Flashcards in Oral mucosa and histology Deck (27)
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
Special tests/investigations for oral medicine
Different types of oral samples
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.
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
How to take a plain swab sample
If on dry tissue - moisten with saline solution
If on abscess/wet tissue - use dry
What kind of samples would you take of a pus lesion
Plain swab sample or fine needle aspirate
What kind of samples would you take for mucosal/skin lesions
What kind of biopsies are GDPs NOT meant to do
If malignant or pre-malignant lesion, bone biopsies
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
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
Local measures for abscesses
- 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
Black pigmented anaerobes/ anaerobic cocci e.g. Prevotella, Pepto-streptococcus
Spirochaetes e.g. treponema/ T. denticola
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
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.
Acute ulcerative gingivitis and Microbial aetiology:
Ulceration, pain and destruction of interdental papilla. Halitosis, malaise, lymphadenopathy.
Anaerobic cocci, black pigmented anaerobes (prevotella) spirochaetes (treponema) fusobacteria. Worsened by smoking, stress, poor OH.
Needs debridement and antibiotics
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
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.
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.
Gonorrhoea in oral cavity
Can affect any part of oral mucosa and pharynx.
Lymphadenopathy, ulcers, pseudo-membranes, pain, oedema.
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.
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.
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.
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)
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.
Why can broad spectrum antibiotics be bad
Kills all the bacteria and lets C. diff infect.