Oral Medicine Exam Prepration

OSPE and exam prepration
Forchheimer's sign occurs in 20% of cases,(Rubella)
and is characterized by small, red papules on the area of the soft palate.



Melanoma
You can use a mnemonic (ABCDE) to memorize its appearance.
Asymetric
Borders; irregular borders
Color; Variegated color (many colors together)
Diameter; large diameter
Evolving; enlarging macule, papule or nodule



Dermoid Cysts of the Floor of the Mouth







Major aphthous ulcer
leukodema



Frey's Syndrome is a syndrome that includes sweating while eating (gustatory sweating) and facial flushing. It is caused by injury to a nerve, called the auriculotemporal nerve, typically after surgical trauma to the parotid gland. This nerve, when itheals, reattaches to sweat glands instead of the original salivary gland (which had been removed during surgery). This means that when you are supposed to salivate, you sweat instead. Redness and sweating appear when the affected person eats, sees, dreams, thinks about, or talks about foods which produce strong salivation. The patient has flushing and sweating over the temple, cheek, and upper neck areas.



Trigeminal neuralgia
Clinical Characteristics
Trigeminal neuralgic pain typically arises in the persons, who have no abnormal neurologic deficit such as loss of corneal reflexes, anaesthesia, paraesthesia,
muscular atrophy or weakness, etc.
• TN typically manifests as a sudden, unilateral, intermittent paroxysmal, sharp, shooting, lancinating, shock like pain, elicited by slight touching
superficial ‘trigger points’ which radiates from that point, across the distribution of one or more branches of the trigeminal nerve
• Pain is usually confined to one part of one division of trigeminal nerve—mandibular or maxillary, but may occasionally spread to an adjacent division or rarely involve all three divisions
• Pain rarely crosses the midline
• The pain is of short duration and lasts for a few seconds, but may recur with variable frequency. Even though there is a refractory period (complete
lack of pain) between the attacks, some patients report a dull ache in between the attacks
• During an attack, the patient grimaces with pain, clutches his hands over the affected side of the face, stopping all the activities and holds or rubs his face,
which may redden or the eyes water until the attack subsides. Male patients avoid shaving. The oral hygiene is poor, as patient avoids brushing of teeth
• The paroxysms occur in cycles, each cycle lasting for weeks or months and with time, the cycle appears closer and closer. With each attack, the pain
seems to become more intense and unbearable.
• In extreme cases, the patient will have a motionless face—the ‘frozen or mask like face’
• Presence of an intraoral or extraoral trigger points
provocable by obvious stimuli is seen in TN. It may be brought on by touching face at a particular site or by chewing or even by speaking or smiling, brushing, shaving or even washing the face, etc.
• The location of the trigger points depends on which division of trigeminal nerve is involved.
i. In V2—points are located on the skin of the upper lip, ala nasi or cheek or on the upper gums.
ii. In V3—this is the most frequently involved branch. Trigger points are seen over the lower lip, teeth or gums of the lower jaw. Tongue is
rarely involved.
iii. In V1—the trigger zone usually lies over the
supraorbital ridge of the affected side.
• It is characteristic of the disorder, that attacks do not occur during sleep.
• Many patients will lead a very poor quality of life, because of excruciating pain.
• It is very common for these patients to undergo
indiscriminate dental extractions on the affected
side without any relief from pain, because the pain of the trigger zone and pain fibre distributions often mimic pain of odontogenic origin.
• More than 50 per cent of patients experience early
remissions of greater than 6 months before return of active pain.


Necrotizing sialometaplasia
ETIOLOGY AND PATHOGENESIS
This is a benign salivary condition that occurs almost exclusively in the hard palate, although other sites where minor salivary glands are located may be affected. The condition is caused by local ischemia secondary to altered local blood supply, which in turn causes infarction of the salivary glands. Local trauma through injury or surgical manipulation is believed to be the most important etiologic factor.
CLINICAL FEATURES
Necrotizing sialometaplasia is characterized by the development of a painless swelling with dusky erythema in the hard palate, which ulcerates . Interestingly, there is often an associated anesthesia in the affected area. The clinical presentation can resemble squamous cell carcinoma), although the latter is relatively rare on the hard palate. A solitary lesion is usual but bilateral cases have occasionally been reported.
DIAGNOSIS
A biopsy is required to make the diagnosis. Specialist interpretation is essential since cases of necrotizing sialometaplasia have been falsely diagnosed histopathologically as squamous cell carcinoma.
MANAGEMENT
The condition is benign and self-limiting. An antiseptic mouthwash or spray should be used to treat the ulceration. Healing will occur within 6–10 weeks. Recurrence is unusual and there is no functional impairment.

