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88 Cards in this Set
- Front
- Back
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6 Classifications of Candidiasis
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Acute Pseudomembranous
Acute Erythematous Chronic Atrophic Chronic Hyperplastic Angular Cheilitis Medial Rhomboid Glossitis |
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Thrush
Medical Name |
Acute Pseudomembranous Candidiasis
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Chronic Atrophic Candidiasis
Alternative Name |
Denture Stomatitis
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Acute Erythematous Candidiasis
Alternative Names (2) |
Acute Atrophic
Antibiotic Sore Tongue |
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Topical Antifungals for Candida
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Nystatin (Oral Suspension)
Miconazole (Oral Gel or E/O Cream with Hydrocortisol) |
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Systemic Antifungals for Candida
Methods of delivery (2) |
Fluconazole
Capsule (50mg) Oral Suspension (50mg/5ml) |
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Local Risk Factors for Candidiasis (4)
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Smoking
Appliance Wear Dry Mouth Topical Steroids |
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Systemic Risk Factors for Cadidiasis (7)
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Extremes of Age
Systemic Steroids Antibiotics (Broad Spectrum) Diabetes Immuno-compromised Anaemic Haematinic Defficiency |
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Give 3 species of Candida
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Albicans
Tropicalis Glabrata Kefyr Dublinensis |
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Treatments for Thrush (3)
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Brush area
Topical Anti-Fungals Treat Systemic Cause |
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Treatment for Acute Atrophic Cand.
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None Specific
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Newton's Classifications of Denture Stomatitis
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Type 1 - Discrete Areas
Type 2 - Whole Area Type 3 - Bumpy Areas on the Palate |
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Imprint Culture Technique
Describe |
1cm sq sponge cube
Place on denture Place on colony plate Gives volumes of fungi present |
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Treatments for Chronic Atrophic Cand. (4)
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Conventional Cleaning
Myconazole gel on fitting surface of denture for 30 mins in mouth (then rinse) Soak in CHX Gluconate (Co/Cr) or Sodium Hypochlorite (Acrylic) Fluconazole (14 day course) |
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Angular Cheilitis - Fungal or Bacterial
Difference Clinically |
Staph. Aureus infection presents with golden crust
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Angular Cheilitis Treatment (3)
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Blood Tests (B12, Folate, Full Blood Count)
Miconazole 2% w/ Hydrocortisone 1% if Fungal/ Unknown Sodium Fusidate if Staph. Aureus |
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Form of Candidiasis with pre-malignant potential
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Chronic Hyperplastic (Candidal Leukoplakia)
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Chronic Hyperplastic Cand.
Clinical Presentation |
On Buccal Surfaces at angle of mouth
Adherent homogenous white plaque With or w/o Erythema |
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Chronic Hyperplastic Cand.
Treatment (3) |
Biopsy (Check for dysplasia)
Fluconazole Re-Biopsy if persistent |
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Antifungal Ointment with SOME Antibacterial Properties
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Miconazole (Dactarin)
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Median Rhomboid Glossitis
Treatment |
Systemic Fluconazole
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Median Rhomboid Glossitis
Clinical Presentation |
Smooth patch on middle of tongue (defined border - rhombus/ oval shape)
Surrounding white plaque not scrape-able |
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Interactions of Miconazole and Fluconazole with;
Warfarin Statins |
Increase of activity (^INR)
Increased risk of myopathy |
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Herpes Virus Family
Viruses w/ Oral Complications (5) |
HSV 1+2
Epstein-Barr Herpes Zoster Cytomegalovirus HHV-8 |
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Families of Virus w/ Oral Complications (6)
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Herpes
Cocksakie Retroviruses HPV Paramyxovirus Toga |
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Primary Herpatic Gingivostomatitis
Treatment (5) |
Soft food
Water Paracetamol (Calpol) [Fever + pain] Benzydamine Hydrochloride (Diflam) - Dilute 50% Systemic Aciclovir if intact vesicles |
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Primary Herpatic Gingivostomatitis
Possible Investigations (2) |
Swab (PCR analysis)
Blood sample at presentation + 10-20 days after [IgG should show 4x increase] |
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Herpes Labalis
Treatment (2) |
Topical Aciclovir/ Penciclovir
Penciclovir may be more effective Warn to avoid at risk groups [Infants + Elderly] |
