spray (oral, protective or substitute)
- Artificial saliva gel
- Gel mouth spray
- Moisturising gel
38
What are the clinical features of chickenpox?
● Maculopapular skin rash
● Lesions may be preceded or accompanied by small ulcers (<5mm)
● Skin or palate
39
What is the first-line treatment for trigeminal neuralgia?
Carbamazepine (tegretol)
40
Name this tumour
Pleomorphic adenoma
41
What causes lymphomas?
Exposure to toxic chemicals, high dose radiation or immunodeficiency
42
Name this lesion from its clinical findings:
● Central erythematous (red) mucosa surrounded by a slightly elevated white border
● Fine perpendicular white ‘paint-brush’ like white lines
● ‘Butterfly rash’
Discoid lupus erythematosus (auto-immune)
43
Name this lesion
Median rhomboid glossitis
44
What is the treatment for Fordyce spots?
No treatment is needed
45
What are aphthous ulcers associated with?
Aphthous stomatitis
46
Name this lesion based off its clinical findings:
● Asymptomatic
● Red patch or plaque on oral mucosa that cannot be rubbed off
● Any intra-oral site - FOM most frequent
Erythroplakia
47
What is orofacial granulomatosis?
Inflammation in the orofacial region associated with sensitivity to foodstuffs, especially: benzoates and cinnamon
48
Name this lesion
White Sponge Naevus (inherited)
49
What usually causes chronic erythematous candidiasis/denture stomatitis?
Occurs usually in patients who wear an upper denture and is caused by inflammatory changes in underlying mucosa
50
Name this idiopathic lesion
Sialolith (salivary stones)
51
Name this traumatic lesion
Traumatic keratosis
52
What types of HSV are associated with primary herpetic gingivitis?
Type I and II
53
What is the treatment for sialadenitis?
No treatment is needed
54
What virus causes hand, foot and mouth?
Coxsackie virus
55
What should you do if you see minor aphthous or herpetiform ulcers?
Blood test to check for any underlying causes
56
Name this lesion
Pseudomembranous candidiasis (oral thrush) - fungal
57
What % of the population of Europe and North America have herpes?
60%
58
What are the risk factors of erythroplakia?(5)
● Tobacco
● Alcohol
● Haematinic deficiency
● Chronic trauma
● Age (middle aged-elderly)
59
What is the treatment for papillomas?
Surgical Excision
60
What are pleomorphic adenomas derived from?
The neoplastic transformation of salivary acinar-type cells and myoepithelial cells
61
Name this inflammatory lesion based off of its clinical findings:
● Asymptomatic
● Red palatal mucosa with margins corresponding to the periphery of the appliance
● May appear nodular - papillary hyperplasia
● Mainly found in the palate
Chronic Erythematous Candidosis/Denture Stomatitis
62
Name this lesion based on its clinical findings:
● Painless swelling but overtime it may hurt
● Blue
● Dome shaped
● Fluctuant swelling
● Looks like a ‘frogs belly’
● FOM
Ranula
63
What is the treatment for pleomorphic adenomas?
Surgical excision
Potential for malignant transformation if left untreated
64
What type of margin is a red flag for malignancy?
Rolled
65
Name this lesion based on its clinical findings:
● Fat cells surrounded by a thin fibrous capsule
● Asymptomatic
● Slowly enlarging, soft, smooth-surfaced mass within sub-mucosal tissues
● Yellowish
● They are rare in the oral cavity
Lipoma
66
What is the treatment for discoid lupus erythematosus?
● Immunosuppressants
● Antiseptic mouthwash
● Betamethasone mouthwash
● Topical steroids
67
Name this ulcerative lesion based off its clinical findings:
● Pain
● Involve as many as 50-100 separate lesions
● Around 1-2mm diameter
● Healing occurs within 2 weeks without scarring
Herpetiform ulcers
68
Name this lesion
Nicotinic Stomatitis
69
Name this lesion based off its clinical findings:
● Burning sensation
● Diffuse loss of filiform papillae of the dorsal of the tongue
● Reddened, ‘bald’ appearance of the tongue
Acute Erythematous Candidiasis
70
Name this fungal lesion
Chronic hyperplasic candidiasis
71
How does chronic hyperplastic candidiasis occur?
The present candida infection complicates epithelial dysplasia (abnormal growth)
72
What is hairy leukoplakia cased by?
