Oral Medicine in Primary Dental Care

Question 1

what conditions is taking an oral rinse helpful for

Answer 1

suspected cases of altered taste ,dry mouth, burning mouth syndrome

Question 2

what are the routine haematological investigations

Answer 2

full blood count
vitamin B 12
ferritin
folate
HbA1c

Question 3

what do the presence of antibodies anti-ro and anti-la suggest

Answer 3

sjogrens

Question 4

what does the presence of antibody ANA suggest

Answer 4

systemic lupus erythematous

Question 5

what does the presence of RF antibody suggest

Answer 5

rheumatoid arthritis

Question 6

what questions should we ask about ulcer history

Answer 6

is it painful
how many
how long
which sites in mouth
suffered from similar ulcers?
started any new drugs?

Question 7

if a patient gives a history of previous ulceration what further questions need to be asked

Answer 7

at which sites
how long to heal
how many at one time
does it happen at other body sites
aware of predisposing factors
do you have any allergies

Question 8

what is the treatment of a traumatic ulcer

Answer 8

remove any persistent traumatic factor
chlorhexidine 0.2%

Question 9

what does minor RAS present as

Answer 9

small ovoid or circular lesions affecting non-keratinised sites in anterior oral cavity

Question 10

what does major RAS present as

Answer 10

<1cm in diameter affecting posterior part of mouth and involve keratinised mucosa

Question 11

what does herpetiform RAS present as

Answer 11

multiple small round ulcers which can coalesce to form larger areas of irregular ulceration

Question 12

how do you manage RAS in primary dental care

Answer 12

history
chlorhexidine 0.2% or benzydamine 0.15% 3x daily
diet advice
avoid SLS
review after 4 weeks

Question 13

if after 4 weeks there is no improvement of RAS what do you do

Answer 13

doxycycline 100mg broken into 10ml water used as mouthwash for 2mins 3x daily
beclometasone MDI 2x daily

Question 14

if after 8 weeks from initial appointment there is no improvement of RAS what do you do

Answer 14

arrange haematological investigations with GMP
consider referral

Question 15

what bacteria is involved in necrotising gingivitis

Answer 15

anaerobic bacteria
fusobacterium species

Question 16

what is the management of necrotising gingivitis including antibiotic dose

Answer 16

debridement
metronidazole 400mg 3x daily for 3 days

Question 17

when does an ulcer require biopsy

Answer 17

if it fails to respond to initial treatment within 2-3 weeks

Question 18

if there are lots of small ulcers on a keratinised part of mucosa on the posterior part of the mouth what disease could this be

Answer 18

herpes simplex virus

Question 19

what is the oral clinical presentation of erythema multiforme

Answer 19

rapid onset of extensive oral ulceration with blood crusted lips

Question 20

what is angular cheilitis characterised by

Answer 20

erythema, soreness and ulceration occurring at the angle of the mouth
yellow crusting

Question 21

what should be in the differential diagnosis of angular cheilitis

Answer 21

recurrent herpes labialis
lichen planus

Question 22

what is the common microorganisms found in angular cheilitis

Answer 22

candida species like candida albicans
staph aureus

Question 23

what tests should be done for angular cheilitis

Answer 23

swab or smear of angle of mouth
swab of anterior nares
swab or imprint of palate
swab or imprint of fitting surface of upper appliance

Question 24

what is the management of angular cheilitis in primary dental care

Answer 24

provide topical antimicrobial agent to erythematous tissues and potential source of infection
improve hygiene

Question 25

what is it called when there is an erythematous pattern where the upper appliance is usually worn

Answer 25

chronic erythematous candidosis

Question 26

how is chronic erythematous candidosis treated

Answer 26

apply sugar free miconazole oromucosal gel to fitting surface of appliance four times a day

Question 27

what can a patient with denture stomatitis soak their denture in for a short term period to clear candidal infection

Answer 27

chlorhexidine

Question 28

who is acute erythematous candidosis seen in

Answer 28

patients who use steroid inhaler

Question 29

how do steroids cause candida

Answer 29

they suppress host defence system locally and promote candidal colonisation within certain areas of the mouth

Question 30

what should you tell a patient with a steroid inhaler to do

Answer 30

rinse after using inhaler or use a spacer

Question 31

what is geographic tongue characterised by

Answer 31

areas of erythema surrounded by white margins on the dorsum of tongue

Question 32

what can the symptoms of geographic tongue be

Answer 32

discomfort on eating hot or spicy foods

Question 33

how do you manage geographic tongue

Answer 33

reassure it is non-serious no treatment really dispersible form of zinc sulphate at dose of 125mg dissolved in 10ml of water used as mouthwash for 2 mins three times daily for 3 months