 

Maxillary view showing hard palate defect of patient with Wegner's granulomatosis. B, Magnetic resonance imaging of this patient. Note hard palate defect as well as extensive destruction of nasoethmoid region.
Wegener's granulomatosis (WG), is a form of vasculitis (inflammation of blood vessels) that affects small- and medium sized vessels in many organs. Damage to the lungs and kidneys can be fatal. It requires long-term immunosuppression
Sign & symptoms : strawberry gingivitis, underlying bone destruction with loosening of teeth, non-specific ulcerations throughout oral mucosa
Hyperplastic granular gingivitis or "strawberry gingivitis" is a rare manifestation of Wegener's granulomatosis (WG), but it is nearly pathognomonic for this multisystem autoimmune vasculitis. The dentist may be the first health care professional to see patients with symptoms and findings of this condition. Early diagnosis and treatment is the most important factor in the management of this potentially fatal disease



Black and Brown Lesions
Pigmented oral lesions are a large group of disorders in which the dark or brown color is the essential clinical characteristic. Usually, the dark color of the lesions is due to melanin production by either melanocytes or nevus cells. In addition, exogenous deposits and pigment-producing bacteria can also produce pigmented lesions. Benign disorders, deposits, benign and malignant neoplasms, and systemic diseases are included in the group of pigmented lesions.

O Normal pigmentation
O Amalgam tattoo
O Heavy-metal deposition
O Drug-induced pigmentation
O Smoker’s melanosis
O Black hairy tongue
O Ephelis
O Lentigo
O Lentigo maligna
O Pigmented nevi
O Nevus of Ota
O Melanoma
O Addison disease
O Peutz–Jeghers syndrome





A granuloma is an organized collection of macrophages, with lymphocytes, giant cells and fibrosis, sometimes necrosis, which arises as a reaction to an antigen.
The term “granulomatous” refers to inflammatory diseases or reactions characterized by granulomas. In the mouth, these include:
• Granulomatous reactions to:
— unknown antigens (e.g. sarcoidosis, Crohn disease and orofacial
granulomatosis (OFG))
— foreign bodies (e.g. to silicone used as esthetic filler in lips)
— infections (e.g. tuberculosis and mycoses)
• Wegener granulomatosis – a granulomatous reaction with necrotizing vasculitis, and infiltrating neutrophils, eosinophils and
lymphocytes.
The term granuloma is also used in oral lesions such as pyogenic
granuloma, giant cell granuloma and periapical granuloma but is then inappropriate, since none are granulomatous reactions.




Angina bullosa hemorrhagica (localized oral purpura; traumatic oral hemophlyctenosis) :
it characterized by Blood blisters appearing with no defined cause spontaneously or after trivial trauma.
Prevalence (approximate): Uncommon.
Age mainly affected: Older people.
Gender mainly affected: F > M.
Etiopathogenesis: Unclear, though this disorder is analogous to senile purpura, bleeding tendency, autoimmunity or diabetes do not appear to underlie this condition. Corticosteroid inhalers may sometimes predispose.
Clinical features
Oral: Blood blisters are typically solitary, large, and confined to the
non-keratinised mucosa – soft palate and occasionally the lateral border of tongue or buccal mucosa.
Investigations
Blood tests are needed to confirm hemostasis is normal. Biopsy to
exclude pemphigoid if that is likely. Immunostaining for IgG, IgA, or
C3 consistently are non-contributory.
Management
There is no specific treatment other than reassurance. Most lesions recover spontaneously but airway obstruction has been reported rarely. It may be helpful to burst the blister. Topical analgesics may provide symptomatic relief.






Fordyce spots (“Fordyce granules”)
Definition: Small, painless, raised, white or yellowish spots or bumps 1 to 3 mm in diameter seen beneath the buccal or labial mucosa.
Prevalence (approximate): Seen in probably 80% of the population.
Age mainly affected: After puberty.
Gender mainly affected: M > F.
Etiopathogenesis: These are sebaceous glands containing neutral
lipids similar to those found in skin sebaceous glands, but not associated with hair follicles.
Diagnostic features
History: Often not noticeable until after puberty (although they are present
Differential diagnosis: Thrush or lichen planus. Occasionally they
may be mistaken for leukoplakia or Koplik spots (measles).
Diagnosis is clinical: investigations are rarely required.
Management
The spots may become less prominent if isotretinoin is given. CO2 laser and photodynamic therapy are reportedly effective therapies but no treatment is indicated, only reassurance.
Prognosis
Excellent: They are of cosmetic concern only.




