sravani

Salivary Glands Important Notes

1. Sialolith is common in the submandibular gland due to

• Tortuous course of Wharton’s duct
• Higher calcium and phosphorous content
• Dependent position of submandibular salivary gland

2. Various terms

3. Mucocele

• Originates due to rupture of salivary duct following trauma
• Results in pooling of saliva
• Types
  • Extravasation
  • Retention

4. Ranula

• Associated with sublingual gland
• Causes swelling in the floor of the mouth below the tongue

5. Syndrome

6. Causes of xerostomia

• Duct calculi
• Sialadenitis
• Drugs like anticholinergic, sympathomimetics, tricyclic antidepressants, bronchodilators, diuretics
• Sjogren’s syndrome
• Patients under radiotherapy
• Ectodermal dysplasia
• Parkinson’s disease
• Diabetes

Oral Medicine Salivary Glands Long Essays

Question 1. Enumerate autoimmune diseases. Discuss clinical features, diagnosis, And management of Sjogren’s syndrome
or
Classify functional disorders of salivary glands. Discuss the etiology, clinical features, diagnosis, and management of Sjogren’s syndrome.

Answer:

Autoimmune Disorders:

• Associated with mucocutaneous lesions « Recurrent aphthous ulcer
  • Behcet’s disease
  • Pemphigus
• Salivary gland
  • Mikulicz’s disease a Sjogren’s syndrome
• Blood disorder
  • Pernicious anemia
  • Purpura
• Collagen disorder
  • Systemic lupus erythematous
  • Scleroderma
  • Rheumatic arthritis
• Miscellaneous
  • Myasthenia gravis
  • Oral submucous fibrosis

Salivary Glands Functional Disorders:

• Sialorrhoea
• Xerostomia

Read And Learn More: Oral Medicine Question and Answers

Sjogren’s Syndrome:

• It is a chronic autoimmune disease
• Characterize by oral and ocular dryness, exocrine dysfunction, and lymphocytic infiltration

Salivary Glands Types:

1. Primary:

• It involves the salivary and lacrimal gland

2. Secondary:

• It also involves other connective tissue diseases (rheumatoid arthritis, scleroderma)

Etiology:

• It is unknown

Salivary Glands Presentation:

• Decreased salivary function
• Dry mouth
• Difficulty in chewing, swallowing, and speech
• Increased risk of caries
• Altered taste
• Diy cracked lips
• Angular cheilitis
• Mucosa is painful and sensitive to species
• Mucosa is pale and dry
• Friable or furrowed
• Minimal salivary pooling
• The tongue is smooth and painful
• Increased dental caries and erosion of enamel
• Susceptible to infection
• Increased risk of developing malignant lymphoma
• Difficulty in wearing dentures
• From one-third to one-half of the patients have diffuse, firm enlargement of major salivary glands
• Swelling is usually bilateral
• Maybe non-painful or slightly tender
• May be intermittent or persistent
• Due to decreased salivary flow, there is a high risk of bacterial sialadenitis

Salivary Glands Lab Investigations:

• Hypergammaglobulinemia
• Autoantibodies: anti-SS-A and anti-SS-B
• Elevated sedimentation rate
• Decreased WBC
• Monoclonal gammopathies
• Hypocomplementemia
• Rose Bengal test:
  • Keratoconjunctivitis sicca is characterized by corneal keratotic lesion, which stains pink when rose Bengal dye is used
• Schirmer’s test:
  • A strip of filter paper is placed in between the eye & eyelid to determine the degree of tears measured in mm
  • If it is < 5 mm in 5 min, it is positive
• Sialometry:
  • It estimates the salivary flow rate
  • In Sjogren’s syndrome, it is reduced to 0.5- ml/min(Nl-1.5)

Radiographic Features:

• Sialography:
  • It typically demonstrates a “cherry blossom” appearance
  • Scintigraphy:
    • It shows the decreased flow and delayed emptying of iso¬tope

Differential Diagnosis:

• Chronic bacterial and granulomatous infection
• Multiple parotid cysts associated with HIV
• Diffuse cervical lymphadenopathy is common in HIV but not in Sjogren’s syndrome

Salivary Glands Management:

• Treated symptomatically
• Dry eyes managed by periodic use of artificial tears
• Conserve the tear film by use of sealed glasses to prevent evaporation
• For Xerostomia: use of sugarless candy or gum
• Use of oral hygiene products that contain lactoperoxidase,
• lysozyme and lactoferrin
• Ex: Biotene toothpaste and mouth rinse, oral balance gel
• Sialogogues such as pilocarpine (dose: 5 mg TDSj are used
• Due to the high risk of caries in these individuals daily fluo¬ride application is done

Question 2. Classify salivary gland disorders. Write in detail about the etiology, clinical features, and management of bacterial sialadenitis.

Answer:

Salivary Glands Classification:

1. Developmental Anomalies:

• Agenesis
• Atresia
• Hypoplasia
• Ectopic

2. Obstructive Lesions

• Mucocele
• Sialolithiasis

3. Infective Lesions:

• Bacterial sialadenitis
• Viral sialadenitis

4. Immune Disorders:

• Sjogren’s syndrome
• Mikulicz’s disease

5. Functional Disorders:

• Ptyalism
• Xerostomia

6. Salivary Glands Tumours:

• Epithelial Tumours:
  • Adenomas
  • Pleomorphic adenoma
  • cystadenoma
  • Basal cell adenoma
  • Warthin’s tumour
• Carcinoma
  • Adenocarcinoma
  • Epidermoid carcinoma
• Non Epithelial Tumours:
  • Fibroma
  • Lipoma
  • Lymphoma
•  Malignant Lymphoma
• Secondary Tumours
• Unclassified Tumours
• Tumour Like Lesions
  • Sialadenitis
  • Oncocytosis
  • Necrotizing sialometaplasia

Bacterial Sialadenitis:

• It is a bacterial infection of the salivary glands

Etiology:

• Microorganism: staphyloma / streptococci
• Decreased host resistance
• Poor oral hygiene
• Dehydration

Clinical Features:

• Age: older age
• Site: common in the parotid

Presentation:

Unilateral enlarged and tender gland
↓
Elevation of ear lobes
↓
Redness of overlying skin
↓
Generalized symptoms
↓
Cervical lymphadenopathy

Management:

• Maintenance of oral hygiene
• Soft diet
• Maintenance of electrolyte balance
• Surgical drainage if the above measures fail

Oral Medicine Orofacial Pain Important Notes

1. Trigeminal neuralgia/ Fothergiirs disease

• Characterized by stabbing or lancinating pain
• Initiated by touching the trigger zones
• These are the vermillion borders of the lip, around the eyes, ala of nose

2. Drugs used in the treatment of trigeminal neuralgia

• Gabapentin
• Pregabalin
• Oxycarbamazepine
• Phenytoin
• Lamotrigine
• Topiramate
• Pimozide

3. Dose of carbamazepine for trigeminal neuralgia

• Initial dose – 200 mg/day
• Increased to 800-1200 mg/day

4. Bell’s palsy

• Manifests as
  • Drooping of the corner of the mouth
  • Drooling of saliva
  • Watering of eye
  • Inability to blink
  • Patient as an expressionless face
  • Speech difficulty
  • Loss of taste in the anterior part of the tongue

5. Frey’s syndrome

• Occurs due to damage of the auriculotemporal nerve following surgery in the parotid or mandibular ramus area
• The patient exhibits flushing and sweating of the involved side of the face

6. Migraine

• It is the most common vascular headache
• Causes pain of the face and jaws
• Occurs due to vasoconstriction of intracranial vessels followed by vasodilation
• Basilar migraine is common in young women
• Drugs used are: ergotamine and sumatriptan

Read And Learn More: Oral Medicine Question and Answers

7. Cluster headache

• It is unilateral
• Most painful of all headaches
• Periorbital pain is common
• Associated with homolateral lacrimation

Oral Medicine Orofacial Pain Long Essays

Question 1. Write a differential diagnosis of orofacial pain. Write a note on the etiology, clinical features, and management of idiopathic trigeminal neuralgia.
OR
Define pain. Describe trigeminal neuralgia including its management.

