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Oral Mucous diseases Flashcards

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1
Q

what medicines are used in oral med

A

anti virals - acyclovir
antifungals - nysatin, fluconazole
topical steroids
benzdamine mouthwash
carbamazepine

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2
Q

what is benzdamine mouthwash useful for

A

it is a non steroidal anti inflammatory, can provide analgesia for oral ulcers - make eating easier

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3
Q

what is a licensed medicine

A

a medicine that has been proven in evidence to the MHRA to be significantly effective at treating a disease - usually by clinical trial

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4
Q

what is an unlicensed medicine and give an example used in oral med

A

a medication that has not proven efficacy for the condition it is being treated for. It will be a licensed but for another condition, however, it doesnt mean it is not effective at treating the other condition. Just no evidence has been supplied. Inhaled steroid - beclomethasone

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5
Q

when supplying an unlicensed medicine what information must be given to patients

A

that it is being used for an unlicensed use - other medical conditions. But that it is proven to be effective at treating this condition
explain dose range and frequency of use
explain hazards of exceeding standard dose
explain possible side effects
add special instructions

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6
Q

what is the SDCEP guidance for steroid and non-steroid topical therapy in oral mucous lesions

A

non-steroid topical therapy should be used for inconvienent lesions with discomfort
steroid topical therapy should be used for disabling immunologically driven lesions

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7
Q

give examples of non-steroid topical therapy

A

chlorhexidine mouthwash
benzdamine mouthwash
OTC medication - igloo, listerine, bonjela

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8
Q

give examples of steroid topical therapy

A

hydrocortisone mucoadhesive pellet
betamethasone mouthwash
meclomethasone metred dose inhaler

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9
Q

how do hydrocortisone mucoadhesive pellets work

A

place over ulcer, then dissolves to form gel - covers the ulcer and releases hydrocortisone - concentrated in this are

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10
Q

how does the betamethasone mouthwash work and what should the patient be told about this

A

dissolve 2 0.5mg tablets in water, swirl around mouth and spit out. must be told to not swallow any mouthwash as it will have a systemic effect. there is also a small risk of oral candida

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11
Q

how does beclomethasone MDI work and why does it have to be a MDI

A

puffer is placed over ulcer and puffed twice - releases particles which are absorbed by tissue. Cannot be breathed activated device as would not be breathing into it

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12
Q

what mucosal lesion should a gdp refer

A

anything suspected to be cancer or dysplasia - cancer referral to hospital
any symptomatic oral lesions that cannot be controlled with SDCEP guidelines - prescribed all they can but symptoms not going away
any benign lesion that the patient cannot be convinced isnt cancer

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13
Q

what does orthokeratosis mean

A

thickening of stratum corneum layer of epithelium - in gingiva and hard palate where trauma is expected

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14
Q

what does parakeratosis mean

A

loss of non-nucleated cells in the epithelium, loss of stratum corneum

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15
Q

what layers make up epithelium

A

stratum basale, stratum spinosum, stratum granulosum, stratum lucidum and stratum corneum, and lamina dura

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16
Q

what are some reactive changes of the oral mucosa to disease in histology

A

keratosis - thickening of keratinised layer
acanthosis - hyperplasia of stratum spinosum
elongated rete ridges - hyperplasia of basal cells

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17
Q

what can be seen in the mucosa in response to disease or trauma

A

atrophy - loss of layers
erosive - partial thickness loss
ulcerative - fibrin on surface
oedema - within cells - intracellular or between cells - intercellular
blister - vesicle or bulla

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18
Q

what are common benign lesions of the tongue

A

hairy tongue, geographic tongue

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19
Q

what are symptoms of geographic tongue

A

sensitivity to acidic or spicy foods - due to thinning of epithelium

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20
Q

give an example of a type 3 hypersensitivity reaction

A

erythematous multiforme

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21
Q

give an example of antibody mediated reaction

A

pemphigoid, pemphigus

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22
Q

what is a systemic disease with local consequences

A

sjorgens syndrome, systemic scerlosis, pemphigoid

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23
Q

what is erythema multiforme, how does it present and how is it treated

A

antibody-antigen complex is large and wedges in capillaries, causes complement, results in inflammation. clinical signs include crusting of lips, vesicles/erosion around front of mouth, can include skin. very painful, can affect eating and drinking and result in dehydration. must be treated with immunosuppressants and can use acyclovir

