Oral Med Flashcards

Question

What could a cause of white or red patch be

Answer 1

White ➔ more keratin, hyperkeratosis Red ➔ atrophy, hyperaemia or loss of keratinisation

Answer 2

> 3-week duration > 50 years old Smoking High alcohol consumption History of oral cancer Non-homogenous Non-healing ulceration Induration Exophytic Tethering of tissue Tooth mobility Non-healing extraction sockets Difficulty speaking/swallowing Cervical Lymphadenopathy Weight loss/appetite loss/fatigue Numbness/altered sensation

Answer 3

Homogeneous leukoplakia: It is uniformly white, flat and thin, has a smooth surface, and may exhibit shallow cracks. Verrucous leukoplakia : The surface is raised, exophytic, wrinkled or corrugated

Answer 4

Difficult to predict which will progress to cancer 0.13 – 34%

Answer 5

if size >200mm If texture non-homogeneous If colour red or speckled If site FOM or tongue If dyspalsia is severe or high risk of dysplasia

Answer 6

Leukoedema White sponge nevus Frictional keratosis Chemical injury Acute pseudomembranous candidiasis Hairy leukoplakia Lichen planus (plaque-like variant) Lichenoid reaction (local factors and medications) Discoid lupus erythematosus

Answer 7

Thorough History, examination and System enquirey Exclude red flags Does it wipe away? Get photos Is there an obvious cause – correct it and review If there is no improvement or you are unsure of diagnosis, REFER Does this need a biopsy? – why do I need a biopsy? – confirm the diagnosis, exclude dysplasia?, exclude malignancy?

Answer 8

red patch or lesion

Answer 9

Atrophic lesion Localised/focal Well defined borders Velvety/red texture Can have a speckled appearance (Erythroleukoplakia) 'fiery red patch that cannot be characterised clinically or pathologically as any other definable lesion.’ Soft palate/buccal mucosa/floor of mouth are common sites Strong association with tobacco use

Answer 10

51% showed invasive carcinoma 40% carcinoma in situ 9% mild or moderate dysplasia 50% malignant transformation rate May have p53 mutation REFER URGENTLY to OMFS or Oral Medicine

Answer 11

Speckled red/white patches Heterogenous appearance Exists on a spectrum with red and white patches HIGHLY SUSPICIOUS for SCC or Severe Dy

Answer 12

Thorough History and examination Exclude red flags Get photos Is there an obvious cause – correct it and review Red patches or red-speckled patches have HIGH malignant potential If the red patch can’t be attributed to another cause, a biopsy is needed for an accurate diagnosis

Answer 13

Nociceptive – Normal physiological response, pain that arises from actual or threatened damage to non-neural tissue and is due to the activation of nociceptors Neuropathic – Lesion or disease of the somatosensory nervous system – TN is a NEUROPATHIC PAIN Nociplastic pain – It results in increased sensitivity from the altered function of pain-related sensory pathways in the periphery and central nervous system (Triggered by non-nociceptive stimuli)

Answer 14

A disorder characterized by recurrent unilateral brief electric shock-like pains, abrupt in onset and termination, limited to the distribution of one or more divisions of the trigeminal nerve and triggered by innocuous stimuli

Answer 15

classical secondary idiopathic

Answer 16

Stabbing, electric shock, scary, 10/10 pain, severe, will remember first episode

Answer 17

Sight -Unilateral, Mandibular/Maxillary distribution – usually one branch(60%) infrequently two (35%) Onset -Sponatenous onset, sometimes triggers, but not always Character -Sharp/electric shock like/10/10/worst pain ever/severe Radiation -Spread along branch of TN nerve, may have a focused starting point Associated features Distress, suicidal ideation, Time -Random. Short lived up to two minutes, multiple times a day, MAY have constant less severe background pain Exacerbating/relieving -Exacerbating: Cold wind, washing face/shaving/brushing teeth -Relieving: not moving face, avoiding triggers, Severity - 10/10

Answer 18

Eating Washing face Brushing teeth Eating Speaking Smiling Cold wind Temperature change Stress

Answer 19

Sensory motor defects Deafness Loss of balance Optic neuritis History of cranio-facial malignancy Bilateral TN Systemic symptoms < 30 years of age