Answer:

Trigeminal Neuralgia Definition:

Pain is an unpleasant emotional experience initiated by noxious stimuli and transmitted over the specialized neural network to CNS

Orofacial Pain:

• Differential diagnosis

Trigeminal Neuralgia Extracranial Causes:

• Dental and oral
• Dentinal hypersensitivity
• Pain due to pulpal disorders: hyperemia
• Pain due to periodontium disorders
• Mucogingival pain: gingivitis
• Osseouspain: dry socket
• Pain from paranasal sinuses
• Musculoskeletal: eagle’s syndrome

Trigeminal Neuralgia Intracranial Causes:

• Disorders of pain receptors
• Neoplasms
• Edema

Trigeminal Neuralgia Vascular Causes:

• Migraine headache
• Tension headache
• Neurogenic Pain:
• Syndrome Associated: Reiter’s syndrome
• Psychogenic Pain: Anxiety

Idiopathic Trigeminal Neuralgia:

• Etiology:
  • Pathological
  • Environmental
• Dental pathosis -Allergic
• Traction on divisions of the trigeminal nerve.- Irritation to the ganglion
• Ischaemia – secondary lesions
• Aneurysm of internal carotid artery

Trigeminal Neuralgia Clinical Features:

• Age: around 35 years
• Sex: common in female
• Site: right lower portion of the face, usually unilateral
• Duration: a few seconds to a few minutes
• As time passes duration between the cycles decreases
• Nature: stabbing or lancinating
• Aggravating factors: activation of Trigger Zones
• These are the Vermillion border of the lip, around the eyes, ala of nose
• Interference with other activities:
• The patient avoids shaving, washing their face, chewing, and brushing, as these may aggravate pain
• These lead to a poor lifestyle
• Extreme cases: leads to “Frozen Or Mask Like Face”

Trigeminal Neuralgia Management:

1. Medical:

• Carbamazepine: initial dose:100mg twice daily until relief is achieved
• Dilantin: 300-400mg in single or divided doses
• Combination therapy: dilantin + carbamazepine

2. Surgical:

• Injection of alcohol in gasserian ganglion
• Nerve avulsion: performed on the lingual, buccal or mental nerve
• Part of the nerve is sectioned
• Electrocoagulation of gasserian ganglion: diathermy is done
• Rhizotomy: Trigeminal sensory root is sectioned
• Newer technique: Tens
• Low-intensity current is used at high frequency is applied to the skin through electrodes attached by a conduction paste

Oral Medicine Orofacial Pain Short Essays

Question 1. Bell’s palsy.

Answer:

Bell’s palsy

• Idiopathic paralysis of the facial nerve of sudden onset

Etiology: 5 Hypothesis:

• Rheumatic
• Cold
• Ischaemia
• Immunological
• Viral

Bell’s palsy Clinical Features:

• Pain in post auricular region
• Sudden onset
• Unilateral loss of function
• Loss of facial expression
• Absence of wrinkling
• Inability to close the eye
• Watering of eye
• Inability to blow the cheek
• Obliteration of nasolabial fold
• Loss of taste sensation
• Hyperacusis
• Slurring of speech

Bell’s palsy Management:

1. Physiotherapy:

• Facial exercises
• Massaging
• Electrical stimulation

2. Protection to eye

• Covering of eye with a bandage

3. Medical management

• Prednisolone – 60-80 mg per day
  • 3 tablets for 1st 4 days
  • 2 tablets for 2nd 4 days
  • 1 tablet for 3rd 4 days

4. Surgical treatment

• Nerve decompression
• Nerve grafting

Question 2. Atypical facial neuralgia.

Answer:

It refers to a mixed group of conditions which are defined and diagnosed by the exclusion of other typical patterns of facial pain

Atypical facial neuralgia Clinical Features:

• Age and sex: More common sixth-decade women
• Features:
  • Deep, poorly localized pain
  • Pain is often boring, pressing, burning, pulling or aching
  • Pain is constant
  • Pain is referred to the temple, neck, and occipital area
  • The mucosa of the affected area may contain a zone of increased temperature and bone marrow activity

Atypical facial neuralgia Management:

• Opioid analgesic:
• Tricyclic antidepressants like amitriptyline
  • Psychotherapy
  • Behavior modification
  • Transcutaneous electrical nerve stimulation
• Sympathetic nerve block

Oral Medicine Orofacial Pain Short Answers

Question 1. Bell’s sign.

Answer:

Bell’s sign

• Seen in Bell palsy
• The inability to close the eye occurs in it
• On attempting to close the eye, the eyeballs roll upwards
• This peculiar sign is called “Bell’s Sign”

Question 2. TENS therapy.

Answer:

TENS therapy

• It is one of the popular forms of pain control
• It employs low-intensity current at a high frequency of 50 to 100 Hz
• It is applied to the skin via electrodes attached by a conduction paste
• It is used to stimulate nonnociceptive cutaneous afferent neurons that activate descending pain inhibition mechanism without involving opioid peptides
• The analgesic effect ranges from 50 to 70%

Question 3. Classification of headache.

Answer:

Classification Of Headache:

1. Migraine headache
2. Tension-type of headache
3. Cluster headache
4. Miscellaneous headache
5. Traumatic headache
6. Headache due to vascular causes- hematoma
7. Headache due to nonvascular causes- due to increased pressure
8. Headache due to substance abuse- alcohol
9. Headache due to systemic infection
10. Headache due to metabolic disorders
11. Headache due to referred pain- from ear, etc.
12. Cranial neuralgia- trigeminal neuralgia
13. Unclassified headache

Question 4. Alarm clock headache.

Answer:

Alarm clock headache

• It is a feature of sphenopalatine neuralgia
• Its attack develops regularly
• Usually, it develops once at day time over a prolonged period
• Some patients experience it at the same time daily
• Thus it is referred to as an alarm clock headache

Oral Medicine Orofacial Pain Viva Voce

1. Herpetic inflammation of 7 cranial nerves leads to geniculate neuralgia
2. Conjunctival reddening is observed in cluster headache
3. Cluster headache is triggered by smoking
4. Post-herpetic neuralgia can be treated by analgesics and tricyclic antidepressants
5. Auriculotemporal nerve damage leads to Frey’s syndrome
6. Pain in trigeminal neuralgia occurs on touching the trigger zones
7. Cluster headache is the most painful of all headaches
8. Carbamazepine is drug of choice in trigeminal neuralgia

Developmental Disorders Important Notes

1. Developmental defects

2. Syndromes associated with fissured tongue

• Melkerson Rosenthal syndrome
• Down’s syndrome

3. Synonymsforgeographictongue

• Erythema migrans
• Wandering rash
• Benign migratory glossitis

4. Ghost teeth/ Regional odontodysplasia

• Etiology:
  • Defect in mineralization
• Clinical features:
  • Enamel and dentin are very thin
  • The pulp chamber is extremely large
  • Maxillary anterior teeth are more frequently involved

5. Dentinogenesis imperfecta

6. Defect in the papilla of the tongue

7. Submerged teeth

• They are deciduous teeth that are ankylosed
• Prevents subsequent replacement by permanent teeth
• Affected teeth lack mobility
• Gives solid sound on percussion
• X-ray shows partial/ complete absence of periodontal ligament space

8. Dentin dysplasia

9. Talon’s cusp

• Located on the lingual surface of anterior teeth
• Extends half distance for CEJ to incisal edge
• Composed of normal enamel and dentin
• Contains horn of pulpal tissue
• Seen in
  • Mohr syndrome
  • Rubinstein Taybe syndrome
  • Sturge Weber syndrome

10. Teeth involved in different defects

11. Taurodontism

• The body of the tooth is enlarged at the expense of the root
• Pulp chambers are elongated
• Apical displacement of bifurcation/trifurcation
• The Crown has a rectangular shape
• Classification
  • Hypotaurodont – bifurcation is slightly apical. It is a mild form
  • Hypertaurodont – it is in extreme form. Bifurcation is near apices
  • Mesotaurodont- between Hypertaurodont and hypotaurodont

12. Syndromes associated with taurodontism

• Klinefelter syndrome
• Tricho-into-osseous syndrome

13. Turner’s hypoplasia

• Etiology
  • Trauma
  • Periapical infection of deciduous teeth
• Clinical features
  • The teeth affected are – permanent maxillary incisors, maxillary or mandibular premolars
  • Teeth have Hypoplastic crown
  • Range from mild discoloration to severe pitting.

Oral Medicine Developmental Disorders Long Essays

Question 1. Clinical examination of the tongue. Describe clini¬cal features of glossodynia and its treatment plan.