Question 34

if someone has a nutritional deficiency what does the oral mucosa appear like

Answer 34

erythematous tongue depapillated and painful angular cheilitis and RAS

Question 35

what does erythroleukoplakia mean

Answer 35

speckled red and white appearance

Question 36

what is white sponge naevus

Answer 36

developmental condition affecting males and females

Question 37

what does pseudomembranous candidosis look like

Answer 37

white patch which can be scraped off with underlying erythema

Question 38

what is the treatment for pseudomembranous candidosis

Answer 38

systemic fluconazole

Question 39

what is chronic hyperplastic candidosis

Answer 39

candida occurring bilaterally in commissure region as homogenous or speckled lesions

Question 40

how do you treat chronic hyperplastic candidosis

Answer 40

systemic fluconazole smoking cessation

Question 41

what is seen in the histopathology of chronic hyperplastic candidosis

Answer 41

candida hyphae

Question 42

what is the management of lichen planus in primary dental care

Answer 42

steroid preparation e.g., beclomethasone MDI 2x daily or betamethasone 0.5mg tablets in 10ml used 3x daily consider fluconazole to eradicate secondary candidosis

Question 43

if there is no improvement of lichen planus after 4 weeks of topical steroid treatment what do you do

Answer 43

refer to oral medicine

Question 44

what can cause a lichenoid reaction

Answer 44

contact with restorative material or adverse event with systemic drug therapy

Question 45

what is the difference in pattern of lichen planus and lichenoid reactions

Answer 45

lichen planus is bilateral lichenoid reactions occur asymmetrically

Question 46

what drugs most commonly cause lichenoid reactions

Answer 46

NSAIDS ACE inhibitors beta blockers

Question 47

what viral infection is responsible for primary herpetic gingivostomatitis

Answer 47

HSV type 1

Question 48

What is the presentation of primary herpetic gingivostomatitis

Answer 48

widespread oral ulceration blistering of lips pyrexia

Question 49

what is the management of primary herpetic gingivostomatitis in primary dental care

Answer 49

aciclovir oral suspension 200mg in 5mL 5x/day for 5 days use chlorhexidine 0.2% to reduce bacterial infection dont touch lesions encourage fluids

Question 50

what is the treatment for recurrent herpes labialis (cold sore)

Answer 50

aciclovir 5% cream applied topically

Question 51

what treatment is offered for erythema multiforme

Answer 51

chlorhexidine dietary exclusion for persistent disease

Question 52

what is angina bullosa haemorrhagica

Answer 52

blister formation when eating and then it bursts

Question 53

what are the oral features of pemphigoid caused by

Answer 53

subepithelial blistering seen as ulceration or desquamative gingivitis

Question 54

what is the treatment for angina bullosa haemorrhagica

Answer 54

chlorhexidine

Question 55

what is the treatment for oral pemphigoid

Answer 55

topical corticosteroids like betamethasone for gingival lesions can use fluocinolone acetonide cream in vaccuum formed splint refer for systemic treatment if persistent

Question 56

what is the treatment of pemphigus

Answer 56

high dose prednisolone

Question 57

what are the oral features of pemphigus

Answer 57

non-specific mucosal erosions

Question 58

what is the treatment of squamous cell papilloma

Answer 58

simple excision

Question 59

what does a fibroepithelial polyp look like

Answer 59

rubbery and round

Question 60

what is a pyogenic granuloma

Answer 60

nodular red lesion that is ulcerated and bleeds easily on touch

Question 61

what are the clinical signs of OFG

Answer 61

facial or lip swelling angular cheilitis full width gingivitis oral ulceration mucosal tags cobble stoned appearance of buccal mucosa

Question 62

what is the management of ofg

Answer 62

exclusion diet for 3 months

Question 63

what is the treatment of sialadenitis when it produces pus

Answer 63

ensure drainage of gland using hot salty mouthwash and analgesia amoxicillin if required sialography after resolution

Question 64

what medications can give gingival hyperplasia

Answer 64

phenytoin nifedipine oral contraceptives

Question 65

what does addisons disease (raised ACTH) present like in the mouth

Answer 65

diffuse mucosal pigmentation due to addison's disease

Question 66

what is the treatment for trigeminal neuralgia

Answer 66

carbamazepine 3x daily

Question 67

what does trigeminal neuralgia present like

Answer 67

unilateral intense stabbing pain along the trigeminal nerve lasting a few seconds

Question 68

what is the treatment of post herpetic neuralgia

Answer 68

aciclovir

Question 69

what are the 5 main causes of prolonged reduction of salivary production

Answer 69

drug induced diabetes autoimmune disease radiotherapy congenital absence of salivary glands

Question 70

what drugs can give a dry mouth

Answer 70

anticholinergic drugs like tricyclics

Question 71

what is the management of xerostomia in primary dental care

Answer 71

frequent sips of water saliva substitutes salivary stimulant OHI topical fluoride diet advice avoid smoking