Ulcers continued

Question 1

Minor ulcer ______ in diameter: lasts 5–10 days

and heals without scarring

Answer 1

<5 mm

Question 2

Major ulcer >8 mm: can persist for up to _____weeks

Answer 2

6

Question 3

Recurrent ulcers: consider ______, _____ and _____

Answer 3

Behçet syndrome.

Check serum iron and folate

Question 4

Healing options for ulcers

________0.1% (Kenalog in Orabase) paste,
apply three times daily after meals and nocte
(preferred method but be careful of herpes
simplex ulcers).

Answer 4

Triamcinolone

Question 5

Tx considerations for large ulcers

Answer 5

Consider:
injection of steroids into the base of the ulcer
and/or
oral prednisolone 25mg daily, 5–7 days

Question 6

Complementary measures for ulcers
1
2
3

Answer 6

Teabag method.
Melaleuca (tea-tree) oil.
Acupuncture.

Question 7

_______are caused by people leaving
salicylate-based tablets to dissolve against oral
mucosa.

Answer 7

Aspirin ‘burns’

Question 8

Several drugs can induce a lichenoid drug reaction
of the oral mucosa, that is, cause shallow mucosal
erosions similar to lichen planus. The drugs
include ____, ______, _______, _____

Answer 8

gold, the NSAIDs, carbimazole, selected

antihypertensives and cytotoxics

Question 9

Tx of herpes infection

Answer 9

aciclovir or similar antiviral
if seen early, e.g. 48 hours from onset;
fluids + + + ; analgesic mouth rinses, e.g.
Difflam; consider admission for IV aciclovir and
hydration

Question 10

Neoplasia that can look red includes
1
2
3

Answer 10

squamous

cell carcinoma, Kaposi sarcoma and erythroplakia

Question 11

_______ is similar in significance to leucoplakia
except for the erythematous feature. It is an
important condition to recognise since about 90% of
cases are either dysplastic or cancer

Answer 11

Erythroplakia

Question 12

An interesting condition is ________
on the dependent floor of the mouth, which appear
white. Causes include tea-tree oil mouthwash and the
sucking of aspirin

Answer 12

hyperkeratotic burns

Question 13

________ is any white lesion that cannot be
removed by rubbing the mucosal surface (unlike
oral candidiasis). About 5% of cases represent either
dysplasia or early SCC

Answer 13

Leucoplakia

Question 14

This is usually tender and looks like white or yellowish
curd-like patches overlying erythematous mucosa.
Unlike lichen planus or leucoplakia, they are usually readily rubbed off and hence only the underlying red
patch may be seen.

Answer 14

Oral candidiasis (thrush)

Question 15

The carriage rate of Candida albicans in the oral
cavity is________. The diagnosis is made clinically
but a wet preparation using _________ will
reveal spores and perhaps mycelia.

Answer 15

60–75%

potassium hydroxide

Question 16

Tx of oral candida

Answer 16

nystatin suspension, rinse and swallow qid
or
miconazole oral gel (as directed by manufacturer)
or
amphotericin 10 mg or nystatin 100 000 U
lozenges dissolved slowly in oral cavity, 6 hourly,
for 7–14 days

Question 17

Feature is redness, soreness and maceration of the

corners of the mouth. Usually associated with oral candidiasis

Answer 17

Angular cheilitis

Question 18

_____________(Vincent
infection or trench mouth) caused by anaerobic
organisms is rarely seen but is more common in
undernourished or ill young adults under stress

Answer 18

Acute necrotising ulcerative gingivitis

Question 19

Caused by plaque (bacterial biofilm) with calculus

tartar secondary to poor oral hygiene

Answer 19

Gingivitis

Question 20

Features of gingivitis

Answer 20

• Red, swollen gingivae adjacent to teeth
• Bleeds with gentle probing
• Halitosis
• Usually no pain

Question 21

This is a very painful form of gingivitis. Treatment is
as for gingivitis but add antibiotics e.g. metronidozole
400 mg (o) 12 hourly or tinidazole 2 g (o) single dose
and drain pus from abscess.