The Epstein Barr Virus (HPV4) as it infects the keratinocytes in the mucosa
73
Name this lesion (hint - it is associated with RAS)
Herpetiform ulcers
74
What is the treatment for traumatic keratosis?
● Remove the source of trauma
● Biopsy to rule out neoplastic inflammatory process
75
What are the 6 groups of orofacial pain according to International Classification of Orofacial Pain (ICOP)(2020)?
1. Dentoalveolar/anatomy related pain
2. Myofascial pain
3. TMJ pain
4. Cranial nerve related pain
5. Resemble headaches
6. Idiopathic pain
76
Which type of biopsy only removes a portion of the tumour/lesion?
Incisional
77
What are the three members of the idiopathic orofacial pain group according to the International Classification of Orofacial Pain (ICOP)(2020)?
1. Burning mouth syndrome (BMS)
2. Persistent idiopathic facial pain
3. Persistent idiopathic dentoalveolar pain
78
Name this lesion from its clinical findings:
● Relatively mild burning sensation of oral mucosa
● Unpleasant taste - salty/bitter
● White cottage cheese or curdled milk look
● Removable patches
● Erythematous/bleeding base
● Commonly found on tongue
Pseudomembranous candidiasis (oral thrush) - fungal
79
Name this lesion
Chronic Erythematous Candidiasis/Denture Stomatitis
80
Name this lesion
Adenoid cystic carcinoma
81
What is secondary trigeminal neuralgia caused by?
An underlying disease e.g. multiple sclerosis and space occupying lesions (tumours and cysts)
82
What type of oral presentation of syphilis is being described:
● Ulcer looking (chancre)
● Firm nodule at the site of inoculation which breaks down after a few days to leave a painless ulcer with indurated (hardened) margins
Primary
83
What is xerostomia?
A sensation of oral dryness
84
What disease causes ulcerations like this and also genital ulceration?
Bechet's disease
85
What is the treatment for chickenpox?
Bed rest and patience
86
Name this lesion
Leukodema (congenital)
87
What is hypoalgesia?
The reduction in response to a stimulus which would normally cause pain
88
How does primary herpetic gingivitis happen?
The HSV virus affects the epithelial cells to produce intraepithelial blisters
89
What is the main difference between Herpes-Zoster trigeminal neuropathies and Post-Herpetic trigeminal neuropathies?
Herpes-Zoster type has been there less than three months, post-herpetic has been there longer than 3 months
90
Define Erythroplakia
A red patch or plaque on oral mucosa that cannot be rubbed off and cannot be characterised as any specific disease
91
What are the two main classification systems for orofacial pain?
International Classification of Headache Disorders which is now in its 3rd edition (2018)
International Classification of Orofacial Pain (ICOP)(1st edition)(2020) (more specific to orofacial pain)
92
Name this lesion based off of its clinical findings:
● Usually asymptomatic
● Redness (erythema)
● Cracking at angles of the mouth
● Check for accompanying signs of intra-oral candidosis (often associated with denture stomatitis)
● Reduced OVD
Angular cheilitis
93
What causes traumatic keratosis?
Occurs secondary to physical, frictional, chemical and/or thermal irritation
94
Name this congential lesion from its clinical findings:
● Asymptomatic
● Diffuse
● Grey/white
● Biateral
● +/- wrinkling/corrugation
● Does not rub off
● Disappears when stretched
● Buccal mucosa
Leukodema
95
What are herpetiform ulcers associated with?
Recurrent aphthous stomatitis (RAS)
NOT HERPES
96
What is this lesion based on its clinical findings?
● Usually asymptomatic
● Usually resolves in 7-10 days
● Macular, vesicular eruptions on hands, feet and mucosa
Hand, foot and mouth disease
97
What percentage of the population are affected by erosive lichen planus?
1-2%
98
What are the main dental procedures that can pre-dispose a patient to the onset or osteoradionecrosis?
Tooth extraction, perio disease, peri-apical infections
99
What is the treatment for median rhomboid glossitis?
Systemic antifungals
100
What are the risk factors of squamous cell carcinoma (SCC)?(9)
● Tobacco
● Betel nut/areca nut
● Alcohol
● Iron deficiency
● Vitamin A deficiency
● Vitamin C deficiency
● Fungal infection
● Stress
● HPV 16
101
What is classic trigeminal neuralgia caused by?