Answer:

Tongue

It is defined as a painful tongue

Etiology:

• Local factors:
  • Excessive use of tobacco
  • Excessive drinking
  • Bruxism
  • Irritating dentures, clasp, prosthesis
  • Referred pain from tonsils
  • Malformed teeth, malocclusion
  • TMJ disturbances
• Systemic factors
  • Multiple myeloma
  • Amyloidosis
  • Pernicious anemia
  • Pellagra
  • Diabetes

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• • Gastric disturbances
  • Xerostomia
  • Prolonged antibiotic activity
• Neurological factors
  • Trigeminal neuralgia
  • Glossopharyngeal neuralgia
  • Cerebrovascular accident
• Idiopathic
  • Depression
  • Cancerophobia
  • Neurosis

Clinical Features:

• Presence of burning, tingling, or numbness of the tongue
• It may occur as isolated features or a group of symptoms
• It may occur with observable changes over the tongue

Management:

• Removal of local cause- construction of plastic retainers
• Treatment of muscular problems- use of muscle relaxants like diazepam
• Treatment of the systemic cause
• Surgical exploration with neuropathy
• Use of topical analgesia- 0.5% lidocaine

Oral Medicine Cysts Important Notes

1. Pseudo cysts are:

• Stafne’s cyst
• Aneurysmal bone cyst
• Hemorrhagic bone cyst
• Mucocele

2. Aneurysmal bone cyst

• It is a lesion of young persons
• Commonly occur in long bones and vertebral column with a history of trauma
• Characterized by excessive bleeding

3. Cysts and their radiographic features

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4. Cyst and their location

5. Cysts and their Origin

6. Nasolabial cyst

• Arises at the junction of the globular portion of the lateral nasal process, medial nasal process, and maxillary process
• It is a soft tissue cyst
• Has no radiographic features

7. Syndromes associated with dentigerous cyst

• Cleidocranial dysplasia
• Maroteaux Lamy syndrome

8. Gorlin Goltz syndrome

• Multiple Odontogenic keratocyst
• Basal cell carcinoma
• Bifid basal rib
• Sexual abnormalities
• Neurological and ophthalmological abnormalities

9. Rushton bodies are seen in

• Periapical cyst
• Dentigerous cyst
• Gingival cyst of infants

Oral Medicine Cysts Short Essays

Question 1. Median mandibular cyst.

Answer:

Median mandibular cyst

They have been derived from epithelium remnants between the fusing mandibular process during the embryonic phase

Median Mandibular Cyst Clinical Features:

• It is a rare lesion
• Site: in the midline of the mandible
• It may cause displacement of the adjacent teeth
• The cystic swelling may be palpable buccally
• The teeth associated with the lesion are vital
• Radiographic Features:
  • Well-defined small radiolucency is seen in the mid-line of the mandible

Median Mandibular Cyst  Management:

• Enucleation of the cyst is done
• Care should be taken not to damage the apices of the teeth

Question 2. Gingival cyst of infants.

Answer:

Gingival cyst of infants

• Gingival cysts of the infant are multiple small, nodular, keratin-filled, cystic lesions seen in the oral cavity
• Depending on their location, they are divided into:
  • Cyst of the dental lamina
    • These are mostly found along the alveolar ridge and are odontogenic in origin
  • Epstein’s pearls
    • These small cystic lesions are found along the mid-palatine raphe
    • They are derived from the epithelium, entrapped along the line of fusion of the palate during embryogenesis
  • Bohn’s nodules
    • These are small cysts usually found along the junction of the hard and soft palate and over buccal and lingual aspects of the alveolar ridge
    • They are derived from remnants of the mucosal glands

Gingival cyst of infants Clinical Features:

• They are usually multiple, asymptomatic
• They are small, discrete, white nodules developing in several parts of the oral cavity
• They may discharge the contents by fusion with the overlying alveolar mucosa
• They may undergo spontaneous regression

Gingival cyst of infants Management:

• No treatment is required

Question 3. Dentigerous cyst.

Answer:

Dentigerous cyst Clinical Features:

• Sex: Common in males
• Age: First and 3rd decade
  • Site: Mandibular 3rd molar, maxillary canines, maxillary 3rd molar
  • Expansion of bone
  • Facial asymmetry
  • Displacement of adjacent teeth
  • Resorption of adjacent teeth

Dentigerous cyst Radiological Features:

• The unilocular, well-defined radiolucency
• Margins- sclerotic

Dentigerous cyst Types:

1. Central: covering the crown of an unerupted tooth
2. Circumferential: covering the crown from all the sides
3. Lateral: covering crown from the side

Dentigerous cyst Management:

• Marsupialization- In children
• Enucleation – In adults

Question 4. Odontogenic keratocyst.
(or)
Question 4. Primordial cyst.

Answer:

Odontogenic keratocyst Clinical Features:

• Age: 2ndand 3rd decade
• Sex: Common in males
• Site: mandible
• Features:
• Asymptomatic
  • If secondary infected, causes expansion of cortical plates
  • Mobility of teeth
  • Pain and tenderness of the site

Odontogenic keratocyst Radiological Features:

• Unilocular or multilocular radiolucency
• Margins: well-defined sclerotic margins
• Expansion of cortical plates
• Soap bubble appearance

Odontogenic keratocyst Management:

• Enucleation of cyst:
  • Smaller single cyst through intraoral approach
  • Unilocular lesions through marginal excision
  • Large multilocular lesions

Resection of involved bone
↓
Reconstruction of the site
↓
Bone grafting

Question 5. Radicular cyst.

Answer:

Etiology:

• Dental caries
• Fractured tooth
• Thermal/ Chemical injury to the pulp
• Iatrogenic injury to the pulp

Radicular cyst Clinical Features:

• Sex: common in males
• Age: Young age
• Site: common in maxillary anterior
• Nonvital tooth
• Smaller cysts are asymptomatic
• Larger lesions produce slow enlarging, bony hard swelling
• Expansion and distortion of cortical plates
• Severe bone destruction
• Springiness of jawbones
• Pain is secondarily infected
• Intraoral or extraoral pus discharge
• Pathological fractures
• Formation of an abscess called “cyst abscess”

Radicular cyst Radiological Features:

• The unilocular radiolucent area around the apex of the nonvital tooth
• Border: sclerotic
• Diameter: less than 1 cm
• Discontinuity of lamina dura

Radicular cyst Treatment:

• Nonvital tooth
• Extraction
• RCT
• Smaller cyst
  • Removed through socket
• Larger cyst
  • Marsupialization

Oral Medicine Cysts Short Answers

Question 1. Residual cyst.

Answer:

Residual cyst

• Any cyst may have an associated periapical or periodontal cyst which is asymptomatic

Residual cyst Clinical Features:

• The patient may complain of tooth pain
• The tooth may be extracted without noticing the presence of a cyst in the region associated with the tooth
• In such cases, the cyst is known as a residual cyst
• It continues to grow even after the tooth is removed as the cystic lining is still present
• The cyst is seen in an edentulous area, in place of the extracted tooth
• Incidence is more in the maxilla than mandible

Residual cyst Treatment:

• Enucleation

Question 2. Globulomaxillary cyst.

Answer:

Globulomaxillary cyst

• A common type of developmental cyst
• Arises in the bone suture, between the maxilla and premaxilla

Residual cyst Clinical Features:

• Asymptomatic
• If the secondary infection causes pain and discomfort
• Small swelling between canine and premolar
• Vital teeth

Residual cyst Radiographic Features:

• The inverted pear-shaped radiolucent area between the roots of the upper lateral incisor and canine
• Divergence of the roots

Residual cyst Treatment:

• Surgical excision

Oral Medicine Cysts Viva Voice

1. A nasolabial cyst is a soft tissue cyst
2. Stafne cyst is due to the developmental inclusion of sali-vary glandular tissue on the lingual surface of the mandible below the mandibular canal
3. A nasopalatine cyst is the most common Odontogenic cyst
4. Globulomaxillary cyst is found within bone
5. A globulomaxillary cyst is present between the maxillary lateral incisor and cuspid
6. Globulomaxillary cyst is fissural cyst
7. A radicular cyst is an inflammatory cyst
8. Botryoid Odontogenic cyst is a multicystic variant of lateral periodontal cyst
9. Eruption cyst is a form of dentigerous cyst

Temporomandibular Joint Important Notes

1. Myofascial pain dysfunction syndrome

• Masticatory muscle tenderness
• Pain in TMJ
• Limitation of motion
• Clicking noise present

Temporomandibular Joint Long Essays

Question 1. Describe the etiology, clinical features, differential diagnosis, and treatment of myofascial pain dysfunction syndrome.
Answer:

