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MODULE 6 > ORAL MED - white patches > Flashcards

ORAL MED - white patches Flashcards

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1
Q

what is the aetiology of white sponge nevus?

A

hereditary but may also be sporadic

very rare

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2
Q

what are signs and symptoms of white sponge naevus?

A

asymptomatic
may feel rough

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3
Q

what are the clinical features of white sponge naevus?

A

white/greyish white patches which merge with the surrounding normal mucosa
firmly adherent
no erythema or ulceration
surface is folded, soft and spongy

affects any area of oral mucosa, very variable

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4
Q

other than the oral cavity, where else does white sponge naevus affect?

A

oesophagus
nasal
genital
ano-rectal mucosa
skin, nails, hair

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5
Q

what investigations are performed for white sponge naevus?

A

diagnosis made clinically and with family history
genetic testing for mutation - keratin 4 +/or 13

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6
Q

what is the management of white sponge naevus?

A

explanation of condition - not potentially malignant

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7
Q

what is the aetiology of leukoedema?

A

secondary to low grade mucosal irritation, causing intracellular oedema in superficial layers of epithelium

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8
Q

what are signs and symptoms of leukoedema?

A

asymptomatic

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9
Q

what are clinical features of leukoedema?

A

buccal and labial mucosa filmy white/grey appearance
soft on palpation

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10
Q

what investigations are performed for leukoedema?

A

diagnosis made on clinical grounds

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11
Q

what is management of leukoedema?

A

explanation of condition
advice - potential source of irritation

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12
Q

what is the aetiology of epitheliolysis (oral mucosal peeling)?

A

secondary to mucosal irritation by toothpaste, mouthwashes

sodium lauryl sulphate in toothpaste

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13
Q

what are signs and symptoms of epitheliolysis?

A

asymptomatic

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14
Q

what are the clinical features of epitheliolysis?

A

strands of gelatinous milky white material
removable by wiping
no abnormality to underlying tissue

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15
Q

what investigations are performed for epitheliolysis?

A

diagnosis normally made on clinical grounds

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16
Q

what is the management of epitheliolysis?

A

explanation of condition
avoidance of sodium lauryl sulphate containing products, cease mouthwash use

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17
Q

what is the aetiology of traumatic keratosis?

A

secondary to physical (frictional), chemical, thermal irritation

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18
Q

what are the signs and symptoms of traumatic keratosis?

A

asymptomatic
affected areas may feel rough or ridged to the tongue

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19
Q

what are the clinical features of traumatic keratosis?

A

white plaque not removed by rubbing/ scraping
may have a shaggy surface, appear macerated or be associated with ridging
clinical appearance should match cause

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20
Q

what investigations should be performed for traumatic keratosis?

A

diagnosis made on clinical grounds
biopsy if cause not clear

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21
Q

what is the management of traumatic keratosis?

A

explanation of condition
management/ removal of cause
if lesion does not resolve - biopsy

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22
Q

what causes stomatitis nicotina?

A

smoking related
60% pipe smokers
30% cigarette smokers

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23
Q

is stomatitis nicotina malignant?

A

not potentially malignant

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24
Q

what are clinical features of stomatitis nicotina?

Study These Flashcards
A

generalised white/ greyish white appearance on the hard palate extending onto soft palate