Neurovascular compression
102
Name this lesion
Amalgam tattoo (traumatic)
103
Name this condition based on its clinical presentations:
● Progressive enlargement of the maxilla and mandible
● Edentulous patients will complain that their dentures are too tight
● Hat size may increase
● Bone pain
● Headaches
● Auditory and visual disturbances (due to compression of neurovascular elements)
● Radiographic cotton wool appearance of bone
● Hypercementosis and ankylosis of teeth
Paget's disease
104
What are the three main ways to manage dry mouth?
1. Stimulation
2. Replacement
3. Prevention
105
What are the risk-factors for leukoplakia?
● Tobacco
● Alcohol
● Invasive candida infection
● Haematinic deficiency
● Chronic trauma
● Middle aged and elderly
106
What does a score of 7-10 mean on the Challacombe scale?
Severe dryness and you need t assess the cause and exclude Sjogren's syndrome
107
What causes fibrous epulis?
Chronic irritation
108
Name this lesion (hint - it is associated with a virus)
Primary Herpetic Gingivitis (associated with the herpes simplex virus)
109
What is dysesthesia?
An unpleasant abnormal sensation affecting the skin or mucosa e.g. burning, tingling, crawling, stinging, pain
110
Name this inflammatory lesion based on its clinical findings:
● Widespread, painful oral ulceration
● General feeling of unwell
● Blood crusted lips
● Skin involvement (concentric rings of erythema)
● Lymphadenopathy
Erythema Multiforme
111
Name this inflammatory lesion based off its clinical findings:
● Widespread irregular white patches
● Sometimes ulceration and sloughing
● White/erythematous (with or without peripheral striae)
● White lesions next to possible source
● Not wipeable
● Usually on the lateral border of the tongue or buccal mucosa
Lichenoid reaction
112
What causes denture-induced hyperplasia?
An ill-fitting denture
113
What is the treatment for cheek biting?
No treatment is needed
114
What are the three subgroups of trigeminal neuropathies?
1. Attributed to Herpes Zoster Virus
2. Post-herpetic
3. Post-traumatic
115
What is sialadenosis?
A non-inflammatory, non-neoplastic swelling of the major salivary glands
116
What is the malignant transformation rate of leukoplakia?
8-22%
117
Name this lesion
Mucocele
118
What is sialadenitis?
Inflammation of the salivary glands that causes pain, redness and swelling
119
Name this ulcerated lesion based off of its clinical findings:
● Pain
● More severe than minor form
● Number: occur singularly or 2-3 at a time
● >10mm in diameter
● Take up to 3 months to heal and there may be scarring
● They can appear on any oral site - including keratinised mucosa
Major aphthous ulcer
120
Name this lesion
Linea Alba (traumatic)
121
What is the treatment for erosive lichen planus?
Antiseptic mouthwash
Topical steroid therapy (prednisolone or betamethasone)
122
Name this idiopathic lesion
Melanotic macule
123
Name this ulcerated lesion based off of its clinical findings:
● Pain
● Regular, round or oval
● Red (erythematous) borders
● Single or small number of shallow ulcers (1-5)
● <10mm in diameter
● Take 10-14 days to heal without scarring
● Affects non-keratinised sites within the mouth (e.g. labial mucosa, buccal mucosa, FOM)
Minor aphthous ulcer
124
What is an adenoid cystic carcinoma?
A malignant tumour of the salivary glands that accounts for around 25% of carcinomas occurring in the salivary glands
125
Why may you do an excisional biopsy for amalgam tattoos?
To eliminate melanocytic neoplasia
126
Name this traumatic lesion
Pyogenic granuloma
127
What is Paget's disease?
A chronic, slow progressive disorder of bone metabolism that leads to excessive resorption and deposition of bone
128
What virus are papillomas associated with?
The human papillomavirus (HPV).
129
Name this traumatic lesion from its clinical findings:
● Asymptomatic
● Macules/slightly raised lesions
● Blue/black/grey
● Well defined borders/irregular/diffuse
Amalgam tattoo
130
Name this autoimmune lesion based on its clinical findings:
● Likely pain
● Oral manifestations are non-specific with areas of erosion at any mucosal site
● Non-keratinised sites appear to be the most affected
Pemphigus (autoimmune vesiculobullous)
131
Other than carbamazepine, what can a GDP prescribe to help with trigeminal neuralgia?
- Lidocaine nasal spray
- Lidocaine Ointment
- Lidocaine Infiltration/Block
132
How does HSV spread?