Myofascial pain dysfunction syndrome

• It is a disorder characterized by facial pain limited to the mandibular function, muscle tenderness, joint sounds, absence of significant organic and pathologic changes in TMJ
• It may be due to functional derangement of dental articulation, psychological state of mind, or physiological state of the joint
• Coined by Laskin

Etiology:

• Extrinsic factors
  • Occlusal disharmony
  • Trauma
  • Environmental influences
  • Habits
• Intrinsic factors
  • Internal derangement of TMJ
  • Anterior locking of disc
  • Trauma

myofascial pain dysfunction syndrome  Features:

• Unilateral preauricular pain
• Dull constant sound
• Muscle tenderness
• Clicking noise
• Altered jaw function
• Absence of radiographic changes
• Absence of tenderness in ext. auditory meatus

myofascial pain dysfunction syndrome Management:

• Reassurance
• Soft diet
• Occlusal correction: 7 ‘R’s
  • Remove-extract the tooth
  • Reshape grind the occlusal surface
  • Reposition orthodontically treated
  • Restore conservative treatment
  • Replace by prosthesis
  • Reconstruct TMJ surgery
  • Regulate control habits
• Isometric exercises
  • Opening and closing of mouth 10 times a day
• Medicaments
  • Aspirin: 0.3-0.6 gm/ 4 hourly
  • NSAIDS: For 14-21 days
  • Pentazocine: 50 mg/ 2-3 times a day

Read And Learn More: Oral Medicine Question and Answers

• Heat application
  • It increases circulation
• Diathermy
  • Causes heat transmission to deeper tissues
• LA injections
  • 2% lignocaine into trigger points
• Steroid injection
  • As anti-inflammatory
• Anti-anxiety drugs
  • Diazepam-2-5 mg * 10 days
• Tens
• Acupuncture

Question 2. Define trismus. Discuss various causes and management of trismus.
(or)
Define trismus. Discuss various causes and differential diagnoses of trismus.

Answer:

Trismus

It is a condition in which muscle spasm prevents the opening of the mouth

trismus Causes:

• Orofacial infection
• Trauma
• Inflammation
• Myositis
• Tetany
• Tetanus
• Neurological disorders
• Drug-induced
• Extra articular fibrosis
• Mechanical blockage

Pathogenesis:

Injection of inferior alveolar nerve block
↓
Bleeding at the site
↓
Haematoma
↓
Fibrosis
↓
Trismus

trismus Differential Diagnosis:

• Internal derangement of TMJ
• Fracture of mandibular condyle
• TMJ dislocation
• Septic arthritis
• Osteoarthritis
• Ankylosis
• Hematoma
• Acute infections

trismus Treatment:

• May resolve on its own
• Manipulation of the jaw by jaw stretcher

Temporomandibular Joint Short Essays

Question 1. Articular disc disorders of the temporomandibular joint.

Answer:

Articular disc disorders of the temporomandibular joint

In osteoarthritis, an articular disc of TMJ is affected

Etiopathogenesis:

temporomandibular joint Types:

1. Primary: Due to wear and tear
2. Secondary: Due to local and systemic factors

temporomandibular joint Clinical Features:

• Age: Older age
• Site: common in TMJ

temporomandibular joint Presentation:

Unilateral painful joint
↓
Interference in biting and
mandibular movements
↓
Sensitive to palpation
↓
Crepitation of joint
↓
Spasm of muscle
↓
Limitation of joint movements

temporomandibular joint Management:

• Elimination of cause
• Relief of pressure
• Physiotherapy
• Myotherapy
• Doxycycline

Question 2. Internal dearangement of temporomandibular joint.

Answer:

temporomandibular joint Definition:

It is the anteromedial displacement of the interarticular disc associated with the posterosuperior displacement of the condyle in the closed jaw position

temporomandibular joint Features:

• Pain on biting
• Clicking sound over the joint
• Deviation of mandible
• Restricted mouth opening due to pain

temporomandibular joint Management:

1. Anterior repositioning appliances

• Placed on occlusal surfaces

2. Supportive therapy

• NSAIDs to relieve pain
• Heat application

3. Occlusal correction

Question 3. Ankylosis of temporomandibular joint.

Answer:

Temporomandibular Joint Classification:

• False or true ankylosis
• Extra articular or intra articular
• Fibrous or bony
• Unilateral or bilateral
• Partial or complete

Etiology:

• Trauma Congenital
• Infections -Osteomyelitis
• Inflammation osteoarthritis
• Rare causes measles
• Systemic diseases typhoid
• Other causes of prolonged trismus

Temporomandibular Joint Pathogenesis:

Trauma
↓
Extravasation of blood into joint space
[haemarthosis]
↓
Calcification of joint space
↓
Obliteration of joint space
↓
Immobility of joint
↓
Ankylosis of joint

Temporomandibular Joint Features:

• Unilateral:
  • Deviation of the chin on the affected side o Fullness of the face on the affected side
  • Flatness on the unaffected side
  • Crossbite
  • Angle’s class malocclusion
  • Condylar movements absent on the affected side
• Bilateral:
  • Inability to open mouth
  • Neck chin angle reduced
  • Class 2 malocclusion
  • Protusive upper incisors
  • Multiple carious teeth

Temporomandibular Joint Management:

1. Condylectomy

• Pre auricular incision given
• Horizontal osteotomy cut given over condylar neck
• The condylar head is separated
• Smoothened the remaining structures
• Close the wound in layers
• If required bilateral condylectomy done

1. Exposure of the condylar head via a preauricular incision
2. Sectioning of condylar head,
3. Breaking the fibrous adhesions
4. Condylectomy complete
5. Suturing the capsule
6. Final skin suturing

1. Gap arthroplasty:

• Two horizontal cuts are given
• Removal of a bony wedge between the glenoid fossa and ramus

1. Interposition arthroplasty

• • Creation of gap
  • Insertion of barrier (autogenous or alloplastic)

Kaban’s Protocol:

• Early surgical intervention
• Aggressive resection
• Ipsilateral colectomy
• Contralateral colectomy
• The lining of the glenoid fossa with temporalis fascia
• Reconstruction of ramus with a costochondral graft
• Early mobilization
• Regular follow up

Kaban’s  Complications:

• Frey’s syndrome
• Parotid fistula
• Facial palsy

Question 6. Clinical features and management of degenerative arthritis.

Answer:

degenerative arthritis Clinical Features:

• Age and sex: Older aged women are more affected
• Site: Many joints are affected but it is not found often in TM]

Degenerative Arthritis Features:

• Unilateral pain over the joint
• It is sensitive on palpation
• Pain on movement or biting
• Pain aggravates during the evening
• There is the deviation of the jaw towards affected side
• The affected joint is swollen and warm to touch
• There is the presence of crepitation of the joint
• There is a limitation of jaw movements
• It results in stiffness and locking of the jaw

Degenerative Arthritis Management:

• Elimination of the causative agent:
  • Occlusal adjustment or grinding of teeth
  • Replacement of missing teeth
  • Replacement of ill-fitted denture
  • Treatment of caries and periodontal problems
• Drugs
  • Analgesics and anti-inflammatory drugs are given.
• Physiotherapy
• Myotherapy
• Arthroscopic lavage
• A low dose of doxycycline
• Others
  • Glucosamine
  • Chondroitin sulfate

Question 7. Rheumatoid arthritis.

