Oral disease for medical professionals

what does a healthy mouth look like

soft tissues are pink and moist

no plaque or calculus on teeth

tooth surface free from decay

gums are pink and firmly bound down

list common oral diseases

tooth decay

fungal infection

dental abscess

ulceration and inflammatory disease

oral cancer

hyposalivation

what is the cause of teeth demineralisation

demineralisation of the teeth caused by acid produced by plaque bacteria metabolising carbohydrate

signs of tooth decay

holes in teeth

black marks on teeth

soft enamel

radiolucency on xray

symptoms of tooth decay

asymptomatic

pain with sweet foods

hypersensitivity

food trapping

what are risk factors for tooth decay

hyposalivation

head and neck radiotherapy

poor oral hygiene

plaque retention factors

what are the four factors contributing towards decay

plaque

time

susceptible surface

carbohydrate

how to keep the mouth healthy

brush teeth and gums twice daily with a fluoride toothpaste

do not rinse the mouth, promote spitting of toothpaste

minimise sugar intake and restrict to meal times

regular dental review

what are features of gum disease

erythematous/oedematous gums

teeth that move

receding gums

plaque

gums that bleed easilt

how to manage gum disease

scale and polish by dentist

improve oral hygiene

stopping smoking

improving diabetes control

what is the character of dental pain and abscess

dull, aching, throbbing

what is associated symptoms with dental pain and abscess

bad smell/bad taste, swelling

where can dental pain and abscess radiate to

often spreads along maxilla/mandible

what are red flags of dental pain and abscess

rapidly spreading erythema and swelling

submandibular, anterior neck or periorbital swelling

change in voice or drooling

trimus

floor of mouth swelling

what is the management for dental pain and abscess

radiographs

extraction

root canal

incision and drainage

antibiotics

what are the risk factors for oral candidiasis

dentures

comorbidities

recent antibiotics

smoking

steroid inhalers

dry mouth

mucosal disease

immunocomprommisation

what are symptoms of oral candidiasis

nipping

burning

worse on eating

sore to hot drinks

cant taste anything

how can dentures be corrected to avoid candidiasis

leave dentures out at night

clean twice daily with soap, water and soft toothbrush

steep denture in milton

use a soft brush to lightly brush palate for 1 minute in upper full denture wearers

how can steroid inhaler use be corrected to avoid candidiasis

gargle with water

consider spacer device

how to treat candidiasis

manage risk factors

may need antifungal treatment

regular mouth wash

what impact will dry mouth have

eating

drinking

food sticking

tablets sticking

what are complications of oral dryness

reduced enjoyment of food

self conscious

increased tongue coating

increased caries risk

increased infection risk

increased trauma to mouth lining

mucous plus and salivary stones

what blood investigations can be done for oral dryness

U&Es

TFTs

FBC

HbA1c

what is used to investigate oral dryness

bloods

USS of salivary glands if swelling

unstimulated salivary flow rate measurement (0.1ml/min)

medication reconciliation

how to treat oral dryness

hydration - regular sips of plain water, avoid regular caffeine and advice on sugar in diet

salivary stimulation

salivary substitutes - spray, gel, regular use

what are the different types of oral ulceration

traumatic

infective

drug induced

neoplastic

inflammatory

metabolism

allergy

immunological

idiopathic

where are non idiopathic aphthous ulcers found

haematinic deficiency

coeliac disease

behçets

lupus

systemic sclerosis

monogenic inflammatory disease

crohns

sweet syndrome

cyclic neutropenia

what are predisposing risk factors for reoccurrent aphthous stomatitis

trauma

stress

growth

coeliac disease

SLS toothpaste

cessation of smoking

infective disease

connective tissue disease

anaemia

what are the subtypes of RAS

minor, major and herpetiform

what is the characteristics of minor RAS

most common

<1cm

no scarring

heal in 7-14 days

non-deratinised mucosa

what are the characteristics of major RAS

>1cm

non keratinised or keratinised mucosa

may heal with scarring

what are the characteristics of herpetiform RAS

multiple 1-2mm

may merge to form large ulcers

what investigations which are done for RAS

FBC/B12/ferritin/folate/coeliac

HIV screen

ask about food that trigger symptoms

what is secondary care for RAS

topical corticosteroids

systemic therapies such as prednisolone, colchicine

list the risks for oral cancer

smoking

alcohol

HOV

poor hygiene

low fruit and veg

chewing tobacco

list the neoplastic presentations

raised

hard to touch

non moveable

not always painful

sensory disturbance

what is orofacial granulomatosis

the presence of persistent enlargement of the soft tissues of the oral and maxillofacial region characterised by non-caseating granulomatous inflammation

list the clinical features of orofacial granulomatous

lip swelling

buccal cobblestoning

gingival hypertrophy

staghorning

mucosal tags

linear ulceration

skin changes

what is the difference in the clinical presentations from OFG and crohn’s disease

OFG responds between to exclusion diets

crohn’s disease is more likely to see ulceration in the sulcus

posterior mouth lesions are more commonly associated with crohn’s disease

anterior mouth lesions are more commonly associated with OFG

what blood investigations can be done for OFG

FBC, haematinics, serum ACE, CRP, ESR

what investigations can be done for OFG

bloods

fecal calprotectin

enquire into abdominal systems

potential oral biopsy

patch testing

oral sarcoidosis

what is the treatment for OFG

benzoate, cinnamon and chocolate excluded from diet

topical steroids

intralesional triamcinolone

topical tacrolimus

what is the treatment for OFG in recalcitrant cases

azathioprine

mycophenolate

what is the treatment for oral manifestations of crohn’s disease

anti-TNF

ustekinuman

what is pyostomatosis

a rare pustular neutrophilic mucocutaneous disorder

where does pyostomatosis effect

oral mucosa and skin

what is the pathophysiology of pyostomatosis

cross-reactivity of unidentified antigens between bowel, skin and oral mucosa

leads to neutrophilic and eosinophilic mucocutaneous inflammation

what are the oral features of pyostomatosis

multiple yellow/white pustules

if the pustules rupture it can cause snail track erosions

swelling, thickening, cobblestoning

vegetations

what is pyostomatosis commonly associated with

inflammatory bowel disease

what laboratory work can be done for pyostomatosis

FBC

LFTs

calprotectin

what WBC is commonly found in early intraepithelial or subepithelial pustules

eosinophils

what WBC is commonly found in late intraepithelial or subepithelial pustules

neutrophils

what is gardeners syndrome

Gardner’s syndrome is a rare, inherited genetic disorder that is a subtype of familial adenomatous polyposis (FAP) and causes numerous abnormal tissue growths, or polyps, in the colon and rectum, along with various tumors outside the colon