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Oral Medicine pt. 2 (OSCE Cases: (Leukoplakia (Hairy Leukoplakia (Ae:…
Oral Medicine pt. 2
OSCE Cases:
Leukoplakia
Ae: A whitish patch or plaque that cannot be
that cannot be characterized clinically/pathologically as anything else
feats: white pathes that cannot be rubbed off
nb: risk of malignant transformation = 1-2%
Tx: BIOPSY
severity = dependent on level of dyspalsia
No dysplasia- No Tx, but periodic review
Mild dysplasia- conservative, elimination of tobacco or alcohol habits, Tx of any candida infection
Moderate to severe dysplasia- consider excision due to the risk of malignant change
Hairy Leukoplakia
Ae: Epstein-Barr Virus (HSV 4)
feats: asymptomatic white hairy
tongue, ie superimposed infections
tx: Treatment of the underlying cause ie HIV/AIDS
Oral Lichen Planus
Ae: T-cell mediated basal cell degeneration
feats: plaque-like, atrophic, erosive, papular, bullous, symmetrical bilateral presentation
nb: can appear on the
flexor surfaces
of the arms/legs
Tx: (BIOPSY), High potency topical steroids, good OH
Angular Chelitis
Ae: Candida species & Staph aureus
feats: fissuring at the commissure of lips
tx: Miconazole (antifungal and antibacterial)
cessation support, tx systemic disease,
Apthous Ulcer
Major
Indications:
>
1cm, >14days, scarring present, occurs anywhere include KT
Management:
elminate sources of trauma, investigate vit/mineral definecies
Minor
Indications:
< 1cm, <14 days, Non scarring, occurs on non-KT
Management:
elminate sources of trauma, investigate vit/mineral definecies
Oral SCC
Ae:
Established = Smoking, chewing tobacco/betel quid, alcohol, HPV type 16
Strongly suggestive = sunlight, radiation
Feats:
Non-healing lesion for longer than two months
Range: small erythematous patch through to large swelling/ulceration
= Dx: Through a incisional biopsy + inspect nodes
Tx:
Surgery, Radiotherapy or Combination of both
Mucous Membrane Pemphigoid (MMP)
Ae:
Autoimmune blistering
, unclear?
feats: interepithelial clefting, +ve Nikolsky sign, lesions that burst
Tx:
(correct diagnosis) =
Direct Immunofluorescence
Topical/oral Steroids or sparing or systemic (severity depends)
Pemphigus Vulgaris
Ae: Idiopathic? (possible; medications, radiation, surgery, stress)
feats:
blistering
, erosive lesions widespread
Tx:
(correct diagnosis) =
Direct Immunofluorescence
Topical/oral Steroids or sparing or systemic (severity depends)
Erythema Multiforme
Ae: Acute recurrent hypersensitivity reaction
feats: Target lesions on the skin, crusting on the lips, mouth ulceration
nb: SJS would also be a possible (More acute)
Tx: No treatment/pallative care
Varcosities
Ae: degeneration of connective tissue supporting vessels
feats: lips and buccal vessels prominent
tx: None, unless aesthetics concerned
Haemangioma
Vascular lesion, structural deficiencies in the vessels
benign proliferation of vessels
Viscaroties common, bilateral
Assessment:
elicit blanching from the lesion on pressure
Solar Keratosis
Ae: skin gets damaged by ultraviolet (UV) radiation from the sun
feats: PMOD, patch of thick, scaly, or crusty skin,
potentially SCC in lower lip/ BCC in upper lip
tx: Avoid direct sun/indoor tanning, use high SPF+, cover!!
Black Hair Tongue
Ae: Heavy smokers, general debilitation, AB, poor oral hygiene, and a hx of radiation
feats: elongated papillae are usually brown, yellow, or black
Tx:
Avoid tobacco, staining foods + periodic scraping/brushing. + 3% hydrogen peroxide.
Swellings
Normal
Pterygoid hamulus
Parotid papillae
if prominent can look like swellings
Erupting teeth
Developmental
Haemangioma
Vascular lesion, structural deficiencies in the vessels
benign proliferation of vessels
Viscaroties common, bilateral
Lymphangioma
malformation of lymph vessels
management: surgical removal, laser, sclerotherapy
Maxillary and mandibular Toti
over grown bone which is normal
Hereditary Gingival Fibromatosis
assoc. gene involvement
progressive overgrowth of fibrous CT of gingiva
Neurofibromatosis
(Von Recklinghausen’s)
Oral: multiple intra oral neuromas, café-au-lait macules of lips, face
Skin: multiple nuerofibroms, seizures, frecking iris
Inflammatory
Abscess
pyogenic (pus producing) organisms - possible abcess formation
Pyogenic Granuloma
benign inflam response to chronic irritation
Tx: improve inflammation before excision
Crohn’s disease - good hx required to make diagnosis
Orofacial Granulomatosis
Sarcoidosis
Wegener’s Granulomatosis
Traumatic
Epulis
Fibroepithelial polyp (epulis not on the gingiva)
Denture-induced hyperplasia
removal of irritant and possible excision of tissue will result in good resolution
Cystic
Odontogenic Cysts
Developmental
Dentigerous, eruption, gingival {adults, infants}, lateral, apical
Inflammatory
Periodontal(radicular), residual, paardental
Neoplastic
Cystic Ameloblastoma, COC, ect
Non-Odontogenic cyst
Pseudocysts cysts
Nasopalatine, Nasolabial
Hormonal
Pregnancy epulis
Contraception related gingivitis
Neoplasms
Leukamia
Lymphoma
(Hodgkin's Disease)
Malignant limphoproliferative disorder
(Non-Hodgkin's Disease)
In the oral cavity usually as extra nodal lesion, solid mass
(Burkitt’s Lymphoma)
Associated with EBV
OMSCC
Salivary gland
Medications
Antiepileptics (penytoin, dilantin)
Immunosupressant (Cyclosporin)
= cause generalized gingival enlargement, fibrous component, OH issue compounded through inflammation