Answer 21

Acute ulcerative gingivitis

Question 22

It is a sequel to gingivitis and shows periodontal ligament
breakdown with recession or periodontal pocketing
and alveolar bone loss. There is possible loosening of
teeth and periodontal abscess formation

Answer 22

Periodontitis

Question 23

Oral dermatoses include 
1
2
3
4

Answer 23

lichen planus, pemphigus
vulgaris (uncommon), mucous membrane
pemphigoid (uncommon) and lupus erythematosus

Question 24

• affects 2% of the population, usually over 45 years
• can vary from asymptomatic to severely painful
• usually white lace-like patterns on mucosa,
cheeks and tongue
• may form superficial erosions

Answer 24

Lichen planus

Question 25

Where are SLE oral lesions found?

Answer 25

usually on lateral aspects of the hard palate

Question 26

Labs for painful tongue

Answer 26

Investigations may include an FBE, serum vitamin B 12 , folate and ferritin levels, a swab or a biopsy of a suspicious lesion

Question 27

A miserable child with a painful mouth and | tongue is likely to have _______

Answer 27

acute primary herpetic | gingivostomatitis or hand, foot and mouth disease

Question 28

A long history of soreness with spicy or other | foods indicates___________

Answer 28

benign migratory glossitis (geographic tongue) or median rhomboid glossitis

Question 29

``` Macroglossia (large tongue): consider 1 2 3 4 ```

Answer 29

acromegaly, | myxoedema, amyloidosis, lymphangioma

Question 30

Strawberry tongue: consider_____ and _____

Answer 30

scarlet fever, | Kawasaki disease

Question 31

______ (painful tongue): characteristically presents as a burning pain on the tip of the tongue. It can be a real ‘heartsink’ presentation. Consider _______ as an underlying cause.

Answer 31

Glossodynia depressive illness

Question 32

Also known as __________ this benign condition shows changing patterns of desquamatous areas and erythema on the dorsum and edges of the tongue

Answer 32

benign migratory glossitis,

Question 33

Cause of the geographic tongue

Answer 33

It is considered to be a hypersensitivity reaction | but the offending allergen has not been identified.

Question 34

This is due to overgrowth of papillae or reduced wear | of papillae, e.g. debility and lack of fibrous foods.

Answer 34

Black or hairy tongue

Question 35

What is the appearance of a Black or hairy tongue

Answer 35

dark, elongated filiform papillae giving brownish appearance to dorsum (posterior) of tongue.

Question 36

Causes of black hairy tongue

Answer 36

• Unknown • Poor oral hygiene/debility • Iatrogenic (e.g. antibiotics, major tranquillisers, corticosteroids

Question 37

SCC is the most common malignancy of the oral | cavity, accounting for ______of cases

Answer 37

90%

Question 38

It has a 5-year survival rate of _______ without lymph node involvement and ______with local node metastases

Answer 38

65% 50%

Question 39

Cancer of the lip is usually treated successfully by_______ but intraoral cancer has significant morbidity and mortality.

Answer 39

excisional biopsy

Question 40

Predisposing or associated factors for SCC include

Answer 40

tobacco and marijuana abuse, alcohol abuse, excessive sunlight and immune suppressive disorders such as HIV, lymphoma and various medications

Question 41

Usual locations of SCC SCC is usually found as a chronic indurated ulcer on the_______ and ________surfaces of the tongue followed by the floor of the mouth and buccal mucosa

Answer 41

ventral lateral

Question 42

What are considered pre-malignant lesions for SCC

Answer 42

The red patches of erythroplakia (in particular) and the white patches of leucoplakia may be premalignant or early invasive cancer and necessitate further investigation, particularly incisional biopsy.

Question 43

Tx of SCC

Answer 43

Treatment for oral cancer is surgery ± radiotherapy and chemotherapy

Question 44

An_______is a benign, localised gingival swelling. It is a very ancient term with no pathological significance, meaning a ‘tumour situated on the gum’.

Answer 44

epulis

Question 45

2 types of epulis

Answer 45

