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Flashcards in Oral mucosa and histology Deck (27)
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1

Important details to get when doing a history and why

Pre-exisiting/underlying conditions, medical history, medications, family history, chronic illnesses - all can affect oral presentations and management options

2

Special tests/investigations for oral medicine

Biopsy
Imaging
Sialometry (saliva)
Shirmers (eye)
Blood tests
Swabs/smears/oral rinses

3

Different types of oral samples

Biopsy
Aspirate
Plain swab
Rinse

4

What is an aspirate sample/how do you take it

Inject into an abscess/something similar and get some pus - better because keeps the bacteria in the natural environment.

5

Different types of biopsies and details

Fine needle aspirate
Core needle biopsy - similar to FNA but a bigger tissue sample
Incisional - when you don't have clear margins, don't know how to manage, large diffuse lesions.
Excisional - small, clear margins.
Punch biopsy - but gives you a circular sample which is hard to orientate

6

How to take a plain swab sample

If on dry tissue - moisten with saline solution
If on abscess/wet tissue - use dry

7

What kind of samples would you take of a pus lesion

Plain swab sample or fine needle aspirate

8

What kind of samples would you take for mucosal/skin lesions

Biopsy
Plain swab
Smear/rinse

9

What kind of biopsies are GDPs NOT meant to do

If malignant or pre-malignant lesion, bone biopsies

10

What is an abscess/how to diagnose

Pus filled cavity
Fluctuant swelling, painful.
No Xrays needed usually bc takes 7-10 days for it to show on xray. Can sometimes be shown as widening of PDL space and loss of lamina dura

11

Treatment of acute infections/abscesses - general/systemic

antibiotics. IV for systemically unwell/septic patients.
Broad range -> narrow when you've done cultures
Usually amoxicillin/metronidazole combo
NSAIDs, analgesics

12

Local measures for abscesses

Drainage;
- LA not into the abscess but on the mucosa overlying
- horizontal incision
- open and drain
Warm saltwater rinses for 24h after
Antibiotics to stop spread of infection
Remove cause

13

Microbial aetiology:
Dento-alveolar abscess

Black pigmented anaerobes/ anaerobic cocci e.g. Prevotella, Pepto-streptococcus
Eurobacteria
Fusobacteria
Spirochaetes e.g. treponema/ T. denticola

14

Periodontal abscess and Microbial aetiology

Periodontal pockets become occluded and infected/secondary infection of lateral periodontal cyst.

Xray will show radiolucency on lateral aspect of root

Tx = Drainage and debridement

Same bacteria as chronic periodontitis + candida

15

Streptococcal gingivostomatitis and Microbial aetiology:

Inflammation and pain of gingiva
Can cause fasciitis, rheumatic heart failure and tissue destruction
Treat w penicillin
Bacteria = Strep. pyogenes, viral and drug causes so needs lab sampling.

16

Acute ulcerative gingivitis and Microbial aetiology:

Ulceration, pain and destruction of interdental papilla. Halitosis, malaise, lymphadenopathy.

Microbes:
Anaerobic cocci, black pigmented anaerobes (prevotella) spirochaetes (treponema) fusobacteria. Worsened by smoking, stress, poor OH.
Needs debridement and antibiotics

17

Cancrum oris/Noma and Microbial aetiology:

South african and south asian. High mortality rate.
Usually preceded by ANUG, or previous illness/parasitic infection (measles, malaria, TB), malnutrition, immuno-suppression.

Prevotella, T. denticola, fusobacterium

18

TB in oral cavity and Microbial aetiology and investigations

cough, lymphadenopathy, ulcers on tongue, delayed healing after XLA and can have steomyelitis.
Investigations = Zeil Neilson stain of biopsy, Lowenstein Jenson culture, PCR/T cells serology and look at histology - giant cells, caseation, epithelioid granulomas.

19

Syphillis stages and effects on oral cavity

Caused by treponema pallidum spirochaetes.

Primary = ulcers, painless oedema, lymphadenopathy, lesions on lip or tongue.

Secondary = rashes on palm of hands and feet, lymphadenopathy, snail track ulcers on lip. 6 weeks after initial lesions heal

Tertiary = firm necrotic centre surrounded by inflammation on tongue, tonsils and palate. Leukoplakia on tongue which increases chance of oral cancer.

Congenital = concave incisor edge, multi-crowned molars.

20

Gonorrhoea in oral cavity

Neisseria gonorrhea.
Can affect any part of oral mucosa and pharynx.
Lymphadenopathy, ulcers, pseudo-membranes, pain, oedema.

21

Acintomycosis and Microbial aetiology:

Large lump under angle of mandible. Can be secondary to trauma e.g. broken jaw. Slow growing and walled off so needs drainage, debridement and antibiotics.

Caused by Acintomyces Oris and A. Isreali.

22

Acute bacterial sialadenitis - what it is, symptoms, microbial aetiology and treatment

ascending infection of parotid/Warton's duct. Can be due to blockage, or Sjogrens, drugs or infection.

Causes trismus, red painful swelling, pus released by duct. Unilateral.

Treat w antibiotics e.g. amoxicillin.

Bacteria = anaerobic strep, staph aureus.

23

Angular chelitis - what is it, treatment, causes

Fungal/bacterial infection at lip commissures (candida or opportunistic staph. aureus)

Caused by loss of vertical height, Vit B12/folate/iron deficiencies.

Treat using antifungals (miconazole, nystatin, fusidic acid) and treating underlying causes.

24

Complications of oro-facial infections - cavernous sinus thrombosis

Infection can drain into sinus surrounding pituitary gland and make the blood here thrombose.
Presents as chemosis (red eye), ptosis (dropping upper eyelid), proptosis (bulging eye) and no eye movement (opthalmoplegia)

25

When would orofacial infections need antibiotics

If systemic sign/spreading infection e.g. throat pain, lymphadenopathy. If chronic infection that is persistent despite drainage e.g ANUG, acintomycosis.

26

Why can broad spectrum antibiotics be bad

Kills all the bacteria and lets C. diff infect.

27

Why can antibiotics fail

- Not enough blood supply to the area/access to the area if it's been walled off or something blocking the area
- Poor patient compliance
- Antibiotic resistance or wrong antibiotic used.
- Too low dose
- Bacteriocidal in immunosuppressed patients instead of bacteriostatic.