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Viral Activation of Erythema Multiforme
Which and how often? |
HSV
30% |
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Shingles
Presentation and Cause (3) |
Herpes Zoster-> Varicella Zoster
Rash of ≧1 dermatome of trigeminal nerve Preceded by tingling or pain (Pre-herpetic neuralgia) |
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Shingles
Treatment (3) |
Systemic Aciclovir
If Opthalmic division then urgent referal to Opthalmologist Warn of Post-Herpetic Neuralgia |
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Ramsay Hunt Syndrome Type 2
Cause + Presentation (3) |
Herpes Zoster activation in Geniculate Ganglion
May result in facial nerve palsy Bulous Vessicles form around ear |
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Coxsackie Virus
Oral Presentations (3) |
Herpangina
Hand, Foot and Mouth Acute Lymphonodular Pharyngitis |
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Hand, Foot and Mouth
Presentation and Treatment (4) |
Preceded by 2 days of malaise
Fever Bulous Vessicles on hands, feet and mouth Palliative care only |
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Measles
Oral Presentation |
Coplix Spots (white/red pinhead spots on buccal/palatal mucosa)
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Mumps
Cause and Presentation |
Paramyxovirus
Salivary Gland Swelling (Usually bi-lateral parotid) |
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Human Papilloma Virus
Oral Presentations (3) |
Squamous Cell Papilloma
Verruca Vulgaris Condyloma Acuminatum Focal Epithelial Hyperplasia (Inuit) [Not Pre-Malignant] |
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Facial Pains
Name 4 Neuralgias |
Trigeminal
Pre-Herpetic Post-Herpetic Glossopharyngeal |
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Facial Pains
Only drug available for prescription on NHS as a GDP for CNV Neuralgia? |
Carbamazepine
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Facial Pains
Diagnose: Sudden, usually unilateral, severe, brief, stabbing pain. Recurrent episodes of pain along one or more thirds of the face |
Trigeminal Neuralgia
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Trigeminal Neuralgia
Prevelance |
4-5 : 100,000
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Trigeminal Neuralgia
Give one system of classification and the group responsible for its implementation |
Classical - With no known cause
Symptomatic - As a symptom of an other disease process International Headache Society |
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Trigeminal Neuralgia
Most common Trigger Areas (2) |
Naso-Labial Fold
Mentalis |
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Trigeminal Neuralgia
Diagnostic Criteria for Classical form |
A) - Paroxysmal attacks of up to 2 mins affecting >/= 1 branch of CNV
B) - Intense sharp superficial stabbing pain/ precipitated by trigger areas or factors C) - Attacks are stereotypical per pt D) - No clinically evident neurological deficit E) - Not attributed to another disorder |
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Trigeminal Neuralgia
Alterations to Classical form's Diagnostic criteria for Symptomatic |
A) - With/ Without persistant ache between paroxysms
D) - Causative lesion evident (excluding vascular compression) on either clinical or post. fossa examination |
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Trigeminal Neuralgia
% of pt w/ trigger zones? |
50%
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Trigeminal Neuralgia
Any relieving factors for the pain? What % and what? |
Warmth and rest can help
65% have no relief |
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Trigeminal Neuralgia
Branches most often affected? |
Maxillary and Mandibular
Opthalmic in <5% |
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Trigeminal Neuralgia
% of pts presenting initially to dentist |
27%
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Trigeminal Neuralgia
Special Investigation for classical form? (1) |
MRI
(15% cause identified) |
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Trigeminal Neuralgia
Pharmacological Treatments (7) |
Carbamazepine
Oxycarbamazepine Baclofen Lamotringine Pimozide Gabapentin Phenytoin |
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Trigeminal Neuralgia
Carbamazepine Dosage |
100mg bd for 3 days
Review Increase by 100mg every 2 days until sufficient Max = 1200mg daily |
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Trigeminal Neuralgia
New pt presents with symptoms and provisional diagnosis is made (2) |
Refer to secondary care
Consider Carbamazepine prescription |
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Carbamazepine
Effect lessened over 4 weeks - why? |
Auto-induction of enzyme production in liver to break down
Levels off at 4 weeks |
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Trigeminal Neuralgia
% pts with no benefit from carbamazepine? |
19-30%
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Carbamazepine
Interactions (10) |
Clobazam
Clonazepam Lamotrigine Phenytoin Trigabine Topiromate Valproate Zonisamide Primidone Ethosuximide |
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Carbamazepine
Warnings (5) |
Abrupt Withdrawal
Pregnancy Cardiac Disease Stevens-Johnson Syndrome Bone Marrow Suppression |
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Carbamazepine
Side Effects (7) |
Dry Mouth
Nausea Vomiting Oedema Ataxia Dizziness Drowsiness |
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Trigeminal Neuralgia