There are two distinct types—a fibrous epulis and giant cell epulis

Question 46

Where do epulis usually emerge

Answer 46

An epulis emerges between two teeth from the periodontal membrane where there is usually dental decay or a site of irritation, such as a partial denture

Question 47

When is epulis more common

Answer 47

It appears to be more common during pregnancy | where the epulis has a more vascular appearance

Question 48

These may occur on the gums or oral mucosa of the lips and look like pyogenic granulomas of the skin, which also are associated with minor trauma. It is best treated by excision

Answer 48

Pyogenic granuloma

Question 49

________ are probably caused by minor | trauma to the duct. They may rupture spontaneously

Answer 49

Small retention cysts

Question 50

Tx of Small retention cysts

Answer 50

Treatment is by incision and enucleation under local | anaesthesia

Question 51

Tx of larger retention cysts

Answer 51

Larger ones require marsupialisation

Question 52

A special type of retention | cyst is the _____

Answer 52

ranula.

Question 53

Usual location of the ranula

Answer 53

floor of the mouth

Question 54

Hyperplasia of the oral mucosa, a very common condition, is usually seen on the floor of the mouth and is due to chronic irritation from ill-fitting dentures.

Answer 54

Fibrous (fibroepithelial) hyperplasia

Question 55

These appear as a dark blue/purple sessile or modular swelling anywhere in and around the mouth, especially on the vermilion border of the lips, floor of the mouth and tongue.

Answer 55

Haemangioma

Question 56

Tx of Haemangioma

Answer 56

No treatment is | needed except for pressing cosmetic reasons

Question 57

The most common benign intraoral salivary neoplasm is the __________ usually presenting as an asymptomatic swelling of the hard palate or cheeks

Answer 57

pleomorphic adenoma

Question 58

The most common Bony outgrowths of the maxilla and mandible

Answer 58

torus palatinus

Question 59

bony exostosis that occurs inside the mandible, | opposite the premolar teeth and is usually bilateral

Answer 59

torus | mandibularis,

Question 60

When to remove bony exostoses

Answer 60

These lesions are hamartomas and do not require | removal except if there is impending dental obstruction

Question 61

This is a symptom rather than a disease entity. It occurs in about 10% of the population and approximately 70% of patients have a systemic cause

Answer 61

Xerostomia (dry mouth

Question 62

MCC cause xerosthomia

Answer 62

side effect of drug therapy and it is relative rather than absolute

Question 63

Causes of primary xerostomia

Answer 63

• Salivary gland atrophy due to ageing • Salivary gland infections • Autoimmune salivary gland disease (e.g. Sjögren syndrome)

Question 64

Drugs causing xerostomia

Answer 64

antidepressants (especially tricyclic agents), diuretics, anticholinergics, tranquillisers, antihistamines, anti-emetics, antihypertensives (some), antimigraine (some), antiparkinson, lithium and opioids

Question 65

Anemias causing xerostomia

Answer 65

Anaemias: iron, folate, vitamin B12 deficiency

Question 66

CX of xerostomia

Answer 66

interferes with speech, mastication and swallowing and causes difficulty in managing oral hygiene, especially dentures.

Question 67

WHat type of infection is pt predisposed to if he has xerostomia

Answer 67

There is an increase in dental decay and perhaps a | tendency to Candida albicans infection

Question 68

MCC of halitosis

Answer 68

The commonest causes are orodental disorders secondary to poor oral hygiene and inappropriate diet.

Question 69

A 1999 survey showed that 87% of patients with halitosis had an ______ 8% an ear, nose and throat cause with 5% having other or unidentified causes.]

Answer 69

oral cause,

Question 70

What drugs cause halitosis

Answer 70

as isosorbide dinitrate and | various antidepressants as a cause

Question 71

What to consider for unusual mouth ulcers?

Answer 71

acute leukaemia, cancer, blood dyscrasias, Crohn disease and drug therapy such as anti-epileptics and antihypertensives.