Answer 20

Obtain accurate diagnosis, exclude dental/TMD pathology Consider commencing Carbamazepine, liaise with GP for blood monitoring – If you are unsure if carbamazepine is safe to prescribe call Oral Medicine for advice Consider Local anaesthetic if the patient is in extreme pain URGENT Referral To Oral Medicine/OMFS for definitive advice

Answer 21

10 day regimne 1 100mg tablet x2 daily send 20 Care in the elderly as increases falls risk, in those operating heavy machinery/driving/childcare due to blurring of vision and dizziness

Answer 22

MRI Scan All patients -Space occupying lesion -Multiple Sclerosis -Neurovascular conflict Medication Optimisation Use the lowest dose that controls symptoms -carbamazepine -oxcarbazepine -Lamotrigine -Baclofen -gabapentin -pregabalin in refractory cases Local anaesthetic in acute episodes

Answer 23

carbamazepine works by stabilising the electric signals in your nerves This stops the pain signals being sent to your brain

Answer 24

Microvascular decompression Neuro-ablative procedures e.g. balloon compression Stereotactic radiosurgery

Answer 25

persistent alteration to oral sensation, perceived to be abnormal and/or unpleasant in the absence of an identifiable local or systemic cause Prickling Burning Numb Tingling Shooting sensation

Answer 26

Objective numbness -Permanently lost sensation Unilateral symptoms Dysphagia Odynophagia Weight loss Loss of balance/hearing change Unexplained motor or other sensory changes

Answer 27

Exclude dental or mucosal cause for symptoms Explain no worrying features, but acknowledge the patient’s symptoms are real, describe the provisional diagnosis. Refer to OM and simultaneously ask GP to consider blood investigations Consider saliva substitutes and difflam

Answer 28

Antimuscarinic (anticholinergic) -Amitriptyline: 26% reduction Diuretics -Bendroflumethiazide: 10% reduction Lithium -70% have a significant reduction

Answer 29

Sprays -Glandosane -Saliva Orthana Lozenges/pastilles -Saliva Orthana (contains porcine mucin) -Salivix Salivary stimulants -Pilocarpine (Salagen) Oral Care Systems/Gels -Biotene Oralbalance -Bioextra Gel -Xerostom

Answer 30

Obstruction -Something is stopping the saliva from leaving the gland Sialadenitis -Inflammation of the salivary glands Sialosis -Bilateral painless swelling Neoplasm Trauma and fluid -Oedema and blood Solid deposits -Protein build up (Amyloidosis) Intra-gland lymph node swelling

Answer 31

MEALTIME SYNDROME (pain and swelling in the salivary glands particularly during mealtimes) History -Pain history if needed -Ask if associated with eating/food -Coming and going or persistent -Swallowing problems -Bad taste or pus Clinical assessment -Extra-oral exam -Bimanual palpation of Floor of mouth -Express saliva from ducts Investigations -Lower occlusal x-ray +/- OPT to identify calcification – Primary care -Ultra-sound scan – Secondary care -Sialography – Secondary care

Answer 32

Painful parotid swelling Usually bilateral Sometimes can be a single gland No hyposalivation 10% have submandibular gland involvement Very rare to involve ONLY the submandibular gland Malaise, fever and feeling generally unwell, which likely precedes the parotid swelling Trismus Swelling will last approximately seven days

Answer 33

Diagnosis -Clinical grounds -Serum antibodies can be considered -Viral swab of saliva Management -THERE ARE NO SPECIFIC antivirals -Supportive therapy -Hydration -Analgesia -Pyrexia management -Isolation for 6-10 days may be advisable

Answer 34

Most common in parotid glands (parotitis) Typically unilateral Painful swelling Overlying erythema Pus from duct Trismus Pyrexia Cervical Lymphadenopathy Often secondary to salivary gland obstruction

Answer 35

Diagnosis -Clinical grounds -Pus swab for culture and sensitivities -Exclude pyrexia/sepsis Management -Antibiotics through GP or OMFS -First choice is flucloxacillin, erythromycin in penicillin-allergic patients -Airway management if needed -Manage causative factors when acute sialadenitis resolved

Answer 36

Facial palsy Sensory loss Pain Difficulty swallowing Trismus Rapid growth

Oral Med Flashcards

(61 cards)