Answer:

Rheumatoid arthritis

It is a systemic disease that usually affects many joints including the TMJ and the disease is characterized by progressive destruction of the joint structures

Rheumatoid arthritis Clinical Features:

• Age and sex: women from 20-50 years of age are affected
• Site: small joints of fingers and toes
• Presentation
  • Bilateral stiffness
  • Crepitus
  • Tenderness and swelling over the joint
  • Fever, malaise, fatigue
  • Weight loss
  • Polyarthritis affecting large and weight-bearing joints
  • Formation of subcutaneous nodules on the pressure points
  • The joint may become red, swollen, and warm to touch
  • Muscle atrophy around the jaw
  •  Bursitis
• TMJ involvement
  • Bilateral stiffness of the joint
  • Deep-seated pain and tenderness on palpation
  • Swelling over the joint
  • There is a limitation of mouth opening
  • Pain on biting is referred to the temporal region, ear, and angle of the mandible
  • There is a deviation of the jaw on opening
  • Inability to perform lateral movements
  • Anterior open bite
  • Fibrous ankylosis of the joint

Rheumatoid arthritis Complications:

• Subluxation
• Secondary arthritis
• Muscular atrophy
• Bird-like face

Rheumatoid arthritis – Radiographic Features:

• Joint space is reduced
• There is a flattening of the head of the condyle
• Erosion of the condyle
• Hollowing of the condylar cartilage
• Bony destruction of the articular eminence
• The condylar outline is irregular and ragged
• Synovial lining resembles a “sharpened pencil” or “mouthpiece of the flute”
• Subchondral sclerosis and flattening of articular surface may occur

Rheumatoid arthritis Management:

• Supportive treatment:
  • Provide adequate rest
  • Advice soft diet
• Medical
  • Local injection of methyl prednisone acetate
  • 20-80 mg for large joint
  • 4-10 mg for small joint
• Salicylates for pain relief
• NSAIDs
  • Phenylbutazone, indomethacin
• Anti rheumatic
  • Hydroxyl chloroquine sulfate sulphasalazine: 500 mg/day
• Local therapy
  • Diathermy
  • Jaw exercises
  • Mouth stretchers
• Surgical
  • Synovectomy: for removal of synovial membrane

Oral Medicine Temporomandibular Joint Short Answers

Question 1. Myositis ossificans.

Answer:

Myositis ossificans

• It is a condition in which fibrous tissue and hetero-tropic bone forms within the interstitial tissue/ muscle as well as in associated tendons and ligaments

Myositis ossificans Types:

• Localized
• Progressive

Question 2. Laskins criteria for MPDS.

Answer:

• Four cardinal signs
  • Unilateral pain – dull ache in the ear or preauricular area or angle of the mandible
  • Muscular tenderness
  • Clicking noise in TMJ
  • Limitation of jaw movements
• Negative characteristics
  • No radiographic changes
  • No tenderness in TMJ on palpation

Oral Medicine Temporomandibular Joint Viva Voce

1. Temporalis and geniohyoid are most often involved in MPDS

Oral Medicine Investigations Important Notes

1. Oral Medicine Investigations Biopsy:

• It is the removal of part of tissue for the purpose of histological examination And Analysis

Oral Medicine Investigations Types:

• Punch Biopsy.
• Incisional Biopsy.
• Excisional Biopsy.
• Needle Biopsy.

2. Oral Medicine Investigations Tests and their uses:

• Schilling test
  • It is done to detect vitamin B12 deficiency as well as to distinguish and detect lack of intrinsic factor and malabsorption
  • The test is performed in three stages
    • Stage 1 – without intrinsic factor
    • Stage 2 – with intrinsic factor
    • Stage 3 – test for malabsorption of vitamin B12
• Paget’s test
  • It is used to examine the swelling
  • Finger pressure is applied over the swelling
• Lugol’s iodine test
  • It is used as an aid to the diagnosis of malignant lesions
  • It contains iodine, potassium iodide, and distilled water
  • Normal cells- stained brown black
  • Inflammatory tissue- stained dark brown
• Schimmertest
  • It is a diagnostic test for Sjogren’s syndrome
  • A strip of filter paper is placed in between the eye And eyelid to determine the degree of tears measured in mm
  • If it is < 5 mm in 5 min, it is positive
• Tzanck test
  • Tzanck smear shows acantholysis of cells
• Patch test
  • It is used to evaluate drug allergy
  • The suspected allergen is placed on normal non-hairy skin i.e. on the upper portion of the back
• Paul Bunnel test
  • It is a diagnostic test for infectious mononucleosis
  • The normal titer is 1:8
  • Butin the diseased person’s titer becomes 1:4096

3. Oral Medicine Investigations Bence Jones proteins:

• It is an unusual protein which coagulates when urine is heated to 40-60 degrees C and disappears when urine is boiled
• It reappears when urine is cooled
• It is also seen in patients with diseases such as
  • Leukemia
  • Polycythemia vera
  • Multiple myeloma
  • Solitary myeloma

Oral Medicine Investigations Short Essays

Question 1. Endocarditis prophylaxis regimen for dental procedures.

Answer:

1. Standard Prophylaxis:

• Amoxycillin
• Dose= Adult -2 gm
• Child- 50 mg 1 hour before surgery

2. Patient unable to take orally:

• Ampicillin
• Dose: Adult – 2 gm IM/4
• Child- 50 mg 1 hour before surgery

3. Patient allergic to penicillin:

• Clindamycin
• Dose: Adult – 600 mg
• Child- 300 mg 1 hour before surgery

Dental Procedures Requiring Prophylaxis:

• Dental extractions
• Periodontal surgeries
• Implant placement
• Endodontic procedures beyond the apex
• Subgingival placement of fibers
• Intraligamentary LA injections

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That Donot Require:

• Nonintraligamentary injections
• Intracanal endo treatment
• Placement of rubber dam
• Suture removal
• Placement of the removable prosthesis
• Making impressions
• Fluoride treatments
• Shedding of primary teeth

Question 2. Biopsy.

Answer:

Biopsy

It is the removal of part of tissue for the purpose of histological examination And Analysis

Biopsy Types:

1. Punch Biopsy:

The sample is obtained with the help of a punch

Biopsy Indications:

• Mucosal lesions
• Inaccessible areas

2. Incisional Biopsy:

• Indication: large lesions
  • Tumours: Edge biopsy is taken where the tumour cells can be compared with the normal cells

3. Excisional Biopsy:

• Indication: Small lesions
• The entire lesion is excised in a single sitting and sent for histological examination

4. Needle Biopsy:

• FNAC
  • Indication: Cystic cavity:
  • 23-26 gauge needle is used to aspirate the contents of the lesion

Question 3. Exfoliative cytology.

Answer:

Exfoliative cytology

Introduced by Papanicolaou And Traunt

Exfoliative cytology Technique:

Scrap the surface of the lesion
↓
Collect it with the help of a wooden spatula
↓
Prepare a smear
↓
Stain it
↓
Observe under microscope Results:
↓
Class 1: Normal
↓
Class 2: atypical
↓
Class 3: Intermediate
↓
Class 4: Suggestive of cancer
↓
Class 5: Positive of cancer

Question 4. Aspiration biopsy.

Answer:

Aspiration biopsy

• Needle Biopsy: technique
• FNAC:
  • 23-26 gauge needle is inserted into the tissues
    • Aspirate the needle
    • Cystic fluid is collected in it
    • Examine the fluid
• Indication: cystic cavity:
• OKC:

Question 5. Schilling test.

Answer:

Schilling test

It is done to detect vitamin B12 deficiency as well as to distinguish and detect a lack of intrinsic factors and malabsorption The test is performed in three stages

Schilling test Stage 1:

• Without intrinsic factor (IF)
• An oral dose of 0.5-1 pg of radioactively labeled vitamin B12 is administered orally
• After 2 hours a large dose(4 mg) of unlabelled vitamin B12 is given parenterally
• In normal individuals, more than 7% of 1 pg of an oral dose is excreted in a 24-hour urinary sample
• Patients with intrinsic factor deficiency excrete a lower quantity of it

Schilling test Stage 2 (WITH IF):

• If the 24-hour urinary excretion of vitamin B12 is low, the test is repeated using the same procedure but with the addition of a high oral dose of IF is administered
• If the 24-hour urinary output is now normal the low value in the first test was due to IF deficiency
• Patients with pernicious anemia have abnormal tests even after treatment with vitamins due to IF defi¬ciency

Schilling test Stage 3:

• Test for malabsorption of vitamin Bt:
• The same patient absorb vitamin HI2 in water as was stipulated in the original test
• In conditions causing malabsorption, the test is repeated after a course of treatment with antibiotics or anti-inflammatory drugs

Question 6. Types and indications of biopsy.
(or)
Question 6. Biopsy

Answer:

Biopsy

It is the removal of part of tissue for the purpose of histological examination and analysis

Biopsy Types:

1. Punch Biopsy:

The sample is obtained with the help of a punch

• Indications:
  • Mucosal lesions
  • Inaccessible areas

2. Incisional Biopsy:

• Indication: large lesions:
  • Tumours: Edge biopsy is taken where the tumour cells can be compared with the normal cells

3. Excisional Biopsy:

• Indication: small lesions:
  • The entire lesion is excised in a single sitting and sent for histological examination

4. Needle Biopsy:

• FNAC:
• Indication: Cystic cavity:
  • A 23-26 gauge needle is used to aspirate the contents of the lesion

Question 7. Paget’s test.