Crohn’s disease or regional ileitis is a chronic inflammatory
disease that primarily affects the ileum and other parts of the gastrointestinal tract.
Etiology Unknown; probably immunologically mediated.
Clinical features The disease usually affects young individuals, and
presents clinically with abdominal pain, nausea, diarrhea, weight loss, low-grade fever, and rectal bleeding. Extra-abdominal involvement includes arthritis, spondylitis, uveitis, and oral manifestations.
Oral lesions
occur in 10–20% of patients and are characterized by nodular swelling, which may be ulcerated. Diffuse raised nodules resulting in a cobblestone appearance of the mucosa or mucosal tag lesions may occur . Granulomatous lip swelling, angular cheilitis, gingival swelling, and atypical ulcerations may be seen.
Laboratory tests Histopathological examination.
Differential diagnosis Orofacial granulomatosis, epulis fissuratum,
pyogenic granuloma.
Treatment Topical steroids, systemic steroids, sulfasalazine.





Sturge–Weber Angiomatosis
is a relatively rare, sporadic congenital capillary vascular
malformation typically involving areas innervated by the trigeminal
nerve.
Etiology Developmental abnormality.
Clinical features The main clinical features are characterized by unilateral hemangiomas of the facial skin, oral mucosa, and leptomeninges, brain calcification, ocular disorders, epilepsy, and occasionally mild mental handicap. Oral hemangiomas have a bright red or purple color and are usually flat but may also be raised, causing tissue enlargement. Dentists and oral surgeons must be careful during tooth extraction and periodontal surgery so as to avoid bleeding complications.
Facial hemangiomas have a bright red color and are asymptomatic
Facial and oral hemangiomas are usually obvious at birth. The
diagnosis is usually based on clinical criteria.
Differential diagnosis Solitary hemangioma, Klippel–Trénaunay–
Weber syndrome.
Treatment Laser therapy is recommended.




Angina bullosa hemorrhagica
ETIOLOGY AND PATHOGENESIS
The cause of angina bullosa hemorrhagica (ABH) is unknown, but it has been suggested that this blistering condition represents a mild
and localized form of epidermolysis bullosa. In addition, an association between the use of steroid inhalers and ABH has been described.
However, many patients presenting with ABH have no history of steroid therapy.
CLINICAL FEATURES
ABH is characterized by the rapid appearance of a solitary blood-filled blister (hemorrhagic bulla) usually in the soft palate .Patients may complain of apparent tightness (angina) in the area immediately before and during the formation of swelling. The lesion invariably develops during eating and can be quite
alarming to the patient, especially if hemorrhage occurs. In these circumstances, the patient often seeks immediate medical or dental attention. However, by the time of presentation the bulla has usually spontaneously discharged to leave an area of erosion with blood at the periphery
DIAGNOSIS
Clinical history and appearance is often sufficient to make a diagnosis in an otherwise healthy patient. It is essential to exclude the presence of thrombocytopenia and therefore a full blood count to determine platelet levels should be undertaken.
MANAGEMENT
In the absence of any platelet deficiency the patient should be reassured and given an antiseptic
mouthwash.

 

1.

VELscope for oral cancer screening .

Fluorescence technology, in particular, is a noninvasive approach for assessing and aiding in the visualization of chemical and morphological patterns of the various tissues and substances within the oral cavity.

Every cell in the body contain molecules which have characteristic feature of become fluorescent when excited by ultraviolet or violet range radiation of suitable wave length ,the molecular changes occured in abnormal cells will alter their interactions with light .


When the tissue illuminated with short wave length light (usually violet or blue ) the cells become excited and emit longer wave length (low energy)

Normal cells >> emit green light
Abnormal cells >> emit dark light



2.

Condyloma Acuminatum is a sexually transmitted benign
lesion, mainly occurring in the anogenital region, and rarely in the
mouth.

Etiology Human papillomavirus, types 6 and 11.

