Oral Medicine

Question 1

what are 3 viral causes of orofacial soft tissue infections

Answer 1

primary herpes
herpangina
hand foot and mouth

Question 2

what are the bacterial causes of orofacial soft tissue infections

Answer 2

staphylococcal
streptococcal
syphilis

Question 3

what is primary herpetic gingivostomatitis caused by

Answer 3

HSV 1

Question 4

what are the signs and symptoms of primary herpetic gingivostomatitis

Answer 4

fluid filled vesicles
severe oedematous marginal gingivitis
fever
headache
malaise
cervical lymphadenopathy

Question 5

how do you treat primary herpetic gingivostomatitis

Answer 5

bed rest
soft diet/hydration
paracetamol
antimicrobial gel or mouthwash
aciclovir for immunocompromised

Question 6

how long does primary herpetic gingivostomatitis last

Answer 6

14 days

Question 7

what is primary herpetic gingivostomatitis triggered by

Answer 7

sunlight
stress
other causes of ill health

Question 8

what causes herpangina and hand, foot and mouth

Answer 8

coxsackie A virus

Question 9

what is herpangina

Answer 9

vesicles in the tonsillar/pharyngeal region lasting 7-10 days

Question 10

what is hand, foot and mouth

Answer 10

ulceration on gingivae/tongue/cheeks and palate
maculopapular rash on hands and feet
lasts 7-10 days

Question 11

what are the 10 key facts of oral ulceration

Answer 11

onset
frequency
number
site
size
duration
exacerbating dietary factors
lesions in other areas
associated medical problems
treatment so far

Question 12

what are the causes of oral ulceration

Answer 12

infection
immune mediated disorders - crohns
vesiculobulbous disorders
inherited or acquired immunodeficiency disorders
neoplastic/haematological
trauma
vitamin deficiencies
recurrent aphthous stomatitis

Question 13

what do recurrent aphthous ulcerations look like

Answer 13

round or ovoid in shape with grey or yellow base

Question 14

what are the 3 patterns of recurrent aphthous ulcers

Answer 14

minor
major
herpetiform

Question 15

what are the aetiological factors for recurrent ulceration

Answer 15

hereditary predisposition
haematological and deficiency disorders
GI disease
minor trauma in susceptible individual
stress
allergic disorders
hormonal disturbance

Question 16

what investigations for recurrent ulcers

Answer 16

diet diary
FBC
haematinics
coeliac screen

Question 17

how do you manage recurrent ulcers

Answer 17

diet analysis
low ferritin - 3 months iron
low folate/B12 - refer to paediatrician

Question 18

what are exacerbating factors with ulcers

Answer 18

nutritional deficiencies
traumatic factors
sharp or spicy food

Question 19

what pharmacological managementfor ulcers is available in GDP

Answer 19

prevention of superinfection - corsodyl
protect healing ulcers - genigel topical gel
symptomatic relief - difflam spray/LA spray

Question 20

what is orofacial granulomatosis

Answer 20

non caseating giant cell granulomas which can either occur with or without crohns disease

Question 21

what are the clinical features of OFG

Answer 21

lip swelling
full thickness
swelling of non-labial facial tissues
peri-oral erythema
cobblestone appearance of buccal mucosa
liner oral ulceration
mucosal tags
lip/tongue fissuring
angular cheilitis

Question 22

what are investigations for OFG

Answer 22

measure growth
FBC
haematinics
patch testing
diet diary
faecal calprotectin

Question 23

how do you manage OFG

Answer 23

symptomatic relief for oral ulcers
dietary exclusion
manage nutritional deficiencies
topical steroids
oral steroids

Question 24

what is geographic tongue

Answer 24

shiny red areas on tongue with loss of filliform papillae surrounded by white margins

Question 25

what can geographic tongue cause in children

Answer 25

intense discomfort discomfort with spicy food/tomato or citrus fruit and juice

Question 26

how do you manage geographic tongue

Answer 26

bland diet during flare ups

Question 27

what are the 4 main types of solid swellings

Answer 27

fibroepithelial polyp epulides congenital epulis HPV associated mucosal swellings

Question 28

what is a fibroepithelial polyp

Answer 28

firm pink lump mainly in cheeks, lip or tongue which remains a constant size

Question 29

what is fibroepithelial polyp initiated by

Answer 29

minor trauma

Question 30

how do you cure fibroepithelial polyp

Answer 30

surgical excision

Question 31

what is epulides

Answer 31

common solid swelling of oral mucosa benign hyperplastic lesions

Question 32

what are the 3 main types of epulides

Answer 32

fibrous epulis pyogenic granuloma peripheral giant cell granuloma

Question 33

what is a fibrous epulis

Answer 33

pedunculated or sessile mass firm consistency similar colour to surrounding gingivae inflammatory cell infiltrate and fibrous tissue

Question 34

what is a pyogenic granuloma

Answer 34

soft deep red/purple swelling which is often ulcerated and can haemorrhage easily

Question 35

what is a peripheral giant cell granuloma

Answer 35

pedunculated or sessile swelling typically dark red and ulcerated arises interproximally and has an hour glass shape

Question 36

what is a congenital epulis

Answer 36

rare lesion in neonates in anterior maxilla granular cells covered with epithelium but it is benign

Question 37

what are the 2 types of HPV associated swellings

Answer 37

verruca vulgaris and squamous cell papilloma

Question 38

what is a verruca vulgaris

Answer 38

solitary or multiple intra oral lesions associated with skin warts most commonly on keratinised tissue but can be removed surgically

Question 39

what is a squamous cell papilloma

Answer 39

small pedunculated cauliflower like growths which are benign

Question 40

what are the 4 main types of fluid swelling

Answer 40

mucoceles ranula bohns nodules epstein pearls

Question 41

what are the two variants of mucocele

Answer 41

mucous extravasation cyst mucous retention cysts

Question 42

what is a ranula

Answer 42

mucocele but in floor of mouth

Question 43

what do ranulas arise from

Answer 43

minor salivary glands or ducts of sublingual/submandibular gland

Question 44

what investigations are needed for a ranula

Answer 44

ultrasound or MRI

Question 45

what are bohns nodules

Answer 45

gingival cysts filled with keratin on alveolar ridge remnants of dental lamina

Question 46

what are epstein pearls

Answer 46

small cystic lesions found along palatal mid line

Question 47

what is TMJDS characterised by

Answer 47

pain masticatory muscle spasm limited jaw opening

Question 48

what is the history for TMJDS

Answer 48

description of presenting symptoms when did discomfort begin pain worse at any time during the day exacerbating factors habits stress

Question 49

how do you examine TMJDS extraorally

Answer 49

palpation of muscles of mastication both at rest and when teeth clenched palpation of TMJ at rest and when opening and closing check for deviation of jaw extent of normal opening

Question 50

what is intraoral exam of TMJDS

Answer 50

assessment of dental wear facets signs of clenching/grinding - scalloped tongue/buccal mucosa ridges

Question 51

how do you manage TMJDS

Answer 51

explain condition reduce exacerbating factors bite raising appliance allow over worked muscles to rest - soft diet

Question 52

what is used for symptomatic relief of TMJDS

Answer 52

ibuprofen alternating use of hot and cold packs