Oral Medicine in Elderly

Question 1

What are the predominantly oral conditions in the elderly

Answer 1

lichen planes 
mucous membrane pemphigoid
herpes zoster
post herpetic neuralgia 
carcinoma
potentially malignant lesions
sore tongue
candidosis

Question 2

What are the predominantly cardiovascular conditions in the elderly

Answer 2

hypertension and ischemic heart disease
cardiac heart failure
temporal arteritis

Question 3

What are the predominantly respiratory conditions in the elderly

Answer 3

chronic bronchitis and emphysema

pneumonia

Question 4

What are the musculoskeletal conditions in the elderly

Answer 4

osteoarthritis
osteoporosis
paget’s disease

Question 5

What are the hematological conditions in the elderly

Answer 5

anaemia
chronic leukaemia
multiple myeloma

Question 6

What are the genito-urinary conditions in the elderly

Answer 6

urinary retention
urinary incontinence
prostatic hypertrophy and cancer
renal failure

Question 7

What are the neurological conditions in the elderly

Answer 7

poor vision
multi-infarct dementia
parkinsons disease
storkes
ataxia 
trigeminal neuralgia 
alzheimers disease

Question 8

What are the psychological conditions in the elderly

Answer 8

insomnia 
dependence on hypnotics
loneliness
depression
paranoia
acute confusional states
atypical facial pain

Question 9

What are other conditions seen in the elderly

Answer 9

nutritional deficiency
accidents
malignancies

Question 10

What is a hemangioma

Answer 10

collection of BV

looks like a red bump

Question 11

What is a fibroepithelial polyp

Answer 11

there is a bit of trauma and instead of healing properly there is a build up of tissue

can be sessile or on a stalk

Question 12

What is black hairy tongue

Answer 12

overgrowth of the surface of the tongue

commoner in those who smoked

Question 13

What is geographic tongue

Answer 13

looks like a map

10% find it sensitive

Question 14

What is atrophic glossitis

Answer 14

smooth and shiny tongue
uncomfortable
commonest cause if low iron or B12

Question 15

What are denture related problems

Answer 15

traumatic keratosis

frictional keratosis

Question 16

What is traumatic keratosis

Answer 16

trauma lines that run through white patch

need to take away the pressure

Question 17

What is frictional keratosis

Answer 17

trauma

keratinization around it to protect it

Question 18

What is speckled leukplakia

Answer 18

rare type of leukaplakia
can be unilateral or bilateral
more common in pipe smokers

premalignant lesion so must be followed up
linked to candidiasis

Question 19

What is sublingual keratosis

Answer 19

seen under tongue

Question 20

What is denture induced hyperplasia

Answer 20

results in flaps of tissue to protect itself

may see ulcers

Question 21

What’s denture stomatitis

Answer 21

often people don’t know they have it because its painless

there is an area of erythema that corresponds to the denture fitting surface is the candida hyphe burrow onto the surface of the mucosa and into the plastic of the denture

Question 22

What is angular cheilitis

Answer 22

often a staph element to it
check dentures to ensure no issue
take bloods for iron levels
for some elderly face sags and can get moisture into the skin folds creating irritation

Question 23

What is xerostomia often due to in the elderly

Answer 23

polypharmacy most common

radiotherapy

Question 24

What is a good test of xerostomia

Answer 24

use front of mouth mirror
does it stick to tongue?
if sticks then saliva quality is bad

Question 25

What is management of xerostomia

Answer 25

change medication salivary replacement salivary stimulants

Question 26

What are possible salivary replacements

Answer 26

saliva orthana glandosane biotene oral balance bioXtra

Question 27

What are possible salivary stimulants

Answer 27

chewing gum | glycerine and lemon

Question 28

What drugs can cause topical drug reactions

Answer 28

aspirin and iron can cause burns

Question 29

What drugs can cause lichen planus / lichenoid reactions

Answer 29

``` NSAIDs Beta blockers diuretics oral hypoglycaemics statins antimalarials sulphonamides ```

Question 30

What do bisphosphonates do

Answer 30

incorporated into skeleton inhibit bone turnover no repair of microdamage anti-angiogenic

Question 31

What are the non malignant use of bisphosphonates

Answer 31

``` osteoporosis paget's disease osteogenesis imperfecta fibrous dysplasia primary hyperparathyroidism osteopenia ```

Question 32

What are the malignant uses of bisphosphonates

Answer 32

``` multiple myeloma breast cancer prostate cancer bony metastatic lesions hypercalcemia of malignancy ```

Question 33

What are risk factors for MRONJ

Answer 33

``` extremes of age concurrent use of corticosteroids systemic conditions affecting bone turnover malignancy coagulopathies, chemotherapy radiotherapy duration of therapy previous diagnosis of MRONJ potency of drug invasive dental procedures denture trauma poor oral hygiene periodontal disease alcohol or tobacco use thin mucosa coverage ```

Question 34

How do we treat patients at risk fo MRONJ

Answer 34

advise patient of risk informed consent emphasize rarity of conditions don't discourage from meds

Question 35

What are patient advice for those at risk fo MRONJ

Answer 35

regular dental checks maintain good OH limit alcohol and stop smoking report any symptoms

Question 36

What is post herpetic neuralgia

Answer 36

previous episode of shingles constant burning sensation in dermatomal distribution resolves within 2 months may persist for 2 years or longer suicide risk incidence possibly reduced by antiviral therapyy and steroids

Question 37

What is tx for post herpetic neuralgia

Answer 37

``` antidepressants gabapentin carbamazepine topical capsaicin TENS ```

Question 38

What is medical management of trigeminal neuralgia

Answer 38

``` carbamazepine oxcarbazepine gabapentin pregabalin lamotrigine sodium valproate phenytoin ```

Question 39

What can surgical management for trigeminal neuralgia split into

Answer 39

peripheral procedures | ganglion procedures

Question 40

What are the peripheral procedures for trigeminal neuralgia

Answer 40

cryotherapy injection of alcohol or glycerol neurectomy avulsion of nerve

Question 41

What are the ganglion procedures for trigeminal neuralgia

Answer 41

``` balloon compression radio frequency thermocoagulation alcohol or glycerol injection microvascular decompression gamma knife radiosrgery ```

Question 42

What other conditions should you consider for trigeminal neuralgia esp if in younger people

Answer 42

MS | space occupying lesion

Question 43

What is burning mouth syndrome

Answer 43

more common in females | very often underlying degree of depression and anxiety

Question 44

What are causes of burning mouth syndrome

Answer 44

``` most common is no cause psychogenic drugs (ACE or protease inhibitors) dry mouth candidosis hematinic deficiencies diabetes parafunctional acitivty denture factors hypothyroidism allergy ```

Question 45

What are the issues with burning mouth syndrome

Answer 45

may lead to malnutrition slow rehabilitation slow recovery reduce QoL