Clinical features Oral lesions appear as single, or more often multiple, small, sessile, well-demarcated, exophytic masses with a cauliflower-like surface (. The lesions have a whitish or normal color, and usually recur; the average size is 0.5–1 cm. The labial mucosa, tongue, gingiva, buccal mucosa, and soft palate are the sites most frequently affected.

Oral condyloma acuminatum occurs more frequently in HIV-infected
patients . The lesions present as discrete or multiple,
sessile or pedunculated, exophytic, small nodules with cauliflower-like appearance. The lesions may have whitish or brownish color and size that varies from1 –5 mm to several centimeters in diameter.

Laboratory tests Histopathological examination, in-situ hybridization, polymerase chain reaction (PCR).

Differential diagnosis Papilloma, verruca vulgaris, focal epithelial hyperplasia, verruciform xanthoma, sialadenoma papilliferum, focal dermal hypoplasia syndrome, early verrucous carcinoma, molluscum contagiosum.

Treatment Surgical excision, cryosurgery, CO2 laser, electrocautery, topical podophyllin.



3.

Soft-Tissue Osteoma

Osteoma is a benign tumor that represents a proliferation
of mature cancellous or compact bone.

Etiology Unknown.

Clinical features Osteoma is rare in the jaws and extremely rare on the oral soft tissue. The latter formhas been described in the palate, buccal mucosa, tongue, and alveolar process. Clinically, soft-tissue osteoma presents as an asymptomatic, well-defined, hard tumor, covered by thin and smooth epithelium .
The size ranges from0.5 to 2 cmin diameter.

Laboratory tests Histopathological examination.

Differential diagnosis Exostoses, torus palatinus, fibroma.

Treatment Surgical excision.


4.

Cheilitis glandularis is an uncommon chronic inflammatory
condition of the minor salivary glands, characteristically affecting the lower lip.

Etiology Unknown.
Clinical features It presents as a swelling of the lower lip due to
hyperplasia and inflammation of the glands .
Characteristically, the orifices of the salivary glands are dilated, and pressure on the lip may produce mucous or mucopustular fluid from the ductal openings. Crusting and erosions may also occur.

Laboratory tests Histopathological examination.

Differential diagnosis Cheilitis granulomatosa, Melkersson–Rosenthal syndrome, Crohn disease, sarcoidosis, cystic fibrosis.

Treatment Supportive. Vermilionectomy only in severe cases.




5.

Behçet disease is a chronic multisystemic inflammatory disorder.

Etiology The exact cause is unclear, although an immunogenetic basis is suggested .

Clinical features It is more common in males (5–10 times), and the
onset is usually in the 20–30 years age group. The major clinical diagnostic criteria for the disease are:
(a) recurrent oral ulcerations (aphthae,
(b) recurrent genital ulcerations
(c) ocular lesions (conjunctivitis, iritis with hypopyon, uveitis, retinal vasculitis, reduced visual acuity,
(d) skin lesions (papules, pustules, folliculitis, erythema nodosum, ulcers, and rarely necrotic lesions);
(e) positive pathergy test.

Minor clinical features may also be present, e. g., arthritis, arthralgia, thrombophlebitis, vein thrombosis, arterial occlusion and aneurysms, central nervous system involvement, pulmonary, renal, and gastrointestinal manifestations.

The diagnosis is mainly made on clinical grounds. For accurate diagnosis, recurrent oral ulcerations plus two of the other four major criteria must be present.


Laboratory tests Laboratory findings are not diagnostic.

Differential diagnosis Recurrent aphthous ulcers, Reiter syndrome,
ulcerative colitis, erythema multiforme, Stevens–Johnson syndrome, syphilis, Sweet syndrome.

Treatment Topical steroids in mild cases. Systemic steroids, ciclosporin and other immunosuppressive drugs, thalidomide, colchicine, dapsone in severe cases.



6.

Lentigo maligna, or Hutchinson’s freckle, is a premalignant
lesion of melanocytes that probably represents in-situ melanoma.

Etiology Unknown.

Clinical features Lentigo maligna is very rare intraorally. Clinically, it
appears as a slowly expanding black or brown plaque, with irregular borders .

In 5–15 years, it ultimately progresses into invasive melanoma. The lips, buccal mucosa, palate, and floor of the mouth are the common sites affected.

Laboratory tests Histopathological examination.

Differential diagnosis Melanoma, pigmented nevi, amalgam tattoo.

Treatment Surgical excision, radiotherapy.



7.

