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Dentistry > Oral Med > Flashcards

Oral Med Flashcards

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

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2
Q

What cases pyogenic granulomas?

A

Local irritation/trauma

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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

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4
Q

What is the treatment for white sponge naevus?

A

Just explain to the patient

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5
Q

How does carbamazepine work?

A

It binds to voltage dependant sodium channels and inhibits action potential generation

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6
Q

What percentage of erythroleukoplakia will have dysplasia (abnormal cells in the tissue)?

A

90%

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7
Q

Why does osteoradionecrosis happen?

A

Because radiation affects the capacity of osteocytes, osteoblasts and endothelial cells to repair following an injury

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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)

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9
Q

What is a pleomorphic adenoma?

A

A salivary gland tumour that accounts for around 75% of parotid tumours

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10
Q

What are the clinical findings of sialadenosis?

A

● Painless
● Bilateral enlargement of parotid glands

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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

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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

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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

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14
Q

What is the treatment for a polyp?

A

Surgical excision

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15
Q

What is Sicca Syndrome?

A

A combination of dry eyes and dry mouth without the diagnosis of Sjogren’s syndrome

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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

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17
Q

What is the treatment for syphilis?

A

● Intramuscular procaine penicillin
● Follow-up for 2 years

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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

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19
Q

Name this viral lesion

A

Hairy leukoplakia

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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

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21
Q

Who is most likely affected with proliferative verrucous leukoplakia?

A

Elderly women

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22
Q

What is the treatment for lymphomas?

A

Depends on the extent of the disease
● Localised: radiation
● Widespread: radiation and chemo combination

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23
Q

Name this lesion

A

Squamous cell carcinoma

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24
Q

What is the treatment for mucoceles?

A

Surgical excision including the associated duct and surrounding minor glands

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25
Q

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)

A

Adenoid cystic carcinoma

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26
Q

What causes epitheliolysis?

A

Epitheliolysis occurs secondary to mucosal irritation - usually from toothpaste and mouthwash

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27
Q

What is the treatment for epitheliolysis (oral mucosal peeling)?

A

Avoid SLS containing products

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28
Q

Name this traumatic lesion

A

Denture-induced hyperplasia

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29
Q

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’

A

Mucous membrane pemphigoid

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30
Q

What is a ranula?

A

A mucocele of the sublingual gland and its draining ducts

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31
Q

What are the clinical features of shingles?

A

● Vascular eruption (unilateral)
● The infection heals but with scarring
● Skin or palate

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32
Q

What is the treatment for shingles?

A

● Antiviral therapy in cases that present within 48 hours of onset symptoms
● Acyclovir, valacyclovir, famciclovir

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33
Q

Where would glossophayngeal neuralgia be experienced?

A

The ear, base of the tongue, tonsillar fossa and/or beneath the angle of the jaw

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34
Q

Name this lesion

A

Angular cheilitis

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35
Q

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

A

Geographic tongue (inflammatory)

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36
Q

What are the three types of trigeminal neuralgia?

A
  1. Classical trigeminal neuralgia
  2. Secondary trigeminal neuralgia
  3. Idiopathic trigeminal neuralgia
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37
Q

What can a GDP prescribe for replacement of saliva in cases of dry mouth?

A
  • Artificial saliva spray (oral, protective or substitute)
  • Artificial saliva gel
  • Gel mouth spray
  • Moisturising gel
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38
Q

What are the clinical features of chickenpox?

A

● Maculopapular skin rash
● Lesions may be preceded or accompanied by small ulcers (<5mm)
● Skin or palate

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39
Q

What is the first-line treatment for trigeminal neuralgia?

A

Carbamazepine (tegretol)

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40
Q

Name this tumour

A

Pleomorphic adenoma

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41
Q

What causes lymphomas?

A

Exposure to toxic chemicals, high dose radiation or immunodeficiency

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42
Q

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’

A

Discoid lupus erythematosus (auto-immune)

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43
Q

Name this lesion

A

Median rhomboid glossitis

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44
Q

What is the treatment for Fordyce spots?

A

No treatment is needed

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45
Q

What are aphthous ulcers associated with?

A

Aphthous stomatitis

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46
Q

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

A

Erythroplakia

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47
Q

What is orofacial granulomatosis?

