Special Care - Older people: oral medicine

Question 1

What is an haemangioma?

Answer 1

malformation of small blood vessels

Question 2

where are haemangiomas found?

Answer 2

anywhere

commonly;
the lip
side of the tongue
under the tongue

Question 3

What is a fibroepithelial polyp?

Answer 3

overgrowth of the mucosa after healing

(looks identical to healthy mucosa just more of it)

Question 4

What is black hairy tongue?

Answer 4

overgrowth of the surface of the tongue which becomes stained.

can have a foul smell

Question 5

How can we treat black hairy tongue?

Answer 5

Clean tongue with a toothbrush

Question 6

What is atrophic glossitis?

Answer 6

An overly smooth/shiny tongue which can become ulcerated.

Question 7

What causes atrophic glossitis?

Answer 7

iron deficiency

Question 8

What is frictional keratosis?

Answer 8

keratinised areas around sites of trauma

Question 9

what is speckled leukoplakia?

Answer 9

a unilateral or bilateral premalignant lesion

Question 10

Where is speckled leukoplakia found? (2)

Answer 10

angle of the mouth

Smokers

Question 11

When should we refer sublingual keratosis?

Answer 11

if it crosses the midline

Question 12

What denture related problems can older people encounter?

Answer 12

traumatic keratosis

denture induced hyperplasia (looks like healthy tissue)

denture stomatitis (painless erythema)

angular chelitis

Question 13

What are causes of xerostomia?

Answer 13

polypharmacy

sjogrens syndorme

radiotherapy

Question 14

How do we manage dry mouth?

Answer 14

Change the medication – difficult

Salivary replacement – saliva orthana, biotene oral balance, bioXtra (don’t use glandosane as its very acidic) the effects are very short lived.

Salivary stimulus – chewing gum, glycerine and lemon

Question 15

What does lichen planus look like within the mouth

Answer 15

white striae on the buccal mucosa, lips, gums and attached gingivae

Question 16

what are the types of lichen planus?

Answer 16

erosive

reticular

Question 17

what drugs can cause lichen planus? (7)

Answer 17

NSAIDS 
BB
Diuretics 
oral hypoglycaemic 
statins 
antimalarials 
sulphonamides

Question 18

What are Bisphosphonates taken for?

Answer 18

osteoporosis 
malignancies - multiple myeloma, breast, prostate 
padgets disease 
CF 
primary hyperparathyroidism

Question 19

What is the action of Bisphosphonates?

Answer 19

inhibits osteoclast formation and migration and therefore inhibits bone turn over

Question 20

What increases the risk of MRONJ?

Answer 20

how long Bisphosphonates been used for

extremes of age

concurrent use with corticosteroids

Potency and type of Bisphosphonates

use of Bisphosphonates in treating malignancy

chemo/radio therapy

systemic disease affecting bone turnover

Question 21

What is herpes zoster?

Answer 21

unilateral reactivation of the varicella zoster virus on any branch of the trigeminal nerve which leads to shingles

Question 22

what are the symptoms of herpes zoster/shingles?

Answer 22

Prodromal pain

followed by a unilateral rash that appears on the dermatome supplied by a branch of the trigeminal nerve

Question 23

What is post herpetic neuralgia?

Answer 23

Complication of shingles where there is a constant burning sensation on a dermatomal distribution site once it has resolved

Question 24

Who is at risk of post herpetic neuralgia?

Answer 24

those who have had shingles previously

Question 25

How do we treat the pain from post herpetic neuralgia? (3)

Answer 25

gabapentin and carbamazepine

transcutaneous electrical nerve stimulation

antidepressants

Question 26

What is trigeminal neuralgia?

Answer 26

a lancinating pain which commonly affects the maxillary and mandibular branches of the trigeminal nerve.

can either be spontaneous or triggered by an activity

Question 27

How do we treat trigeminal neuralgia?

Answer 27

can only manage via carbamazepine

Question 28

Who is affected by burning mouth syndrome?

Answer 28

females

those with anxiety and/or depression

Question 29

What causes burning mouth syndrome?

Answer 29

50% no cause
20% psychogenic

dry mouth
candidiasis
haematinic deficiency
diabetes

Question 30

Where are common sites of oral cancers?

Answer 30

lateral aspect of tongue

ventral tongue

buccal corridors

Question 31

What are the physical attributes of oral cancer? (4)

Answer 31

heaped

speckled

white patches

different colour than healthy mucosa