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24
Q

what is angina bullous haemhorrhagica, how does it present and how is it treated

A

tight blood blisters, caused by trauma (eating or steroidal inhaler), normally asymptomatic but at vibrating line might be painful, burst after an hour, leave blood stained fluid and ulcer appearance. treated by treating symptoms - chlorhexidine mouthwash or difflam spray

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25
what is the immunology of pemphigoid
antibody attacking hemi desmosomes, causes epithelium to come away from basement membrane and CT, allows fluid and inflammatory exudate to flow in, produces large bullae, thick and full of epidermis
26
how does pemphigoid present clinically
multiple thick large bullae, normally persistant but if they burst, expose underlying connective tissue
27
how does pemphigoid present on immunofluorescent
biopsy should be taken from peri lesion tissue, immunofluorescent of linear along basement membrane, as antibody binds along here
28
how is pemphigoid treated
immunosuppressant to reduce antibody activity - prednisolone, azathioprine, mycophenolate, dapsone
29
what is the immunology of pemphigus
antibodys attack desmosomes, bind epithelial cells together, allows for separation of cells, intra epithelial fluid and bullae
30
how does pemphigus present clinically
very rarely presents with bullae, desquamative gingivitis - bullae have burst and epithelium has thinned out, erythematous, shedding of top layer
31
how does pemphigus present in immunofluorescence
basket weave appearance - desmosomes surround cells therefore antibody attacks on all surfaces - enclosed in green but only supra basal, not below BM
32
how is pemphigus treated
immunosuppressants and immune modulating medications - prednisolone, azathioprine, dapsone, mycophenolate
33
what is the role of saliva
IgA for immunity, antimicrobial, acidity buffering, lubrication
34
what are causes of a dry mouth
medication, radiotherapy, salivary disease, infection, anxiety
35
what medications can result in a dry mouth
tri-cyclic antidepressants - amytriptaline, diuretics - bendrofluazide lithium
36
what medical conditions can have an indirect effect on saliva
diabetes, renal disease, addisons disease, stroke
37
what medical conditions have a direct effect on saliva
ectodermal dysplasia, sarcoidosis, amyloidosis
38
how does HIV cause salivary gland enlargement
lymphoproliferative change into gland, reduces function but increases bulk
39
what are the parts in the challocombe scale of mucosal dryness
scale of severity of dryness part 1 - score 1-3 - mirror sticking to tongue or buccal mucosa, mild, sips of water and gum required - medication related 4-6 - glossy appearance of gingiva, reduced papillae of tongue, no saliva pooling - moderate - requires enhanced prevention 7-10 - debris sticking to teeth and palate, smooth mucosa, scarring of tongue - requires specialist input
40
what tests should be done when investigating salivary disease
FBC U&E's LFT antibody test - ro and la glucose test - diabetes functional assay test labial gland biopsy sialogram ultrasound
41
what is sialography and when should it be done
should be carried out when duct obstruction suspected but no stone seen in radiograph - could be mucous plug this investigates architecture of duct whilst washing it through - dislodging plug
42
how should subacute obstruction of salivary gland be managed
removal of sialoth if possible sialography if suspect mucous plug if fixed and painful - consider gland removal but only if benefit to the patient
43
what is sialosis and how does it differ from sjogrens
hyperplasia of gland tissue on biopsy - tissue normal just more of it doesnt normally cause dry mouth no symptoms associated - mild discomfort diagnosis of exclusion
44
what is sjogrens syndrome
an autoimmune disease affecting the acinar of salivary and lacrimal glands
45
what other diseases can be associated with sjogrens syndrome and what is the name for this
undifferentiated connective tissue disease - rheumatoid arthritis, SLE (lupus) and sclerodema
46
what components contribute to autoimmune disease
genetics, infection, diet and toxins
47
what are the classifications of sjogrens syndrome
primary - no other connective tissue disease, begins with sjogrens secondary - other connective tissue disease present which begins first
48
what are the consequences of sjogrens syndrome