A

Inflammation in the orofacial region associated with sensitivity to foodstuffs, especially: benzoates and cinnamon

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48
Q

Name this lesion

A

White Sponge Naevus (inherited)

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49
Q

What usually causes chronic erythematous candidiasis/denture stomatitis?

A

Occurs usually in patients who wear an upper denture and is caused by inflammatory changes in underlying mucosa

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50
Q

Name this idiopathic lesion

A

Sialolith (salivary stones)

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51
Q

Name this traumatic lesion

A

Traumatic keratosis

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52
Q

What types of HSV are associated with primary herpetic gingivitis?

A

Type I and II

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53
Q

What is the treatment for sialadenitis?

A

No treatment is needed

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54
Q

What virus causes hand, foot and mouth?

A

Coxsackie virus

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55
Q

What should you do if you see minor aphthous or herpetiform ulcers?

A

Blood test to check for any underlying causes

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56
Q

Name this lesion

A

Pseudomembranous candidiasis (oral thrush) - fungal

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57
Q

What % of the population of Europe and North America have herpes?

A

60%

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58
Q

What are the risk factors of erythroplakia?(5)

A

● Tobacco
● Alcohol
● Haematinic deficiency
● Chronic trauma
● Age (middle aged-elderly)

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59
Q

What is the treatment for papillomas?

A

Surgical Excision

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60
Q

What are pleomorphic adenomas derived from?

A

The neoplastic transformation of salivary acinar-type cells and myoepithelial cells

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61
Q

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

A

Chronic Erythematous Candidosis/Denture Stomatitis

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62
Q

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

A

Ranula

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63
Q

What is the treatment for pleomorphic adenomas?

A

Surgical excision
Potential for malignant transformation if left untreated

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64
Q

What type of margin is a red flag for malignancy?

A

Rolled

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65
Q

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

A

Lipoma

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66
Q

What is the treatment for discoid lupus erythematosus?

A

● Immunosuppressants
● Antiseptic mouthwash
● Betamethasone mouthwash
● Topical steroids

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67
Q

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

A

Herpetiform ulcers

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68
Q

Name this lesion

A

Nicotinic Stomatitis

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69
Q

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

A

Acute Erythematous Candidiasis

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70
Q

Name this fungal lesion

A

Chronic hyperplasic candidiasis

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71
Q

How does chronic hyperplastic candidiasis occur?

A

The present candida infection complicates epithelial dysplasia (abnormal growth)

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72
Q

What is hairy leukoplakia cased by?

A

The Epstein Barr Virus (HPV4) as it infects the keratinocytes in the mucosa

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73
Q

Name this lesion (hint - it is associated with RAS)

A

Herpetiform ulcers

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74
Q

What is the treatment for traumatic keratosis?

A

● Remove the source of trauma
● Biopsy to rule out neoplastic inflammatory process

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75
Q

What are the 6 groups of orofacial pain according to International Classification of Orofacial Pain (ICOP)(2020)?

A
  1. Dentoalveolar/anatomy related pain
  2. Myofascial pain
  3. TMJ pain
  4. Cranial nerve related pain
  5. Resemble headaches
  6. Idiopathic pain
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76
Q

Which type of biopsy only removes a portion of the tumour/lesion?

A

Incisional

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77
Q

What are the three members of the idiopathic orofacial pain group according to the International Classification of Orofacial Pain (ICOP)(2020)?

A
  1. Burning mouth syndrome (BMS)
  2. Persistent idiopathic facial pain
  3. Persistent idiopathic dentoalveolar pain
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78
Q

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

A

Pseudomembranous candidiasis (oral thrush) - fungal

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79
Q

Name this lesion

A

Chronic Erythematous Candidiasis/Denture Stomatitis

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80
Q

Name this lesion

A

Adenoid cystic carcinoma

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81
Q

What is secondary trigeminal neuralgia caused by?

A

An underlying disease e.g. multiple sclerosis and space occupying lesions (tumours and cysts)

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82
Q

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

A

Primary

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83
Q

What is xerostomia?

A

A sensation of oral dryness

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84
Q

What disease causes ulcerations like this and also genital ulceration?

A

Bechet’s disease

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85
Q

What is the treatment for chickenpox?