Through saliva
133
What are adenoid cystic carcinomas derived from?
The neoplastic transformation of salivary acinar-type cells and myoepithelial cells
134
What is the treatment for orofacial granulomatosis?
● Avoid benzoates and cinnamon
● Steroids (to reduce swelling)
● Patch test:
- Benzoic acids
- Benzoates
- Cinnamon
- Chocolate
135
What is allodynia?
Pain in response to a stimulus which would not normally cause pain e.g. light touch in mechanical allodynia
136
What is the treatment for angular cheilitis?
● Investigate for anaemia
● Miconazole cream applied to angles of the mouth 2x a day
- Contraindicated with warfarin and statins
137
Name this traumatic lesion from its clinical findings:
● Asymptomatic
● Strands of white gelatinous tissue
● Milky white
● Removable by wiping
● No significant abnormality of underlying tissues
Epitheliolysis (oral mucosal peeling)
138
Name this condition based on its clinical findings:
● Diffuse enlargement of the lips
● Facial palsy
● Fissured tongue
● Full thickness gingivitis
● Mucosal tags
● Folds in the mucosa
● Cobblestone mucosa
● Lips are the most frequently affected
● Can be associated with asthma and eczema
Orofacial granulomatosis
139
If you have signs of median rhomboid glossitis and a corresponding area of erythema (redness) on the palate, what does this indicate?
Chronic multifocal candidosis
140
How are Addison’s Disease/Primary Adrenal lesions managed?
Systemically
141
What is the malignant transformation of proliferative verrucous leukoplakia?
70-100%
142
How do sialoliths (salivary stones) occur?
When there is a calcium deposition in an area of bacteria, mucus or ductal epithelial cells
143
What is the treatment for denture-induced hyperplasia?
New/ease denture and excision, may need biopsy to differentiate from SCC
144
What is mucous membrane pemphigoid?
An autoimmune vesiculobullous disease in which the epithelium is separated from the connective tissues
145
What type of oral presentation of syphilis is being described:
● Nasal deformity
● Hutchinson’s triad
● Screwdriver-shaped incisors
● Mulberry molars
Congenital - pregnant patient with primary or secondary syphilis can infect a developing foetus
146
What % of the population is affected by geographic tongue?
1-2%
147
Name this inflammatory lesion
Erythema Multiforme
148
What is the aetiology of white sponge naevus?
Inherited - autosomal dominant
149
What is Sialorrhea?
Excessive salivary flow
150
What is the treatment for hand, foot and mouth?
● Bland mouthwash (e.g. sodium bicarbonate in warm water) or chlorhexidine mouthwash
● Analgesics if needed for pain relief
151
What is the treatment for linea alba?
No treatment is needed
152
Describe this traumatic lesion from its clinical findings:
● Symptoms depend of severity
● Discomfort
● Tumour-like hyperplasia of fibrous connective tissues
● Single/multiple folds of hyperplastic tissue in alveolar vestibule
● Usually affecting gingivae
● Often ulceration at the base of the folds
● Pink, lobulated masses
Denture-induced hyperplasia
153
What is Addison's disease?
A metabolic autoimmune disease that causes adrenocortical insufficiency
154
What scale is used to assess oral dryness?
Challacombe
155
What is the treatment for lichenoid reactions?
● If medication is the cause, consult with GP about changing medication
● If amalgam is the cause, replace restoration
156
Name this lesion based off its clinical findings:
● Asymptomatic
● White patch that cannot be rubbed off
● Flat white patch/wart-like lesion/thickened leathery patch
● Can be mixed red/white
Leukoplakia
- the mixed red/white are called speckled leukoplakia/erythroleukoplakia
157
Name this lesion (hint - it is associated with RAS)
Minor aphthous ulcer
158
Name this lesion based on its clinical findings:
● Fever, malaise, headache, chills
● Pre-auricular temporal pain
● Swelling
● 75% of patients have bilateral parotid gland disease
● The swellings occur around 2-3 days after symptoms
● It most commonly affects the parotid gland
Viral Sialadenitis
159
What is the malignant transformation rate of submucous fibrosis?
7-30%
160
Where does glossopharyngeal neuralgia spread to?
It does not only spread along the glossopharyngeal nerve but also the auricular and pharyngeal branches of the vagus nerve
161
What is the treatment for primary herpetic gingivitis? (7)
● Reassurance and advice
● Limit contact with lips and mouth
● Chlorhexidine mouthwash
● Analgesics
● Soft diet
● Adequate fluid intake
● Acyclovir (dosage should be halved for children under 2 years)
162
What is the treatment for mucous membrane pemphigoid?