Necrotizing sialometaplasia

ETIOLOGY AND PATHOGENESIS
This is a benign salivary condition that occurs almost exclusively in the hard palate, although other sites where minor salivary glands are located may be affected. The condition is caused by local ischemia secondary to altered local blood supply, which in turn causes infarction of the salivary glands. Local trauma through injury
or surgical manipulation is believed to be the most important etiologic factor.

CLINICAL FEATURES
Necrotizing sialometaplasia is characterized by the development of a painless swelling with dusky erythema in the hard palate, which
ulcerates . Interestingly, there is often an associated anesthesia in the affected area. The clinical presentation can resemble squamous cell carcinoma , although the latter is relatively rare on the hard palate. A solitary lesion is usual but bilateral cases have occasionally been reported.

DIAGNOSIS
A biopsy is required to make the diagnosis. Specialist interpretation is essential since cases of necrotizing sialometaplasia have been falsely diagnosed histopathologically as squamous cell carcinoma.

MANAGEMENT
The condition is benign and self-limiting. An antiseptic mouthwash or spray should be used to treat the ulceration. Healing will occur within 6–10 weeks. Recurrence is unusual and there is no functional impairment.



8.

Geographic tongue (benign migratory glossitis) is a benign condition that occurs in up to 3% of the general population.

Most often, patients are asymptomatic; however, some patients report increased sensitivity to hot and spicy foods. The etiology and pathogenesis of geographic tongue are still poorly understood. Geographic tongue affects males and females and is noted to be more prominent in adults than in children

The classic manifestation of geographic tongue is an area of erythema, with atrophy of the filiform papillae of the tongue, surrounded by a serpiginous, white, hyperkeratotic border.

The patient often reports spontaneous resolution of the lesion in one area, with the return of normal tongue architecture, only to have another lesion appear in a different location of the tongue.

Lesion activity in geographic tongue may wax and wane over time, and patients are occasionally free of lesions.

Differential Diagnoses
Burns, Chemical
Cancers of the Oral Mucosa
Candidiasis, Mucosal
Contact Stomatitis
Fissured Tongue
Lichen Planus
Psoriasis, Plaque

A biopsy is not usually necessary, given the characteristic clinical presentation of geographic tongue.

No medical intervention is required because the lesion is benign and most often asymptomatic

However, Abe et al report successful treatment with cyclosporin, and Sigal and Mock reported treatment with topical and systemic antihistamines. Topical retinoids and topical corticosteroids are occasionally of benefit. In psoriatic patients, the lesions may resolve during systemic therapy for the psoriasis.



9.

Plummer-Vinson Syndrome
A precancerous condition is defined by WHO as
"a generalized state associated with a significantly
increased risk of cancer." The Plummer-Vinson
syndrome, or Petterson-Kelly syndrome (iron
deficiency dysphagia), involves mainly women
between the fourth and sixth decade of life. In
Sweden, oral cancer occurs more frequently in
women than in men (1.2: 1), in contrast to most
other countries, and 25% of these women have
iron deficiency. The Plummer-Vinson syndrome
may be associated with oral epithelial atrophy and
predisposes to squamous cell carcinoma . However, this risk of malignant transformation does not seem to be as high in Europe andother countries as in Scandinavia




10.

Pemphigus vulgaris (PV) is an autoimmune disease which primarily involves the skin and oral mucous membranes. The vesicles and subsequent ulcerations noted in PV are due to antibodies directed against the adhesion molecule desmoglein 3, structures that aid in maintaining cell adhesion.

Oral complaints frequently include oral discomfort, difficulty eating and swallowing. Weight loss is not uncommon.

Intraoral examination will demonstrate widespread superficial and irregularly shaped ulcerations. Blisters can be induced with the application of pressure to the normal mucosa (Nikolsky sign).

PV typically affects adults over the age of fifty.

Other conditions one might consider in a patient with diffuse oral ulcerations include erythema multiforme, benign mucous membrane pemphigoid, erosive lichen planus and recurrent aphthous stomatitis, particularly if there is a possibility of an underlying systemic disease.

Oral lesions may begin months to over a year prior to the development of cutaneous disease. It is believed that initiating treatment when only oral ulcers are present may prevent the development of extraoral manifestations. Because treatment itself is time consuming, costly and associated with serious, sometimes fatal side effects, a heightened level of suspicion is of utmost importance.



11.