A

Bed rest and patience

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86
Q

Name this lesion

A

Leukodema (congenital)

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87
Q

What is hypoalgesia?

A

The reduction in response to a stimulus which would normally cause pain

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88
Q

How does primary herpetic gingivitis happen?

A

The HSV virus affects the epithelial cells to produce intraepithelial blisters

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89
Q

What is the main difference between Herpes-Zoster trigeminal neuropathies and Post-Herpetic trigeminal neuropathies?

A

Herpes-Zoster type has been there less than three months, post-herpetic has been there longer than 3 months

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90
Q

Define Erythroplakia

A

A red patch or plaque on oral mucosa that cannot be rubbed off and cannot be characterised as any specific disease

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91
Q

What are the two main classification systems for orofacial pain?

A

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)

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92
Q

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

A

Angular cheilitis

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93
Q

What causes traumatic keratosis?

A

Occurs secondary to physical, frictional, chemical and/or thermal irritation

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94
Q

Name this congential lesion from its clinical findings:
● Asymptomatic
● Diffuse
● Grey/white
● Biateral
● +/- wrinkling/corrugation
● Does not rub off
● Disappears when stretched
● Buccal mucosa

A

Leukodema

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95
Q

What are herpetiform ulcers associated with?

A

Recurrent aphthous stomatitis (RAS)
NOT HERPES

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96
Q

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

A

Hand, foot and mouth disease

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97
Q

What percentage of the population are affected by erosive lichen planus?

A

1-2%

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98
Q

What are the main dental procedures that can pre-dispose a patient to the onset or osteoradionecrosis?

A

Tooth extraction, perio disease, peri-apical infections

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99
Q

What is the treatment for median rhomboid glossitis?

A

Systemic antifungals

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100
Q

What are the risk factors of squamous cell carcinoma (SCC)?(9)

A

● Tobacco
● Betel nut/areca nut
● Alcohol
● Iron deficiency
● Vitamin A deficiency
● Vitamin C deficiency
● Fungal infection
● Stress
● HPV 16

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101
Q

What is classic trigeminal neuralgia caused by?

A

Neurovascular compression

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102
Q

Name this lesion

A

Amalgam tattoo (traumatic)

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103
Q

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

A

Paget’s disease

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5
Perfectly
104
Q

What are the three main ways to manage dry mouth?

A
  1. Stimulation
  2. Replacement
  3. Prevention
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105
Q

What are the risk-factors for leukoplakia?

A

● Tobacco
● Alcohol
● Invasive candida infection
● Haematinic deficiency
● Chronic trauma
● Middle aged and elderly

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106
Q

What does a score of 7-10 mean on the Challacombe scale?

A

Severe dryness and you need t assess the cause and exclude Sjogren’s syndrome

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107
Q

What causes fibrous epulis?

A

Chronic irritation

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108
Q

Name this lesion (hint - it is associated with a virus)

A

Primary Herpetic Gingivitis (associated with the herpes simplex virus)

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109
Q

What is dysesthesia?

A

An unpleasant abnormal sensation affecting the skin or mucosa e.g. burning, tingling, crawling, stinging, pain

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110
Q

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

A

Erythema Multiforme

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111
Q

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

A

Lichenoid reaction

112
Q

What causes denture-induced hyperplasia?

A

An ill-fitting denture

113
Q

What is the treatment for cheek biting?

A

No treatment is needed

114
Q

What are the three subgroups of trigeminal neuropathies?

A
  1. Attributed to Herpes Zoster Virus
  2. Post-herpetic
  3. Post-traumatic
115
Q

What is sialadenosis?

A

A non-inflammatory, non-neoplastic swelling of the major salivary glands

116
Q

What is the malignant transformation rate of leukoplakia?

A

8-22%

117
Q

Name this lesion

A

Mucocele

118
Q

What is sialadenitis?

A

Inflammation of the salivary glands that causes pain, redness and swelling

119
Q

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

A

Major aphthous ulcer

120
Q

Name this lesion

A

Linea Alba (traumatic)

121
Q

What is the treatment for erosive lichen planus?