small red dots <1mm represent inflamed openings of minor salivary glands

25
what is the management of stomatitis nicotina?
smoking cessation
26
what is the aetiology of oral lichen planus/ lichenoid reaction?
unknown is 75% of cases 25% cases due to medication, dental materials
27
what conditions can mimic oral lichen planus?
lupus erythematosus graft vs host disease
28
what are signs of oral lichen planus/ lichenoid reactions?
any site affected tongue, cheek, and gingivae commonly affected usually bilateral if lichen planus palatal mucosa rarely affected but may be in lichenoid drug reactions can get a combination resulting in a mixture of white and red and ulcerated lesions
29
what is the clinical criteria for oral lichen planus?
bullous lesions are not localised exclusively to the sites of smokeless tobacco placement lesions are not localised exclusively adjacent to and in contact with dental restorations lesion onset does not correlate witht he start of a medication lesion onset does not correlate with the se of cinnamon-containing products
30
describe the appearance of reticular lichen planus?
lace like pattern bilateral
31
describe the appearance of papular lichen planus?
slightly raised small papules that can fuse together
32
what are the 2 presentations of gingival lichen planus?
desquamative gingivitis reticular/ plaque - white striations in sulus extending on to gingivae
33
describe the appearance of atrophic lichen planus?
tongue can lose all papilla
34
list the types of oral lichen planus
reticular papular gingival plaque atrophic bullous erosive, atrophic, and reticular - combinations can occur erosive, atrophic, plaque
35
describe the appearance of erosive (ulcerative), atrophic and reticular lichen planus
ulceration surrounded by atrophy surrounded by striations
36
list the range of symptoms that can occur for oral lichen planus/ lichenoid reaction
asymptomatic affected area may feel rough soreness only on eating - spicy, salty, acidic, rough, hot foods and tooth brushing soreness presented at all times exacerbated by factors symptoms tend to wax and wane in severity stress may be an exacerbating factor
37
what other sites can be affected by lichen planus/ lichenoid reaction?
skin scalp nails genital - vulvovaginal gingival lichen planus
38
what investigations are performed for oral lichen planus/ lichenoid reaction?
diagnosis made on clinical grounds if presentation is classical biopsy swab if suspect super-added candia blood test if associated disease suspected
39
what is the initial non-pharmacological management in primary care for oral lichen planus?
explanation of diagnosis ask if other site involvement and refer is necessary advise potentially malignant counsel - smoking cessation and alcohol baseline photographs consider referral to secondary care if concerns regard: - possible malignancy - diagnosis - ability to manage in primary care
40
what presentation of oral lichen planus is more likely to be malignant?
tongue involvement atrophic and erosive pattern
41
what medications are common culprits of lichenoid reactions?
antihypertensives - ACE inhibitors, beta blockers, CCBs, thiazide diuretics, loop diuretics methyldopa oral hypoglycaemics- tolbutamide, chlorpropamide NSAIDS - ibuprofen, naproxen, phenylbutazone
42
what restorative materials usually cause lichenoid reactions?
amalgam
43
what test can be performed for lichenoid reactions?
patch testing
44
what are the risk factors for malignant transformation in lichen planus/ lichenoid reactions?
tongue lesions, smoking, alcohol consumption, atrophic-erosive lesions, hepatitis C infection42 and female sex.
45
what mechanism underlies lichenoid reactions to restorative materials?
amalgam dental fillings and their interactions with the electrolytes in saliva
46
what is graft vs host disease and why does it cause lichen planus?
Graft-versus-host disease (GVHD) occurs due to the presence of immunocompetent T lymphocytes in the graft attacking the immunodeficient recipient tissue due to histocompatibility differences within 100 days, causing tissue damage
47
what other diseases are associated with lichen planus
hep C lupus erythematous
48
how does hairy leukoplakia present?
firmly adherent corrugated surface lateral border of tongue often super added candida uni or bilateral
49
what diseases is hairy leukoplakia associated with?
EBV (human herpes virus 4) HIV immunosuppressed pts pts using inhaled corticosteroids
50
what tests should be performed for hairy leukoplakia?
biopsy HIV test
51
what is the term for thrush?
acute pseudomembranous candidosis
52
what does thrush present as?
white patches removed by scaping leaving an erythematous/ bleeding base
53
what are underlying and/or systemic predisposing factors of thrush?
dry mouth steroid inhaler anaemia nutritional deficiency diabetes immunosuppressed extremes of age
54
what investigations are performed for thrush?
oral rinse - colony forming units (CFU) per ml of rinse (gold standard) saliva sample - CFU per ml of saliva imprint culture - CFU per mm2 mucosa swab - light or profuse growth sensitivity to antifungals can be carried out
55
when a pt presents with candidosis what do investigations look for?
underlying cuases; - FBC - serum B12, folate, ferritin - HbA1c - TSH
56
how does chronic hyperplastic candidosis present?
firmly adherent white plaques may be inter-mingles erythema and nodularity commisure/ anterior region of buccal mucosa bilateral may also affect tongue
57
what is a significant aetiological factor of chronic hyperplastic candidosis?
cigarette smoking
58
is chronic hyperplastic candidosis malignant?
no longer classified as potentially malignant

MODULE 6 (69 decks)

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