MANAGEMENT of erythema multiforme.
There is no specific treatment for erythema multiforme.
If there is an association with recent drug therapy then this should be stopped. The provision of antiseptic mouthwash and, in severe
cases, a short course of systemic steroid therapy has been found to be helpful. Oral prednisolone (prednisone) should be administered at a dose in the region of 40 mg daily for 3–4 days, gradually
reduced over the following 7–10 days. Hospitalization may be necessary to ensure adequate hydration. It is important to obtain an ophthalmic opinion for patients with eye involvement because blindness is a potential problem. Patients with recurrent disease should undergo patch testing to exclude hypersensitivity to foodstuffs, particularly the benzoate-based preservatives
(E210–E219). Long-term administration of aciclovir (acyclovir) (200 mg twice daily) has been found to prevent recurrent erythema muin patients where herpes activity is thought to be
a predisposing factor.

 

MANAGEMENT of erythema multiforme.
There is no specific treatment for erythema multiforme.
If there is an association with recent drug therapy then this should be stopped. The provision of antiseptic mouthwash and, in severe
cases, a short course of systemic steroid therapy has been found to be helpful. Oral prednisolone (prednisone) should be administered at a dose in the region of 40 mg daily for 3–4 days, gradually
reduced over the following 7–10 days. Hospitalization may be necessary to ensure adequate hydration. It is important to obtain an ophthalmic opinion for patients with eye involvement because blindness is a potential problem. Patients with recurrent disease should undergo patch testing to exclude hypersensitivity to foodstuffs, particularly the benzoate-based preservatives
(E210–E219). Long-term administration of aciclovir (acyclovir) (200 mg twice daily) has been found to prevent recurrent erythema muin patients where herpes activity is thought to be
a predisposing factor.






Exfoliative cheilitis (factitious cheilitis, le tic de lèvres).
Aetiopathogenesis
Exfoliative cheilitis is a chronic superficial inflammatory disorder characterized by hyperkeratosis and desquamation of the vermilion, with persistent
scaling. Most cases occur in girls or young women, the majority of whom seem to have a personality disorder and indeed, a psychogenic cause was proposed by the French, designating this ‘le tic des levres’ to indicate manipulation as being the basis. There appears to be no association
with dermatological or systemic disease, though some cases are infected with Candida species and rare cases are seen in HIV disease.

Clinical features
Exfoliative cheilitis often starts in the centre of the lower lip and spreads to involve the whole of the lower or of both lips. The patient may complain of irritation or burning and can be observed frequently biting or sucking the lips. Persistent scaling of the vermilion is seen and may have a somewhat cyclical nature. The lips can be covered with a shaggy yellowish coating. Lip scaling and crusting is more or less confined to the vermilion border, persisting in varying severity for months or years.

Diagnosis
Similar superficial scaling may be present in actinic cheilitis, contact cheilitis, glandular cheilitis, lupus erythematosus, Candida infections and HIV infection. Biopsy is sometimes indicated.

Management
Some cases resolve spontaneously or with improved oral hygiene. Reassurance and topical corticosteroids may be helpful in others but often
exfoliative cheilitis is refractory to treatment, even including topical fluorinated corticosteroids. Indeed, the peeling in some cases is accentuated by topical medications. When a factitial cause is suspected, a psychiatric consultation and care may be beneficial; some require psychotherapy, antidepressants or tranquillizers.

 

Trigeminal Neuralgia and its Management options
Surgical Treatments : (Peripheral Nerve Surgical Treatments)

Alcohol injections peripheral branches of trigeminal nerve can be blocked by the intraoral injection of 95 per cent absolute alcohol in small quantities (0.5 to 2 ml). This produces anaesthesia of the region, supplied by the branch. Repeated alcohol injections should be avoided, as it causes local tissue toxicity, inflammation and fibrosis. It can also cause a complication of burning alcohol neuritis. The results are variable. Sometimes it provides relief for a period of 6 to 12 months or sometimes patient comes back with pain immediately within short time span.

Extraoral injections into maxillary and mandibular division of the trigeminal nerve at the level of the base of the skull also can be given. Peripheral injections—infraorbital, mental, inferior alveolar
nerve blocks can be given depending on the involvement.

 

Lichen planus
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Thank you very useful can you tell me some thing about pmdc part 1 (dental exam ) too

 

thanks alot. actually i dont have an idea about the exam ur asking but i will defdinitely do my research and let you know whatever i can.