A

Antiseptic mouthwash
Topical steroid therapy (prednisolone or betamethasone)

122
Q

Name this idiopathic lesion

A

Melanotic macule

123
Q

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)

A

Minor aphthous ulcer

124
Q

What is an adenoid cystic carcinoma?

A

A malignant tumour of the salivary glands that accounts for around 25% of carcinomas occurring in the salivary glands

125
Q

Why may you do an excisional biopsy for amalgam tattoos?

A

To eliminate melanocytic neoplasia

126
Q

Name this traumatic lesion

A

Pyogenic granuloma

127
Q

What is Paget’s disease?

A

A chronic, slow progressive disorder of bone metabolism that leads to excessive resorption and deposition of bone

128
Q

What virus are papillomas associated with?

A

The human papillomavirus (HPV).

129
Q

Name this traumatic lesion from its clinical findings:
● Asymptomatic
● Macules/slightly raised lesions
● Blue/black/grey
● Well defined borders/irregular/diffuse

A

Amalgam tattoo

130
Q

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

A

Pemphigus (autoimmune vesiculobullous)

131
Q

Other than carbamazepine, what can a GDP prescribe to help with trigeminal neuralgia?

A
  • Lidocaine nasal spray
  • Lidocaine Ointment
  • Lidocaine Infiltration/Block
132
Q

How does HSV spread?

A

Through saliva

133
Q

What are adenoid cystic carcinomas derived from?

A

The neoplastic transformation of salivary acinar-type cells and myoepithelial cells

134
Q

What is the treatment for orofacial granulomatosis?

A

● Avoid benzoates and cinnamon
● Steroids (to reduce swelling)
● Patch test:
- Benzoic acids
- Benzoates
- Cinnamon
- Chocolate

135
Q

What is allodynia?

A

Pain in response to a stimulus which would not normally cause pain e.g. light touch in mechanical allodynia

136
Q

What is the treatment for angular cheilitis?

A

● Investigate for anaemia
● Miconazole cream applied to angles of the mouth 2x a day
- Contraindicated with warfarin and statins

137
Q

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

A

Epitheliolysis (oral mucosal peeling)

138
Q

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

A

Orofacial granulomatosis

139
Q

If you have signs of median rhomboid glossitis and a corresponding area of erythema (redness) on the palate, what does this indicate?

A

Chronic multifocal candidosis

140
Q

How are Addison’s Disease/Primary Adrenal lesions managed?

A

Systemically

141
Q

What is the malignant transformation of proliferative verrucous leukoplakia?

A

70-100%

142
Q

How do sialoliths (salivary stones) occur?

A

When there is a calcium deposition in an area of bacteria, mucus or ductal epithelial cells

143
Q

What is the treatment for denture-induced hyperplasia?

A

New/ease denture and excision, may need biopsy to differentiate from SCC

144
Q

What is mucous membrane pemphigoid?

A

An autoimmune vesiculobullous disease in which the epithelium is separated from the connective tissues

145
Q

What type of oral presentation of syphilis is being described:
● Nasal deformity
● Hutchinson’s triad
● Screwdriver-shaped incisors
● Mulberry molars

A

Congenital - pregnant patient with primary or secondary syphilis can infect a developing foetus

146
Q

What % of the population is affected by geographic tongue?

A

1-2%

147
Q

Name this inflammatory lesion

A

Erythema Multiforme

148
Q

What is the aetiology of white sponge naevus?

A

Inherited - autosomal dominant

149
Q

What is Sialorrhea?

A

Excessive salivary flow

150
Q

What is the treatment for hand, foot and mouth?

A

● Bland mouthwash (e.g. sodium bicarbonate in warm water) or chlorhexidine mouthwash
● Analgesics if needed for pain relief

151
Q

What is the treatment for linea alba?

A

No treatment is needed

152
Q

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

A

Denture-induced hyperplasia

153
Q

What is Addison’s disease?

A

A metabolic autoimmune disease that causes adrenocortical insufficiency

154
Q

What scale is used to assess oral dryness?

A

Challacombe

155
Q

What is the treatment for lichenoid reactions?

A

● If medication is the cause, consult with GP about changing medication
● If amalgam is the cause, replace restoration

156
Q

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

A

Leukoplakia
- the mixed red/white are called speckled leukoplakia/erythroleukoplakia

157
Q

Name this lesion (hint - it is associated with RAS)

A

Minor aphthous ulcer

158
Q

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

A

Viral Sialadenitis

159
Q

What is the malignant transformation rate of submucous fibrosis?