● Steroid therapy
● Systemic prednisolone followed by topical maintenance
● Maybe azathioprine
163
What is the treatment for adenoid cystic carcinomas?
Diagnosis is established with a biopsy and a CT or MRI is used to assess the extent.
It is difficult to treat successfully but involves surgery removing a large margin. If it is in the parotid, a parotidectomy is used with the sacrifice of the facial nerve (if it is involved). Sometimes postoperative radiotherapy is needed.
164
What is the treatment for leukoplakia?
● If there is no dysplasia, no treatment is needed
● Review and biopsy every 6 months as there is a high malignant transformation risk
165
What is the treatment for viral sialadentitis?
● Rest
● Fluids
● Analgesia
166
What is erosive lichen planus (on a cellular level)?
It is the T-lymphocyte mediated destruction of basal cell keratinocytes and hyperkeratinisation
167
Name this traumatic lesion based on its clinical findings:
● Blue/black-ish
● More vascular that epulis
● Nodular, red lesion
● Ulcerated
● Bleeds easily on touch
● Mainly at gingival margin
Pyogenic granuloma
168
What is the treatment for acute erythematous candidiasis?
● Investigate for candidiasis
● If on steroid inhalers, advise rinse mouth after use
● Antifungals (e.g. fluconazole)
● Discontinue antibiotic therapy
169
Name this lesion (hint - it cannot be wiped off)
Erythroplakia
170
Name this lesion based on its clinical findings:
● Asymptomatic
● Painless fluid filled swelling
● Blue-ish discolouration
● Smooth surface
● Range from a few mm to few cm
● Dome shaped
● Can be either firm or fluctuant to palpation
● Kind of feels like a grape
● Mostly in the lower lip
Mucocele
171
Name this viral lesion based off its clinical findings:
● Asymptomatic
● Firmly adherent (cannot be moved/wiped off)
● Corrugated surface
● Well-demarcated
● Lateral border of the tongue
Hairy leukoplakia
172
What type of lymphadenopathy is a red flag for malignancy?
Cervical lymphadenopathy (enlarged (size more than 1cm), firm, fixed, tethered, non-tender)
173
Name this autoimmune lesion
Pemphigus (autoimmune vesiculobullous)
174
Where is carbamazepine metabolised?
Liver
175
Name this lesion caused by metabolic disease
Addison’s Disease/Primary Adrenal
176
What is bacterial sialadentitis?
Inflammation of the salivary glands that causes pain, redness and swelling caused by: staph aureus, strep viridans and strep pneumoniae (anaerobic bacteria)
177
Name this traumatic lesion from its clinical findings:
● Asymptomatic
● White line at level of occlusal plane
● Buccal mucosa
Linea Alba
178
What is syphilis?
An STD that usually occurs on genitals but also presents on lips or oral mucosa as a result of oro-genital contact
179
What is the treatment for pemphigus?
Pemphigus can be a potentially life-threatening condition so a hospital admission may be required.
● Prednisolone
● BP monitoring
● Once control is achieved, then adjunctive azathioprine and cyclophosphamide are used for management
● Biopsy may be required if there is an intact or ruptured bullae
180
What is the treatment for herpetiform ulcers?
● Avoid foods containing benzoates, crisps, chips, chocolate
● Blood test to check for underlying causes
● Symptomatic relief:
- Chlorhexidine mouthwash
- Benzydamine mouthwash
- Topical corticosteroid preparation
● Systemic: immunomodulating drugs (e.g. prednisolone)
● SLS-free toothpaste
181
Name this disorder based on its clinical presentation:
● Unilateral, recurrent bursts of pain of one or more division of the trigeminal nerve with no radiation beyond
● Pain lasts less than 2 seconds
● Pain of severe intensity
● Electric shock-like, shooting, stabbing or sharp pain
● Caused by an innocuous stimuli
● No other relevant diagnosis
Trigeminal neuralgia
182
What is epitheliolysis?
Oral Mucosal peeling
183
Which type of biopsy removes the entire tumour/lesion?
Excisional
184
What is the treatment for lipomas?
Surgical excision
185
What is the role of the GDP for trigeminal neuralgia?