Answer:

Paget’s test

• It is used to examine the swelling
• Finger pressure is applied over the swelling
• It can be done for small swellings
• The center of the swelling becomes soft as it contains fluid
• While the periphery becomes hard

Question 8. Lugol’s Iodine test.

Answer:

Lugol’s Iodine test

It is used as an aid to the diagnosis of malignant lesions

Lugol’s Iodine test Action:

• It will hind to glycogen present in the normal epithe¬lium
• It retains in normal squamous epithelial cells
• Thus it differentiates it from the abnormal cells

Lugol’s Iodine test Contents:

• Iodine 2 gm
• Potassium iodide 4 gm
• Distilled water- 100 cc

Lugol’s Iodine test Effects:

• Normal cells- stained brown black
• Proliferating epithelium- inversely proportional to the degree of keratosis
• Inflammatory tissue- stained dark brown

Question 9. Investigation of oral cancer 

Answer:

Investigation of oral cancer – Clinical methods:

1. Toulidlne blue staining:

It is used as an aid to the diagnosis of oral cancer and potentially malignant lesions

Investigation of oral cancer Method of Use:

• Make the patient to rinse the mouth with water twice for 20 seconds each
• Next, rinse with 1% acetic acid for 20 seconds
• Dry the area with the help of a gauze piece
• Apply 1% toluidine blue solution with a cotton swab
• Rinse again with acetic acid and water
• Observe the staining if present

Investigation of oral cancer Advantages:

• Good sensitivity
• Very low false negative results
• It is effective in demonstrating dysplasia and early malignant lesion which is not clinically recognize able

2. Lugol’s iodine test:

• • It is used as an aid to diagnosis ol malignant lesions

Lugol’s iodine test Action:

• It will bind to glycogen present in the normal epithelium
• It retains in normal squamous epithelial cells
• Thus it differentiates it from the abnormal cells

3. Acridine binding test’

• In this method, the uptake of acriflavine by desquamated buccal cells is measured
• Since the DNA content of the dysplastic cells are more, they will stain more intensely than normal cells

Photodiagnosis:

1. Autofluorescence spectroscopy:

• It is a non-invasive method
• It is used for the detection of alteration in the struc¬tural and chemical composition of cells

2. Fluorescence photography:

• It shows reduction and diminution of positive fluorescence associated with cancer regression and vice versa

Histopathological methods:

1. Biopsy:

• It is the removal of part of tissue for the purpose of histological examination and  analysis

2. Exfoliative cytology:

Exfoliative cytology Technique:

Scrap the surface of the lesion
↓
Collect it with the help of a wooden spatula
↓
Prepare a smear
↓
Stain it
↓
Observe under microscope

Exfoliative cytology Results:

• Class 1: Normal
• Class 2: Atypical
• Class 3: Intermediate
• Class 4: Suggestive of cancer
• Class 5: Positive of cancer

Molecular methods:

1. Quantification of nuclear DNA content:

• Quantitative analysis of DNA content reflects the total chromosomal content

2. Tumour markers:

• Tumor markers may be produced by host in response to cancerous substances
• They can be seen in blood circulation, body cavity fluids, cell membrane, and cell cytoplasm

Question 10. Coomb’s test.

Answer:

Coomb’s test

Coomb’s test was devised by Coombs, Mourant, and Race in 1945.

Coomb’s test Method:

Coomb’s test Types:

• Direct Coomb test
• Indirect Coomb test

Coomb’s test Uses:

• Detects anti-Rh antibodies
• Demonstrates incomplete antibody

Question 11. Brush biopsy

Answer:

Brush biopsy

This biopsy method utilizes an improved brush to obtain a complete transepithelial biopsy specimen with cellular representation from each of the three layers of the lesion: the basal, intermediate, and superficial layers.

• When used properly and rubbed against an area of suspect tissue aggressively [to the point of minor bleeding] the biopsy brush penetrates to the basement membrane, removing tissue from all three epithelial layers of the oral mucosa
• The oral brush biopsy does not require topical or local anesthetic and causes minimal bleeding and pain.
• The brush biopsy instrument has two cutting surfaces, the flat end of the brush and the circular border of the brush.
• Either surface may be used to obtain the specimen.
• Brush biopsies are utilized routinely in the detection of precancer and cancer in other organ systems.

Oral Medicine Infections Of Oral Cavity Important Notes

1. Theories of dental caries Theory

2. Zones of dental caries

• Enamel caries
  • Zone 1 – Translucent zone
  • Zone 2 – Dark zone
  • Zone 3 – Body of lesion
  • Zone 4 – Surface zone
• Dentinal caries
  • Zone 1 – Zone of fatty degeneration
  • Zone 2 – Zone of dental sclerosis
  • Zone 3 – Zone of decalcification of dentin
  • Zone 4 – Zone of bacterial invasion
  • Zone 5 – Zone of decomposed dentin

Read And Learn More: Oral Medicine Question and Answers

3. Ludwig’s angina

• It is a severe form of cellulitis
• Begins in submaxillary space and secondarily involves sublingual and submental spaces
• Mandibular molars are source of infection
• Manifests as rapidly developing broad-like swelling of the floor of the mouth
• Results in elevation of the tongue with difficulty in swallowing and breathing
• If the infection spreads to the neck it leads to edema of the glottis
• Suffocation may lead to death
• Emergency tracheostomy is done

Oral Medicine Infections Of Oral Cavity Short Essays

Question 1. Focal infection

Answer:

Focal infection

Focal infection is a localized or general infection caused by the dissemination of microorganisms or toxic products from a focus of infection

Focal infection Mechanism:

• Spread of pathogenic micro-organisms from their primary site of infection to the distant part of the body via blood vessels or lymphatics
• Spread of toxins liberated by the pathogenic microbes to distant organs either via blood vessels or lymphatics

Focal infection Significance:

• It causes a great number of systemic diseases like
• Arthritis
• Valvular heart diseases
• Gastro-intestinal diseases
• Ocular diseases
• Skin diseases
• Renal diseases

Question 2. Dental fluorosis.

Answer:

Dental fluorosis

Dental fluorosis is caused by excessive intake of fluoride during tooth development

Dental fluorosis Clinical Features:

• Lustreless, opaque white patches in the enamel may become mottled, striated, or pitted
• Mottled areas may become stained yellow or brown
• Hypoplastic areas may also be present to such an extent in severe cases that normal tooth form is lost
• Enamel fluorosis is a developmental phenomenon due to excessive fluoride ingestion during amelogenesis
• Once crowns are formed no further fluorosis occurs
• The hypocalcified areas of the mottled enamel are less soluble in acids
• They have a greater permeability to dyes
• They emit fluorescence of higher intensity than normal enamel
• Fluorosis occurs symmetrically within arches
• The premolars are usually first affected followed by the second molar, maxillary incisor, canine, first molar, and mandibular incisors

Oral Medicine Infections Of Oral Cavity Short Answers

Question 1. Mucous patches

Answer:

Mucous patches

• It is a feature of secondary syphilis
• Mucous patches develop over the oral mucosa
• They are painless, multiple, greyish-white plaques overlying the ulcerated surface

Question 2. Chemical burn

Answer:

Chemical burn

• It is a burn caused due to caustic chemical agents
• It produces coagulation necrosis of the epithelium

Chemical burn Causes:

• Aspirin and aspirin-containing compounds
• Hydrogen peroxide
• Silver nitrate- Used in the treatment of aphthous ulcers
• Toothache drop burns
• Ethyl alcohol burns- Topical application of ethyl alcohol solution
• Acid burns
• Ingestion- Due to ingestion of caustic chemicals

Chemical burns Clinical Features:

• Painful lesion
• Appears as an irregularly shaped, white pseudomembrane-covered lesion
• Gentle lateral pressure causes the white material to slide away exposing painful central red ulceration

Chemical Burn Management:

• Topical application of dyclonine hydrochloride
• A protective coat of emollient paste
• Surgical debridement of necrosed tissue

Question 3. Causes for bleeding in the oral cavity

Answer:

Causes Of Bleeding From Mouth:

• Bleeding diathesis
• Carcinoma, squamous cell of head and neck – bleeding from the mouth
• Crown placement
• Dental caries
• Dental cleaning
• Dentures
• Hemophilia
• Idiopathic thrombocytopenic purpura
• Leukemia
• Pancytopenia
• Periodontal disease
• Plaque
• Post tonsillectomy bleeding
• Root canal
• Stomatitis
• Thrombocytopenia
• Tonsillar abscess
• Tooth extraction
• Trauma
• Viral Hemorrhagic Fevers