A

7-30%

160
Q

Where does glossopharyngeal neuralgia spread to?

A

It does not only spread along the glossopharyngeal nerve but also the auricular and pharyngeal branches of the vagus nerve

161
Q

What is the treatment for primary herpetic gingivitis? (7)

A

● 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
Q

What is the treatment for mucous membrane pemphigoid?

A

● Steroid therapy
● Systemic prednisolone followed by topical maintenance
● Maybe azathioprine

163
Q

What is the treatment for adenoid cystic carcinomas?

A

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
Q

What is the treatment for leukoplakia?

A

● If there is no dysplasia, no treatment is needed
● Review and biopsy every 6 months as there is a high malignant transformation risk

165
Q

What is the treatment for viral sialadentitis?

A

● Rest
● Fluids
● Analgesia

166
Q

What is erosive lichen planus (on a cellular level)?

A

It is the T-lymphocyte mediated destruction of basal cell keratinocytes and hyperkeratinisation

167
Q

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

A

Pyogenic granuloma

168
Q

What is the treatment for acute erythematous candidiasis?

A

● Investigate for candidiasis
● If on steroid inhalers, advise rinse mouth after use
● Antifungals (e.g. fluconazole)
● Discontinue antibiotic therapy

169
Q

Name this lesion (hint - it cannot be wiped off)

A

Erythroplakia

170
Q

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

A

Mucocele

171
Q

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

A

Hairy leukoplakia

172
Q

What type of lymphadenopathy is a red flag for malignancy?

A

Cervical lymphadenopathy (enlarged (size more than 1cm), firm, fixed, tethered, non-tender)

173
Q

Name this autoimmune lesion

A

Pemphigus (autoimmune vesiculobullous)

174
Q

Where is carbamazepine metabolised?

A

Liver

175
Q

Name this lesion caused by metabolic disease

A

Addison’s Disease/Primary Adrenal

176
Q

What is bacterial sialadentitis?

A

Inflammation of the salivary glands that causes pain, redness and swelling caused by: staph aureus, strep viridans and strep pneumoniae (anaerobic bacteria)

177
Q

Name this traumatic lesion from its clinical findings:
● Asymptomatic
● White line at level of occlusal plane
● Buccal mucosa

A

Linea Alba

178
Q

What is syphilis?

A

An STD that usually occurs on genitals but also presents on lips or oral mucosa as a result of oro-genital contact

179
Q

What is the treatment for pemphigus?

A

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
Q

What is the treatment for herpetiform ulcers?

A

● 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
Q

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

A

Trigeminal neuralgia

182
Q

What is epitheliolysis?

A

Oral Mucosal peeling

183
Q

Which type of biopsy removes the entire tumour/lesion?

A

Excisional

184
Q

What is the treatment for lipomas?

A

Surgical excision

185
Q

What is the role of the GDP for trigeminal neuralgia?

A
  • Diagnose
  • Initiate medical management with GP
  • Refer
186
Q

In what patients is sialorrhea most common?

A

Parkinson’s Disease

187
Q

What is viral sialadentitis?

A

inflammation of the salivary glands that causes pain, redness and swelling caused by the paramyxovirus and is transmitted in saliva

188
Q

What is the treatment for nicotinic stomatitis?

A

Smoking cessation

189
Q

Name this lesion (hint - look at what it is next to)

A

Lichenoid reaction (inflammatory reaction to drugs or materials)

190
Q

What are lichenoid reactions caused by?

A

Hypersensitivity to materials or drugs

191
Q

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

A

Sialolith (salivary stones) - the stone ultimately causes a blockage of the salivary duct that cause the majority of these findings

192
Q

What is the treatment for a ranula?

A

Excision under GA

193
Q

Define Leukoplakia

A

Leukoplakia is a white patch that cannot be rubbed off and cannot be characterised clinically as any specific disease.

194
Q

What are the management options for idiopathic facial pain and dentoalveolar pain?

A

● 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
Q

What is hyperesthesia?

