oral medicine Flashcards
(39 cards)
What are possible oro-facial soft tissue infections
Viral
-Primary herpes
-Herpangina
-Hand foot and mouth
Bacterial
-Staphylococcal
-Streptococcal
-Syphilis
-TB
-Cat Scratch Disease
Fungal
-Candida
What is Primary hepatic gingivostomatitis
Its an acute Infectious disease caused by herpes Simplex Virus I
Primary infection common in children
Transmission by droplet formation with 7 day incubation period
Almost 100% of the adult population are carriers
lasts 14 days
What are S&S of Primary Herpetic Gingivostomatitis
Fluid filled vesicles
–rupture to painful ragged ulcers on the gingivae, tongue, lips, buccal and palatal mucosa
Severe oedematous marginal gingivitis
Fever
Headache
Malaise
Cervical lymphadenopathy
What is the treatment of PHG
Bed rest
Soft diet/hydration
Paracetamol
Antimicrobial gel or mouthwash
topical acyclovir cream for immunocompromised children
What is the most common complication with PHG
Dehydration
What is the recurrency of PHG
Recurrent disease in 50-75% = herpes labialis (cold sores)
As it remains dormant
Coxsackie virus can cause what 2 herpatic like infection
Herpangina
-Vesicles in the tonsillar/ pharyngeal region
-Lasts 7-10 days
Hand/ foot and mouth
-Ulceration on the gingivae/tongue/cheeks and palate
-Maculopapular rash on the hands and feet
-Lasts 7-10 days
What is oral ulceration
A localized defect in the surface oral mucosa where the covering epithelium is destroyed leaving an inflamed area of exposed connective tissue
What are the 10 key facts in oral ulceration history
-Onset
-Frequency
-Number
-Site
-Size
-Duration
-Exacerbating dietary factors
-Lesions in other areas
-Associated medical problems
-Treatment so far (helpful/unhelpful)
What are the causes of oral ulceration
Infection:
-Viral: Hand foot and mouth/ Coxsackie Virus/ Herpes Simplex/ Herpes Zoster, CMV, EBV, HIV
-Bacterial: TB, syphilis
Immune mediated Disorders:
-Crohns, behcets, SLE, Coeliac, Periodic fever syndromes
Vesiculobullous disorders:
-Bullous or mucous membrane pemphigoid, pemphigus vulgaris, linear IgA disease, erythema multiforme
Inherited or acquired immunodeficiency disorders
Neoplastic/Haematological:
Anaemia/Leukaemia/agranulocytosis/cyclic neutropenia
Trauma
Vitamin deficiencies – Iron, B12, Folate
Recurrent Apthous Stomatitis
What is the most common form of oral ulceration in children
Recurrent Apthous ulceration (RAU)
What do RAU’s look like and what are the 3 patterns
are round or ovoid in shape with a grey or yellow base and have a varying degree of perilesional erythema
3 patterns:
Minor - <10mm
Major - >10mm
Herpetiform – 1-2mm
What are posible aeitiology factors of recurrent ulceration
-Hereditary predisposition (FH in 45%)
-Haematological and deficiency disorders (iron Def in 20%)
-Gastrointestinal disease (Coeliac in 2-4%)
-Minor trauma in a susceptible individual
-Stress
-Allergic disorders
-Hormonal disturbance: Menstruation
When investigating ulceration what do you do
Initial Investigations:
-Diet diary
-Full Blood Count
-Haematinics (Folate/B12/Ferritin)
-Coeliac Screen: Anti-transglutaminase antibodies
What is the management of ulceration
Diet anaylsis may suggest exacerbating food groups
Low Ferritin = 3 months of iron supplementation
Low Folate/B12 or positive Anti-transglutaminase antibodies = referral to paediatrician for further investigation
Manage exacerbating factors:
-Nutritional deficiencies
-Traumatic factors
-Avoid sharp or spicy food
Manage pharmacologically:
-Prevention of Superinfection:
Corsodyl 0.2% Mouthwash
-Protect healing ulcers
Gengigel topical gel (hyaluronate)
Gelclair mouthwash (hyaluronate)
-Symptomatic relief
Difflam (0.15% benzydamine hydrochloride)
Local anaesthetic Spray
What is orofacial granulomatosis
Uncommon chronic inflammatory disorder
Idiopathic or associated with systemic granulomatous conditions (Crohn’s disease or Sarcoidosis)
What may OFG be a predictor for
Crohns
What are clinical features of OFG
-Lip Swelling on
-Full thickness gingival swelling
-Swelling of the non labial facial tissues
-Peri-oral erythema
-Cobblestone appearance of the buccal mucosa
-Linear oral ulceration
-Mucosal tags
-Lip/ tongue fissuring
Angular cheilitis
How would you manage OFG
-Oral hygiene support
-Symptomatic relief as per oral ulceration
-Dietary exclusion (does not cure just reduces orofacial inflammation)
-Manage nutritional deficiencies which may contribute to oral ulceration
-Topical steroids
-Topical tacrolimus
-Short courses of oral steroids (severe or unresponsive to topical)
-Intralesional corticosteroids
-Surgical intervention – unresponsive long standing disfigurement
What is geographic tongue
Mucosal lesions of the tongue
Its Idiopathic and non contagious
May be seen at a young age
Shiny red areas on the tongue with loss of filiform papillae are surrounded by white margins
Can cause intense discomfort in children
Discomfort with spicy food/ tomato or citrus fruit/juice
How would you manage Geo. tongue
Bland diet during flair ups
Give examples of solid swellings
Fibroepithelial Polyp
Epulides
Congenital epulis
HPV-associated mucosal swellings
Neurofibromas
What is a fibroepithelial polyp
-Common
-Firm pink lump (pedunculated or sessile)
-Mainly in the cheeks (along occlusal line); lips or tongue
-Once established remains constant size
-Thought to be initiated by minor trauma
-Surgical excision is curative
What is Epulides and what are the 3 main types
Common solid swelling of the oral mucosa
Benign hyperplastic lesions
3 main types:
-Fibrous epulis
-Pyogenic granuloma
-Peripheral giant cell granuloma