Question 4. Cellulitis

Answer:

Cellulitis Definition:

• It is an acute, edematous, purulent inflammatory process that spreads diffusely through different tissue spaces

Cellulitis Sources Of Infections:

• Periapical abscess
• Pericoronitis
• Periodontal abscess
• Osteomyelitis
• Infected post-extraction wound
• Gunshot injuries
• Oral soft tissue infections
• Bloodborne infections

Cellulitis Clinical Features:

• Large, diffuse, painful swelling over the face or neck
• The overlying skin appears purplish
• Fever, chills
• Leukocytosis
• Regional lymphadenopathy
• Pus discharging sinuses

Cellulitis Complications:

• Trismus
• Dyspnoea
• Dysphagia

Question 5. Causes of pigmentations

Answer:

Causes of pigmentations

• Exogenous pigmentation
  • Occupational
    • Lead industry-lead
    • Match industry- Phosphorous
    • Fluorescent lamp industry- mercury
    • Photography- Silver
  • Habits
    • Tobacco
    • Pan
    • Foodstuffs
  • Therapeutic
    • Drugs like anti-malarial drugs
    • Metallic salts
  •  Others
    • Amalgam tattoo
    • Black hairy tongue
• Causes of pigmentations Endogenous
  • Physiologic
    • Racial variation
    • Physiologic melanotic macule and papule
    • Fordyce’s granules
    • Pregnancy
  •  Pathological
    • Addison’s disease
    • Acromegaly
    • Peutz-Jeghers syndrome
    • Nevi
    • Malnutrition

Question 6. Caries vaccine

Answer:

Caries vaccine

• It is a suspension of an attenuated or killed micro-organism administered for the prevention, amelioration, or treatment of infectious diseases

Caries vaccine Mechanism Of Action:

• When the tooth erupts serum antibodies i.e. IgA stimulate opsonization and phagocytosis
• These antibodies have an inhibitory effect on glucosyl transferase and acid production
• It results in the inhibition of the metabolic activity of mutants in teeth

Caries vaccine Route Of Administration:

• Oral route
• Systemic route
• Active gingivo-salivary route
• Active immunization
• Synthetic peptides
• Coupling with cholera toxin subunits
• Fusing with avirulent strains of salmonella
• Liposomes- increases IgA antibodies
• Passive immunization

Oral Medicine Infections Of Oral Cavity Viva Voce

1. Denture sore mouth is rarely found under the mandibular denture
2. Minocycline produced oral pigmentation
3. Amalgam tattoo is the most common source of focal pigmentation
4. Strawberry tongue is the result of an infection caused by streptococcus pyogenes
5. The critical pH of dental caries is 5.2
6. Initiation of dental caries is caused by streptococcus mutans
7. Progression of dental caries is by lactobacillus
8. Pioneer bacteria is seen in the earliest stage of caries

Oral Medicine Infections Important Notes

1. Burning mouth syndrome

• Shows clinically healthy oral mucosa
• A burning sensation of oral mucosa occurs
• Pain starts in the morning and aggravates during the day

Oral Medicine Infections Long Essays

Question 1. Classify ulcers of the oral cavity. Describe the etiology, clinical features, and management of recurrent aphthous stomatitis.

Answer:

Ulcers Of Oral Cavity Classification:

1. Ulcers Of Oral Cavity Classification Acute multiple

• Herpes virus infection
• Primary herpes simplex virus infection
• Coxsackie virus infection
• Varicella-zoster virus infection
• Erythema multiform

2. Ulcers Of Oral Cavity Classification Recurrent oral ulcers

• Recurrent aphthous stomatitis
• Behcet’s syndrome

3. Ulcers Of Oral Cavity Classification Chronic multiple ulcers

• Pemphigus
• Subeplthellal Bullous dermatoses

4. Ulcers Of Oral Cavity Classification Single ulcers

• Histoplasmosis
• Blastomycosis
• Mucormycosis
• It is a common disease characterized by the development of painful, recurrent, solitary ulceration of the oral mucosa

Read And Learn More: Oral Medicine Question and Answers

Ulcers Of Oral Cavity Classification Etiology:

• Immunological abnormalities:
  • Due to T cell-mediated immunological abnormality
• Genetic predisposition
  • Increased susceptibility to PAS
• Microbial organism
  • Form L form of □hemolytic streptococci
• Systemic factors
  • Nutritional deficiency
• Cyclic neutropenia

Ulcers Of Oral Cavity Classification:

• Minor aphthae: the ulcers are less than 1 cm in diameter
• Major aphthae: they are over 1 cm in diameter
• Herpetiform ulcers: they are small ulcers throughout the mucosa

Ulcers Of Oral Cavity Clinical Features:

• Age and sex: common in women of the second and third decade of life
• Site: it occurs most commonly on buccal and lingual mucosa, tongue, soft palate, pharynx, and gingiva
• Prodromal symptoms:
  • It begins with burning, itching, or stinging for 24-48 hours
• Next ulcer appears
• The ulcer gradually enlarges over the next 48-72 hours
  • Later symptoms
  • The lesion is typically painful
• It interferes with eating for several days
• It begins as a single or multiple superficial erosion covered by the gray membrane is surrounded by localized areas of erythema
• Lesions are round, symmetrical, and shallow
• Multiple lesions are present
• Minor aphthae:
  • Size: 0.3-1 cm
  • They heal without scar formation within 10-14 days
• Major aphthae
  • Size: up to 5 cm in diameter
• They interfere with speech and eating
• The large portion may be covered with deep painful ulcers
• The lesions heal slowly and leave a scar
• Due to it, there is decreased mobility of the uvula and tongue
• Herpetiform ulcers
  • Multiple small shallow ulcers often up to 100 in number
• It begins as small pinhead-size erosions that gradually enlarge in size
• Lesions are more painful
• It is present continuously for one to three years
• Patients get relief immediately with 2% tetracycline mouthwash

Ulcers Of Oral Cavity Classification Differential Diagnosis:

• BMMP and pemphigus: absence of vesicles
• Bedner’s aphthae: there is no aphthae
• Erythema multiforme: aphthae ulcers are uniform in distribution

Ulcers Of Oral Cavity Classification Management:

• Topical corticosteroid
  • Triamcinolone acetonide: 3-4 times in a day
• Anesthetic cream
  • Orobase should be given
• Tetracycline mouthwash:
  • 250 mg/ml use four times daily for 5-7 days
• Nutritional supplements:
  • Replacement therapy with vitamin B12, ferritin, folate, and iron
• Maintenance of oral hygiene
  • Chlorhexidine mouthwash is given

Oral Medicine Infections Short Essays

Question 1. Stomatitis medicamentosa

Answer:

Stomatitis medicamentosa

It is an allergic reaction associated with systemic drug intake.

Stomatitis medicamentosa Etiology:

• Oral changes found with cutaneous reaction to drugs
• Mucosal alterations may result from the following:
  • Myelosuppression
  • Direct cytotoxic effect
  • Xerostornic effects
  • Alterations of oral microbial flora

Stomatitis medicamentosa Clinical Features:

• Painful, erythematous, erosive, or ulcerative lesions
• Nonkeratinized locations are often affected initially
• Fixed forms of drug-associated eruptions are relatively uncommon intraorally
• The pseudomembranous necrotic surface may be noted

Stomatitis medicamentosa Differential Diagnosis:

• Chemical or thermal burn
• Erosive lichen planus
• Pemphigus Vulgaris
• Mucous membrane (cicatricial) pemphigoid
• Erythema multiforme
• Acute herpetic gingivostomatitis
• Candidiasis

Stomatitis medicamentosa Treatment:

• Identification and withdrawal of offending drug
• Symptomatic management including topical preparations
• Systemic corticosteroids if the mucosal reaction is not related to antineoplastic treatment

Question 2. Burning mouth syndrome.

Answer:

Burning mouth syndrome

Burning sensation in the structures in contact with the dentures without any visible change in the mucosa

Burning mouth syndrome Features:

• Pain in the morning
• Dry mouth
• Persistent altered taste
• Generalized symptoms

Burning mouth syndrome Etiology:

• Irritation by ill-fitting dentures
• Constant masticatory activity
• Excessive friction on the mucosa
• Candidal infection
• Nutritional deficiency
• Xerostomia
• Medication

Burning mouth syndrome Management:

• Counseling
• Repair of ill-fitted dentures

Question 3. Allergic stomatitis.