A

The increased cutaneous/mucosal sensitivity to a stimulus e.g. touch, temperature changes

196
Q

For a diagnosis idiopathic orofacial pain, how frequent does the pain need to be?

A

More than 2 hours a day for more than 3 months

197
Q

What type of colour lesion is a red flag for malignancy?

A

Speckled (erythroleukoplakia)

198
Q

What are sialoliths?

A

Salivary stones

199
Q

Name this lesion (hint - it cannot be wiped off)

A

Leukoplakia

200
Q

What causes discoid lupus erythematosus?

A

Basal cell damage

201
Q

What is erythema multiforme?

A

An acute inflammatory condition that is a hypersensitivity reaction to potential antigens including infectious agents (e.g. HSV, phenytoin, penicillin etc.)

202
Q

Name this lesion

A

Polyp

203
Q

Name this lesion based off its clinical findings:
● Rhomboidal shape
● Loss of papillae
● Erythema (redness)
● Middle dorsum of tongue
● May be associated with hyperplasia

A

Median rhomboid glossitis

204
Q

What is hyperalgesia?

A

An increased response to a stimulus which would normally cause pain e.g. cold in cold hyperalgesia

205
Q

Name this hereditary lesion based off its clinical findings?
● Asymptomatic
● White/grey spongy patches
● Deeply folded white lesion
● Occurs most commonly on buccal mucosa

A

White sponge naevus

206
Q

Name this lesion

A

Fordyce spots (congential)

207
Q

What condition does this patient have?

A

Paget’s disease

208
Q

Name this autoimmune lesion

A

Discoid lupus erythematosus

209
Q

What is submucous fibrosis?

A

Juxta epithelial inflammation and fibrosis of oral mucosa with progressive trismus

210
Q

What is a polyp?

A

A benign growth of mucosa associated with chronic irritation/trauma

211
Q

What are the clinical findings of squamous cell carcinoma?

A

● 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
Q

Name this lesion

A

Acute Erythematous Candidiasis

213
Q

What are the 2 subgroups of Orofacial pain associated to the cranial nerves according to the International Classification of Orofacial Pain (ICOP)(2020)?

A

Pain attributed to lesion or disease of the:
1. Trigeminal nerve
2. Glossopharyngeal nerve

214
Q

What is the treatment for fibrous epulis?

A

Excision

215
Q

Name this traumatic lesion

A

Cheek biting

216
Q

How long should traumatic ulcers take to heal once the source of trauma has been removed?

A

7-10 days

217
Q

What disease is erythema multiforme associated with?

A

Stevens-Johnson Syndrome

218
Q

What are lipomas primarily comprised of?

A

Adipocytes

219
Q

Name this inflammatory lesion

A

Fibrous epulis

220
Q

What does a score of 4-6 mean on the Challacombe scale?

A

Moderate dryness and further investigations may be required if cause is not clear

221
Q

What is carbamazepine?

A

An anticonvulsant used for epilepsy and bi-polar

222
Q

Name this lesion

A

Geographic tongue (inflammatory)

223
Q

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

A

Squamous cell carcinoma

224
Q

What are the clinical findings of traumatic keratosis?

A

Asymptomatic, white plaque that cannot be moved

225
Q

what percentage of oral malignancies do lymphomas account for?

A

less than 5%

226
Q

Name this auto-immune lesion?

A

Mucous membrane pemphigoid

227
Q

What is a melanotic macule?

A

An accumulation of melanin in epithelium and superficial connective tissues

228
Q

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

A

Chronic hyperplasic candidiasis

229
Q

When is a dose reduction indicated for carbamazepine when treating trigeminal neuralgia?

A

When the patient has been pain free for 4 weeks

230
Q

Name this congenital lesion from its clinical findings:
● Asymptomatic
● Multiple yellow/yellow/white papules
● Oral mucosa

A

Fordyce spots (congenital)

231
Q

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

A

Polyp

232
Q

What is the treatment for hairy leukoplakia?

A

● 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
Q

What does a score of 1-3 mean on the Challacombe scale?

A

Mild dryness

234
Q

What are the most common drugs to cause a lichenoid reaction?

A

Antihypertensives, hypoglycaemics and NSAIDs

235
Q

What is the treatment for geographic tongue?