- Diagnose
- Initiate medical management with GP
- Refer
186
In what patients is sialorrhea most common?
Parkinson's Disease
187
What is viral sialadentitis?
inflammation of the salivary glands that causes pain, redness and swelling caused by the paramyxovirus and is transmitted in saliva
188
What is the treatment for nicotinic stomatitis?
Smoking cessation
189
Name this lesion (hint - look at what it is next to)
Lichenoid reaction (inflammatory reaction to drugs or materials)
190
What are lichenoid reactions caused by?
Hypersensitivity to materials or drugs
191
Name this idiopathic lesion from its clinical findings:
● Pain
● Rapid onset
● Swelling
● Symptoms vary on size and degree of obstruction
● Yellow mass
● Firm to palpate
Sialolith (salivary stones) - the stone ultimately causes a blockage of the salivary duct that cause the majority of these findings
192
What is the treatment for a ranula?
Excision under GA
193
Define Leukoplakia
Leukoplakia is a white patch that cannot be rubbed off and cannot be characterised clinically as any specific disease.
194
What are the management options for idiopathic facial pain and dentoalveolar pain?
● explanation and reassurance
● self management (relaxation, exercise, distraction and mindfulness)
● cognitive behavioural therapy
● acceptance and commitment therapy
● topical treatments (lidocaine ointment)
● systemic treatments (amitriptyline/nortriptyline and duloxetine)
195
What is hyperesthesia?
The increased cutaneous/mucosal sensitivity to a stimulus e.g. touch, temperature changes
196
For a diagnosis idiopathic orofacial pain, how frequent does the pain need to be?
More than 2 hours a day for more than 3 months
197
What type of colour lesion is a red flag for malignancy?
Speckled (erythroleukoplakia)
198
What are sialoliths?
Salivary stones
199
Name this lesion (hint - it cannot be wiped off)
Leukoplakia
200
What causes discoid lupus erythematosus?
Basal cell damage
201
What is erythema multiforme?
An acute inflammatory condition that is a hypersensitivity reaction to potential antigens including infectious agents (e.g. HSV, phenytoin, penicillin etc.)
202
Name this lesion
Polyp
203
Name this lesion based off its clinical findings:
● Rhomboidal shape
● Loss of papillae
● Erythema (redness)
● Middle dorsum of tongue
● May be associated with hyperplasia
Median rhomboid glossitis
204
What is hyperalgesia?
An increased response to a stimulus which would normally cause pain e.g. cold in cold hyperalgesia
205
Name this hereditary lesion based off its clinical findings?
● Asymptomatic
● White/grey spongy patches
● Deeply folded white lesion
● Occurs most commonly on buccal mucosa
White sponge naevus
206
Name this lesion
Fordyce spots (congential)
207
What condition does this patient have?
Paget's disease
208
Name this autoimmune lesion
Discoid lupus erythematosus
209
What is submucous fibrosis?
Juxta epithelial inflammation and fibrosis of oral mucosa with progressive trismus
210
What is a polyp?
A benign growth of mucosa associated with chronic irritation/trauma
211
What are the clinical findings of squamous cell carcinoma?
● No pain at an early stage
● Can range from a small erythematous (red) patch to a large swelling area of ulceration
● Indurated, rolled margins
212
Name this lesion
Acute Erythematous Candidiasis
213
What are the 2 subgroups of Orofacial pain associated to the cranial nerves according to the International Classification of Orofacial Pain (ICOP)(2020)?
Pain attributed to lesion or disease of the:
1. Trigeminal nerve
2. Glossopharyngeal nerve
214
What is the treatment for fibrous epulis?
Excision
215
Name this traumatic lesion
Cheek biting
216
How long should traumatic ulcers take to heal once the source of trauma has been removed?
7-10 days
217
What disease is erythema multiforme associated with?
Stevens-Johnson Syndrome
218
What are lipomas primarily comprised of?
Adipocytes
219
Name this inflammatory lesion
Fibrous epulis
220
What does a score of 4-6 mean on the Challacombe scale?
Moderate dryness and further investigations may be required if cause is not clear
221
What is carbamazepine?
An anticonvulsant used for epilepsy and bi-polar
222
Name this lesion
Geographic tongue (inflammatory)
223
Name the described lesion:
● No pain at an early stage
● Can range from a small erythematous (red) patch to a large swelling area of ulceration
● Indurated, rolled margins
When advanced, it involves metastasis and spreads to the lymph nodes
Squamous cell carcinoma
224
What are the clinical findings of traumatic keratosis?