Indications for surgery? (3) |
Pain not resolved pharmacologically
Inability to have the drugs Severely diminished quality of life |
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Trigeminal Neuralgia
Main areas of surgery? (3) |
Percutaneous Gasserian ganglion procedures
Peripheral Posterior Fossa |
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Trigeminal Neuralgia
What are the most common posterior fossa surgical techniques? (2) |
Gamma knife
MVD (Microvascular Decompression) |
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Trigeminal Neuralgia
Why might Gamma knife surgery be preferable to MVD? |
Non-invasive
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Trigeminal Neuralgia
MVD 5yr pain free %? |
73%
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Glossopharyngeal Neuralgia
Define (7) |
Sudden, usually unilateral, severe, brief, stabbing, recurrent episodes of pain in the distribution of the glossopharyngeal nerve
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Glossopharyngeal Neuralgia
Should an MRI be carried out? |
Yes
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Shingles
How long must the pain remain for to be classified post-herpetic neuralgia? |
>3 months
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Post-Herpetic Neuralgia
Features (6) |
Pain (sharp, stabbing)
Paraesthesia Dysaethesia Allodynia Hyperaesthesia Hyperalgeasia |
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Post-Herpetic Neuralgia
Can the incidence be reduced? If so, how? |
Yes
Antivirals within 72 hours of skin lessions |
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Post-Herpetic Neuralgia
Treatments? (3) |
Gabapentin
Pregabalin Amitriptyline |
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Chronic Idiopathic Facial Pains
Categories (4) |
Persistent idiopathic oro-facial pain (atypical facial pain)
Atypical Odontalgia TMJ Dysfunction Burning mouth syndrome (Oral dysaethesia) |
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Burning Mouth Syndrome
Int. Headache Society diagnostic criteria (3) |
a) Oral pain present and persisting for most of the day
b) Oral mucosa appears normal c) Exclusion of local and systemic disease |
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Burning Mouth Syndrome
Int. Headache Society's definition |
An intraoral burning sensation for which no medical or dental cause can be found
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Oral Dysaethesia
What is glossodynia? |
Burning mouth syndrome only affecting the tongue
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Burning Mouth Syndrome
Epidemiology (3) |
1-15% of population
18-33% post-menopausal F>M |
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Burning Mouth Syndrome
Sites most commonly affected (3) |
Tongue > Palate > Lips
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Oral Dysaethesia
What two problems may present as Burning Mouth Syndrome? |
Thyroid gland abnormalities
Decreased Freeway Space |
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Burning Mouth Syndrome
Investigations (6) |
FBC (Full blood count)
TFT (Thyroid function test) RBG (Random blood glucose) Haematinics Sialometry Exclusion of candida |
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Burning Mouth Syndrome
Treatments (4) |
Reassure
CBT Amitriptyline/ Gabapentin / Pregabalin [Consider recommending Alpha-lipoic acids from Holland & Barrett's. Poor evidence] |
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Persistent Idiopathic Oro-facial Pain
Int. Headache Society's diagnostic criteria (4) |
a) Persistent facial pain for most of the day [B&C fulfilled]
b) Deep, poorly localised pain originating on one side of the face c) No associated physical signs or sensory loss d) Inconclusive investigations [Including radiographs] |
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Persistent Idiopathic Oro-facial Pain
Most common locations of onset (2) |
Nasolabial fold
Mentalis |
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Persistent Idiopathic Oro-facial Pain
Any precipitating factors? (2) |
Yes, Surgery or trauma to the area
If localised to ear or temple region possibly due to ipsilateral lung carcinoma invading the vagus nerve (reffered pain) |
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Persistent Idiopathic Oro-facial Pain
Presentations (3) |
14-19% Bilateral involvement
57-90% painful all day 17-35% Relapsing course |
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Persistent Idiopathic Oro-facial Pain
Relieving factors (3) |
Warmth
Pressure Medications |
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Persistent Idiopathic Oro-facial Pain
Provoking factors (5) |
Stress
Cold Chewing Head movements Life events |
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Persistent Idiopathic Oro-facial Pain
Treatments (2) |
CBT
Amitriptyline/ Gabapentin/ Pregabalin |
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Atypical Odontalgia
Treatments (2) |
CBT
Amitriptyline/ Gabapentin/ Pregabalin |
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Atypical Odontalgia
Presenting features (2) |
Continuous throbbing pain localised to a tooth or extraction socket with no obvious cause
If treated pain may become worse or move to another tooth |
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Dry Mouth
Symptoms (9) |
dry mouth
difficulty eating, swallowing and speaking difficulty wearing dentures mucosal sticking taste disturbances halitosis painful mouth caries salivary gland swelling |