A

● 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
Q

What percentage of post-menopausal women are affected by burning mouth syndrome?

A

18-33%

237
Q

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

A

Bacterial sialadentitis

238
Q

What is a mucocele caused by?

A

Trauma of a salivary gland duct which leads to the accumulation of saliva in the surrounding connective tissue

239
Q

What is the treatment for chronic erythematous candidiasis/denture stomatitis?

A

● 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
Q

Who is most likely to have nicotinic stomatitis?

A

Males who smoke

241
Q

What type of syphilis causes this?

A

Congenital

242
Q

Name this lesion

A

Papilloma

243
Q

What is the treatment for Paget’s disease?

A

Paget’s disease is incurable but bisphosphonates and calcitonin are used to control excessive osteoclastic activity

244
Q

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

A

Nicotinic Stomatitis

245
Q

Name this lesion

A

Ranula

246
Q

What is the treatment for chronic hyperplasic candidiasis?

A

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
Q

Who is most likely to present with trigeminal neuralgia?

A

50-60 year old females

248
Q

What is the treatment for pseudomembranous candidiasis (oral thrush)?

A

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
Q

Which is more common: trigeminal neuralgia or glossopharyngeal neuralgia?

A

Trigeminal neuralgia

250
Q

What causes amalgam tattoos?

A

When amalgam gets into the soft tissues

251
Q

Name this lesion

A

Epitheliolysis (oral mucosal peeling)

252
Q

What is the treatment for bacterial sialadentitis?

A

● Antibiotic therapy (clindamycin, metronidazole)
● Pain relief from NSAIDs
● Hydration

253
Q

Why might the varicella zoster virus reactivate?

A

Immunosuppression (e.g. malignancy, drugs or HIV)

254
Q

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

A

Glossopharyngeal neuralgia

255
Q

What is the 5 year survival rate for squamous cell carcinoma?

A

40% (site dependant)

256
Q

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

A

Pleomorphic adenoma

257
Q

What does Paget’s disease lead to?

A

Excessive resorption and deposition of bone

258
Q

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

A

ANUG (Acute necrotising ulcerative gingivitis) - or whatever the word for it is now

259
Q

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

A

Primary herpetic gingivitis

260
Q

How long does it take for the malignant transformation to occur with proliferative verrucous leukoplakia?

A

Around 23 month

261
Q

What is the treatment for a melanotic macule?

A

No treatment is needed but you can do an excision for aesthetic reasons

262
Q

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

A

Cheek biting

263
Q

What is the treatment for erythema multiforme?

A

Symptoms often resolve spontaneously after 10-14 days. However, if there are recurrences within 2-3 years:
● Antiseptic mouthwash
● Oral prednisolone
● Hydration

264
Q

Name this lesion (hint - it is associated with RAS)

A

Major aphthous ulcer

265
Q

Name this lesion based on its clinical description:
● Asymptomatic
● Can get traumatised
● Pedunculated or sessile
● Can occur anywhere but often palate, tongue, lips

A

Papilloma

266
Q

What is Sjogren’s Syndrome?

A

A systemic autoimmune disease that affects exocrine glands that causes a deficiency in saliva, tears, skin lubrication, and other exocrine secretions

267
Q

What type of lichen planus is this?

A

Erosive lichen planus

268
Q

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

A

Secondary

269
Q

Name this lesion

A

Squamous cell carcinoma

270
Q

What are pyogenic granulomas associated with?

A

Pregnancy

271
Q

What is the treatment for amalgam tattoos?

A

No treatment is needed but you can do an excisional biopsy/radiographs if you want to eliminate melanocytic dysplasia

272
Q

What is the treatment for leukodema?

A

No treatment is needed

273
Q

What can a GDP prescribe for stimulation of saliva in cases of dry mouth?

A

● 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
Q

What is the malignant transformation rate of erythroplakia?

A

5-10%

275
Q

What is the treatment for Sialoliths (salivary stones)?

A

Small stones: can be manipulated into the duct opening
Big stones: ultrasound guided basket retrieval or endoscopy guided surgery

276
Q

What is the treatment for pyogenic granulomas?

A

Surgical excision

277
Q

What is the treatment for minor and major aphthous ulcers?

A

● 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

Dentistry (7 decks)

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