Asymptomatic, white plaque that cannot be moved
225
what percentage of oral malignancies do lymphomas account for?
less than 5%
226
Name this auto-immune lesion?
Mucous membrane pemphigoid
227
What is a melanotic macule?
An accumulation of melanin in epithelium and superficial connective tissues
228
Name this fungal lesion from clinical findings:
● Asymptomatic
● Firmly adherent (not scrapable) white plaques
● Bilateral
● Fine intermingling of red and white areas (speckled leukoplakia)
● Thickened, irregular or smooth white plaques
Chronic hyperplasic candidiasis
229
When is a dose reduction indicated for carbamazepine when treating trigeminal neuralgia?
When the patient has been pain free for 4 weeks
230
Name this congenital lesion from its clinical findings:
● Asymptomatic
● Multiple yellow/yellow/white papules
● Oral mucosa
Fordyce spots (congenital)
231
Name this traumatic lesion based on its clinical findings:
● Asymptomatic (unless further traumatised)
● Pedunculated or sessile
● Round
● Single
● Rubbery
● Normal overlying mucosa
● Commonly on tongue, lip and buccal mucosa
Polyp
232
What is the treatment for hairy leukoplakia?
● Treatment is not required
● However, if the lesion is large, it may cause aesthetic issues
- In this case, it can be treated with acyclovir
233
What does a score of 1-3 mean on the Challacombe scale?
Mild dryness
234
What are the most common drugs to cause a lichenoid reaction?
Antihypertensives, hypoglycaemics and NSAIDs
235
What is the treatment for geographic tongue?
● Analgesic mouthwash or lozenges to numb tongue before meals
● Avoid spicy/acidic foods and carbonated drinks
● Smoking cessation
● Reduce alcohol intake
● Regular dental visits
● Zinc sulphate
236
What percentage of post-menopausal women are affected by burning mouth syndrome?
18-33%
237
Name this lesion based on its clinical findings:
● Reduced salivary flow
● Painful swelling
● Tender to touch
● Purulent discharge from the duct orifice
● Overlying skin may be erythematous
● Fever, malaise
● Affects the major salivary glands
Bacterial sialadentitis
238
What is a mucocele caused by?
Trauma of a salivary gland duct which leads to the accumulation of saliva in the surrounding connective tissue
239
What is the treatment for chronic erythematous candidiasis/denture stomatitis?
● Denture hygiene instruction
- Patients with CoCr denture, should soak in 0.2% chlorhexidine
● Antifungals
- Fluconazole (contraindicated in patients on warfarin and statins)
- Miconazole (contraindicated in patients on warfarin and statins)
- Nystatin
240
Who is most likely to have nicotinic stomatitis?
Males who smoke
241
What type of syphilis causes this?
Congenital
242
Name this lesion
Papilloma
243
What is the treatment for Paget's disease?
Paget’s disease is incurable but bisphosphonates and calcitonin are used to control excessive osteoclastic activity
244
Name this lesion based off its clinical findings:
● Asymptomatic
● Generalised white/grey patch on hard palate extending to soft palate
● Small red dots (<1mm)
- These are inflamed openings of the minor salivary glands
Nicotinic Stomatitis
245
Name this lesion
Ranula
246
What is the treatment for chronic hyperplasic candidiasis?
If on corticosteroid inhaler: advise to rinse out with water/brush teeth ASAP
If not on corticosteroid inhaler:
● Fluconazole (contraindicated with warfarin and statins)
● Miconazole (contraindicated with warfarin and statins)
● Nystatin
● Smoking cessation
● Maybe surgical excision if persistent lesion with signs of epithelial dysplasia
*Remember that chronic hyperplastic candidiasis has the potential for malignant transformation.*
247
Who is most likely to present with trigeminal neuralgia?
50-60 year old females
248
What is the treatment for pseudomembranous candidiasis (oral thrush)?
If on corticosteroid inhaler: advise to rinse out with water/brush teeth ASAP
If not on corticosteroid inhaler:
● Fluconazole (contraindicated with warfarin and statins)
● Miconazole (contraindicated with warfarin and statins)
● Nystatin
249
Which is more common: trigeminal neuralgia or glossopharyngeal neuralgia?
Trigeminal neuralgia
250
What causes amalgam tattoos?