Answer:

Allergic stomatitis

It occurs due to drug allergy

Allergic stomatitis Clinical Features:

• Fever
• Arthralgia
• Inflammation
• Ulceration
• Vesicle formation
• Lymph node enlargement
• Erythematous skin

Allergic stomatitis Oral Manifestations:

• Xerostomia
• Taste alteration
• Eating difficulty
• Vesicle bullae found on the mucosa
• The lesion has diffuse distribution
• There may he ulceration and necrosis of the gingiva
• Severe periodontal problems may occur
• There may be erosion of teeth
• Bathing of teeth with corrosive substances can spread to the pharynx.

Allergic stomatitis Differential Diagnosis:

• Recurrent herpes simplex infection – it occurs in groups,
• ANUG-punched out ulceration
• Erythema multiforme- skin lesions are present

Allergic stomatitis Management:

• Discontinuation of the drug: stop the allergic drug.
  • Use an alternative for it.
• Antihistaminic drug: to relieve the acute sign.
• Topical corticosteroid: to resolve localized reaction.
• Adrenaline

Question 4. Treatment of aphthous stomatitis.

Answer:

Treatment of aphthous stomatitis

• Topical corticosteroid
  • Triamcinolone acetonide: 3-4 times in a day
• Anesthetic cream
  • Orobase should be given
• Tetracycline mouthwash:
  • 250 mg/ml use four times daily for 5-7 days
• Nutritional supplements:
  • Replacement therapy with vitamin B12, ferritin, folate, and iron
• Maintenance of oral hygiene
  • Chlorhexidine mouthwash is given

Oral Medicine Infections Short Answers

Question 1. Major aphthous ulcers.

Answer:

Major Aphthae:

• Size: up to 5 cm in diameter
• They interfere with speech and eating
• The large portion may be covered with deep painful ulcers
• The lesions heal slowly and leave a scar
• Due to it there is decreased mobility of the uvula and tongue

Question 2. Four differences between recurrent aphthous and recurrent herpes ulcers?

Answer:

Four differences between recurrent aphthous and recurrent herpes ulcers

Oral Medicine Infections Viva Voce

1. Chronic osteomyelitis shows the moth-eaten appearance

Oral Medicine Dermatological Diseases Important Notes

1. Various findings of dermatological diseases

2. Ectodermal dysplasia

• It is congenital dysplasia of ectodermal structures
• Manifested as hypohidrosis, hypotrichosis and hypodontia

3. Pemphigus

• Histological features:
  • There is a formation of vesicles or bullae intraepithelial just above the basal layer producing suprabasal split c
  • Intercellular bridges in suprabasal layers disappear due to edema resulting in acantholysis
  • Clumps of degenerating cells are found in vesicular areas called Tzanck cells

4. Scleroderma – features

• Stiff and broad-like tongue
• Lips become rigid
• Microstomia
• Dysphasia
• Inability to open and close mouth
• Extreme widening of PDL

Read And Learn More: Oral Medicine Question and Answers

5. Systemic lupus erythematosus

• It is a multisystem inflammatory disorder

6. Steven Johnson syndrome

• Severe bullous form of erythema multiforme involving the skin, eyes, oral cavity, and genitalia

7. Nikolsky’s sign

• Loss of epithelium due to rubbing resulting in raw sensitive surface
• Seen in
  • Pemphigus
  • Familial benign chronic pemphigus
  • Epidermolysis bullosa

8. Tzanck cells

• They are multinucleated giant cells of epithelial origin
• Seen in
  • Herpes
  • Pemphigus

9. Bulla are seen in

• Intraepithelial bulla
  • Herpes simplex Herpes zoster Chicken pox Pemphigus
  • Familial benign pemphigus
  • Epidermolysis bullosa
  • Oral lesions of eiythema multiforme
• Subepithelial bulla
  • Pemphigoid
  • Bullous pemphigoid
  • Bullous lichen planus
  • Dermatitis herpetiformis
  • Epidermolysis bullosa
  • Skin lesions of erythema multiforme.

Oral Medicine Dermatological Diseases Short Essays

Question 1. Lupus erythematosus.

Answer:

Lupus erythematosus

It is an autoimmune disorder characterized by the destruction of tissue due to the deposition of autoantibodies and immune complexes within it

Lupus erythematosus Types:

Lupus erythematosus Generalized symptoms

• Fever
• Fatigue
• Dysphagia
• Depression
• Splenomegaly
• Lymphadenopathy
• Leucopenia
• Arthritis
• Sjogren’s syndrome
• Raynond’s phenomenon
• Scleroderma
• Pemphigoid
• Pemphigus
• Erythema multiforme

Lupus erythematosus Investigations:

• Anti-nuclear antibodies are present
• Anti-DNA antibodies are present
• Polyclonal hyperactivity of the B lymphocytes
• Decrease in the number of suppressor cells
• Leucopenia
• Thrombocytopenia
• Hemolytic anemia
• Hypergammaglobulinemia
• Profuse proteinuria
• Direct immunofluorescence
  • It reveals deposition of IgG, IgA, and IgM in the base¬ment membrane zone
• Indirect immunofluorescence
  • It reveals circulating auto-antibodies

Lupus erythematosus Management:

• Systemic steroids are given

Question 2. Nikolsky’s sign

Answer:

It is the diagnosis of pemphigus vulgaris

• It is demonstrated by applying gentle pressure over the bullae
• This results in the spreading of the lesion to the adjacent intact surface
• Contacting an intact surface after pressing the lesion will result in the formation of a new lesion

Oral Medicine Dermatological Diseases Short Answers

Question 1. Koplik’s spots.

Answer:

Koplik’s spots

• It is one of the important clinical features of measles
• Site: buccal mucosa
• Presentation
  • The mucosa becomes inflamed
  • Over it, there is the presence of white or white-yellow pinpoint papules

Question 2. Four differences between pemphigus vulgaris and benign mucous membrane pemphigoid

Answer:

Differences between pemphigus vulgaris and benign mucous membrane pemphigoid

Question 3. Mucous membrane pemphigoid.

Answer:

Mucous membrane pemphigoid

It is a relatively uncommon vesiculobullous lesion

Rare Vesiculobullous Lesion Clinical Features:

• It usually produces mild erosion or desquamation of the gingival tissue
• Vesicles or bullae arise from mucosal areas that have become erythematous earlier
• In severe cases, large vesicles or bullae develop on the palate, cheek, alveolar mucosa, or tongue
• They are quite large
• They persist for several days
• They are often tense and are relatively tough
• Once the bullae rupture, they leave painful, eroded or ulcerated areas that heal slowly

Question 4. Pemphigus vegetans.

Answer:

Pemphigus vegetans

• It is a common form of pemphigus lesion

Pemphigus vegetans Types:

• Neumann type
• Hallopean type

Pemphigus vegetans Clinical Features:

• Flaccid bullae appear
• They become eroded and form vegetation
• It becomes covered by purulent exudates
• It exhibits inflamed borders
• It terminates in pemphigus Vulgaris

Pemphigus vegetans Oral Manifestations:

• Granular/ cobblestone appearance
• Gingival lesions are lace-like ulcers with purulent sur¬face on a red base or have a granular/ cobblestone appearance

Question 5. Define Vesicle and Pustule.

Answer:

Vesicle:

• These are elevated blisters containing dear fluid that are under 1cm in diameter

Pustule:

• It refers to loa raised lesion containing purulent material

Question 6. Target lesions

Answer:

Target lesions

• Target lesions are a characteristic feature of erythema multiforme
• They appear on extremities
• They are concentric rings resulting from varying shades of erythema giving rise to target, iris, or Bullseye
• They may be purpuric or paler in the center

Question 7. Auspitz sign.

Answer:

Auspitz sign

• It is seen in psoriasis
• If the deep scales on the surface of the lesion are re­moved, one or two tiny bleeding points are often dis­closed
• This phenomenon is known as the “Auspitz sign”

Oral Medicine Dermatological Diseases Viva Voice

1.  Nikolsky’s sign is a feature of Pemphigus
2. Monro’s abscess is found in psoriasis
3. Cicatricial pemphigoid primarily afr’ettc s
4. Bull’s eye lesion is seen in erythema mar
5. A butterfly rash is seen in systemic iu sese: (SLE)
6. Antinuclear antibodies are a seer. in. SIS
7. Kobner’s phenomenon is seen in Pen mar:
8. Pemphigus vulgaris shows fish net pates immunofluorescence