increased caries risk, increased risk of infection, increased risk of lymphoma, difficulty swallowing
49
what must be present for an AECG diagnosis of sjogrens syndrome
must have at least 4 of the following oral symptoms - dry mouth ongoing for at least 3 months, use of water to aid swallowing, salivary gland involvement ocular symptoms - dry eyes ongoing for at least 3 months, use of tear replacement, sensation of sand or gravel in eye histology antibodies - ro or la ultra sound functional saliva test
50
what is the histology in sjogrens syndrome
50 lymphocytes surrounding ductal acinar - forms focus must have more than 1 focus for diagnosis
51
what is the ultrasound appearance of sjogrens
leopard spot - holes in gland where tissue is missing
52
what has the most weighting in the ACR-EULAR diagnosis of sjogrens
labial gland biopsy then anti-ro then swallowing test
53
how is a dry mouth managed
if the cause can be removed - should do so. I.e. medications removed or changed (anti-muscarinic), diabetes better control, increase hydration if not, salivary replacements used
54
name some salivary substitutes
glandosane, salivary orthana biotene gel and mouthwash lozenges, chewing gum
55
what tests can be done to check for crohns in OFG
faecal calprotectin
56
what test can be done to check for coeliac in ulcer patients
TTG
57
how should OFG be managed initially
consider if part of GI problem - crohns - calprotectin diet history - overuse of allergens - complete exclusion dietary trial topical treatment - miconazole for A.C., tacrolimus ointment intralesional steroid injection systemic treatment - azithromycin, prednisolone
58
what should be avoided in exclusion trial
benzoic acid sorbic acid cinnamon chocolate
59
what drives gingival lichen planus
plaque - requires good oral hygiene
60
what can gingival lichen planus appear as
pemphigus or pemphigoid LP is most common
61
how can you tell gingival lichen planus from gingivitis
full thickness of gingiva inflammed, not just at marginal gingiva
62
what would raise suspicision for cancer referral
persistent, unexplained head and neck lumps longer than 3 weeks ulceration or unexplained swelling of oral mucosa for more than 3 weeks all red or mixed red and white patches of the oral mucosa for more than 3 weeks
63
what is done at max facs after referral
biopsy lymph node biopsy ct scan patient medical assessment stage and grade
64
what is the aim of the dental pre-assessment prior to cancer treatment
identify any existing oral disease or potential sources of disease remove infection and potential infection prior to treatment prepare the patient for the expected side effects establish a good base line for oral hygiene develop plan for maintaining oral hygiene and prevention
65
what treatment can you provide at a pre-assessment
definitively restore teeth extraction of hopeless teeth PMPR fluoride varnish impressions - for planning restorative work and to produce mouthguard OHI - for when mouth is sore too
66
what is the role of the dentist during cancer treatment
denture and oral hygiene chlorhexidine mouthwash - can be diluted if too stingy diet advice delivering fluoride symptomatic relief of xerostomia assess for opportunistic infections
67
what is mucositis and when can it occur
inflammation and ulceration of the mucosa starts 1-2 weeks after beginning treatment and can last for 6 weeks after treatment | more common with chemotherapy
68
how can mucositis be treated
strong analgesic good oral hygiene remove sharp edges or provide mouthguard to reduce rubbing of teeth oral cooling mouth rinses - calcium phosphate, tee tree oil, aloe vera
69
why is it important to treat herpes labialis before appearance in cancer patients
has an atypical clinical appearance, ulcerative and very painful better to treat prophylactically or treat when tingling felt
70
what is osteoradio necrosis
an area of exposed bone of at least 3 months duration in an irradiated site
71
how is ORN prevented
remove teeth of doubtful prognosis in the radiation field prior to treatment - 10 days prior to treatment high prevention close extraction sites with primary closure antibiotic prophylaxis and continued antibiotics until healing achieved
72
what increases the likelihood of someone developing ORN
trauma as a result of extraction - periodontitis, ill fitting dentures radiation dose higher than 60 greys patient is immunodeficient patient is malnourished

BDS4 BAMS (4 decks)

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