When amalgam gets into the soft tissues
251
Name this lesion
Epitheliolysis (oral mucosal peeling)
252
What is the treatment for bacterial sialadentitis?
● Antibiotic therapy (clindamycin, metronidazole)
● Pain relief from NSAIDs
● Hydration
253
Why might the varicella zoster virus reactivate?
Immunosuppression (e.g. malignancy, drugs or HIV)
254
Name this disorder based on its clinical presentation:
● recurring bursts of unilateral pain in the glossopharyngeal area
● pain lasting a few seconds to 2 mins
● severe pain intensity
● electric shock-like, shooting, stabbing or sharp pain
● triggered by swallowing, yawning, coughing or talking
● no better diagnosis
Glossopharyngeal neuralgia
255
What is the 5 year survival rate for squamous cell carcinoma?
40% (site dependant)
256
Name this lesion based on its clinical findings:
● Firm, lobulated mass
● Either extra-oral with a major gland or intra-oral with a minor gland
● Overlying mucosa appears similar to adjacent tissues
● Slow growing
● Painless
● Ranging from a few mm to a several cm
● Mainly associated with parotid
Pleomorphic adenoma
257
What does Paget's disease lead to?
Excessive resorption and deposition of bone
258
Name this lesion from its clinical findings:
● Pain
● Marked halitosis
● Rapid development
● Usually widespread but can also be localised
● Affects the gingival margin and interdental papillae
● Most common on lower anteriors
ANUG (Acute necrotising ulcerative gingivitis) - or whatever the word for it is now
259
Name this lesion based on its clinical findings:
● At first asymptomatic but then blisters rupture
● Associated with pyrexia, headache and cervical lymphadenopathy
● Often goes unnoticed and dismissed as teething
● Erythematous (red)
● Swollen
● Ulcerations
Primary herpetic gingivitis
260
How long does it take for the malignant transformation to occur with proliferative verrucous leukoplakia?
Around 23 month
261
What is the treatment for a melanotic macule?
No treatment is needed but you can do an excision for aesthetic reasons
262
Name this traumatic lesion from its clinical findings:
● Asymptomatic but can become painful with repeated trauma
● Bilateral or unilateral
● Thickened, shredded, white areas
● Irregular ragged surface
Cheek biting
263
What is the treatment for erythema multiforme?
Symptoms often resolve spontaneously after 10-14 days. However, if there are recurrences within 2-3 years:
● Antiseptic mouthwash
● Oral prednisolone
● Hydration
264
Name this lesion (hint - it is associated with RAS)
Major aphthous ulcer
265
Name this lesion based on its clinical description:
● Asymptomatic
● Can get traumatised
● Pedunculated or sessile
● Can occur anywhere but often palate, tongue, lips
Papilloma
266
What is Sjogren's Syndrome?
A systemic autoimmune disease that affects exocrine glands that causes a deficiency in saliva, tears, skin lubrication, and other exocrine secretions
267
What type of lichen planus is this?
Erosive lichen planus
268
What type of oral presentation of syphilis is being described:
● Macular or papular rash
● Illness, malaise, headache, sore throat
● Generalised lymphadenopathy
● Snail-track ulcers
● Usually resolve in 2-6 weeks
Secondary
269
Name this lesion
Squamous cell carcinoma
270
What are pyogenic granulomas associated with?
Pregnancy
271
What is the treatment for amalgam tattoos?
No treatment is needed but you can do an excisional biopsy/radiographs if you want to eliminate melanocytic dysplasia
272
What is the treatment for leukodema?
No treatment is needed
273
What can a GDP prescribe for stimulation of saliva in cases of dry mouth?
● Artificial saliva pastilles DPF (salivix): combination of citric and malic acid
● SST (saliva stimulating tablets): only for patients with no obstruction to salivary glands
274
What is the malignant transformation rate of erythroplakia?
5-10%
275
What is the treatment for Sialoliths (salivary stones)?
Small stones: can be manipulated into the duct opening
Big stones: ultrasound guided basket retrieval or endoscopy guided surgery
276
What is the treatment for pyogenic granulomas?
Surgical excision
277
What is the treatment for minor and major aphthous ulcers?
● Avoid foods containing benzoates, crisps, chips, chocolate
● Symptomatic relief:
- Chlorhexidine mouthwash
- Benzydamine mouthwash
- Topical corticosteroid preparation
● Systemic: immunomodulating drugs (e.g. prednisolone)
● SLS-free toothpaste
