Oral Mucosal Disorders

Self-Study Examination

Instructions: After studying the text answer the following true/false or multiple choice questions.  Remember, there's only one answer to each question.

1. Chronic nonspecific mucosal lesions often have a specific cause which can be re- moved to effect a permanent cure.

a) True
b) False

2. The first step a dentist should take in investigating leukoplakia or erythroleukoplakia is to order a biopsy.

a) True
b) False

3. The article lists eight causative agents for chronic nonspecific mucosal lesions. However, it's often not possible to link a causative agent to a particular lesion due to several reasons. Which of the following is not such a reason?

a) The information is not elicited during patient history taking.
b) Idiosyncratic nature of causative agents.
c) Lesions often do not appear for years after exposure to the agent.
d) Elimination of an etiologic agent often has no immediate effect on the lesions.
e) These lesions do not have a specific cause.

4. With respect to lichenoid drug eruptions, select the correct statement from the following:

a) Oral lesions caused by certain medications can be easily distinguished from lichen planus.
b) Lichenoid drug eruptions generally appear immediately after the patient has started taking a suspect medicine.
c) Lichenoid drug eruption is infrequent in older adults although they commonly use LDE-producing drugs.
d) Once the suspect medication is discontinued, lesions disappear promptly.

5. Which of the following drugs is generally not associated with lichenoid reaction?

a) diuretics
b) tooth bleaching agents
c) oral contraceptives
d) NSAIDS
e) antihypertensives

6. Which of the following dental materials has been known to cause the most oral allergic lesions?

a) amalgam
b) mercury
c) chromium
d) gold

7. Lesions caused by foods containing cinnamon generally remit within two weeks of cessation.

a) True
b) False

8. Sanguinaria-related lesions are slow to resolve.

a) True
b) False

9. In arriving at a differential diagnosis of lichenoid mucositis, it is important to consider candidosis for the following reason:

a) chronic atrophic or hyperplastic candidosis may present as a lichenoid lesion;
b) candida may be superimposed on other lesions, thus altering the lesional appearance;
c) steroid therapy used to treat chronic mucositis is contraindicated if candida is present;
d) all of the above

10. In the differential diagnosis of chronic nonspecific mucosal lesions, a sequence of investigation is proposed. Name the first step in this investigation:

a) rule out causative agents;
b) rule out candida;
c) rule out immunologic diseases;
d) rule out dysplasia/squamous cell carcinoma.

11. Use of steroids to treat chronic lichenoid lesions is not recommended for the following reason:

a) Steroids are contraindicated if candida is present.
b) Steroids alter the histologic appearance of lesions.
c) Steroid therapy may delay a diagnosis of dysplasia or cancer.
d) Patient may be subjected to an unnecessarily long regime of steroid therapy.
e) all of the above

12. Galvanism caused by amalgam fillings in contact with old restorations has been implicated as a cause of lichenoid lesions but there's no conclusive proof.

a) True
b) False

13. Oral lesions occurring as a result of various systemic diseases are classified as

a) Metabolic
b) Inflammatory
c) Neoplastic
d) Developmental

14. Red lesions represent

a) thickening of the epithelium
b) thinning of the epithelium
c) loss of the epithelium
d) proliferations of the surface epithelium

15. The author proposes the mnemonic MIND to aid in the diagnosis of lesions of the oral mucosa. Select the incorrect reference to the mnemonic MIND from the following:

a) Metabolic
b) Inflammation
c) Neoplastic
d) Differential diagnosis

16. Using the MIND classification system, classify lesions caused by infectious diseases (viral, bacterial, fungal):

a) Metabolic
b) Inflammatory
c) Neoplastic
d) Developmental

17. Oral lesions due to amalgam filling material or root canal sealers are usually

a) white
b) red
c) gray to black
d) blue

18. Intact blisters of oral mucosa are rarely seen.

a) True
b) False

19. Often a biopsy is necessary to establish the final diagnosis. However, occasionally biopsy is unnecessary such as for a

a) positive radiographic finding in an amalgam tatoo
b) positive candidal microbiological test
c) positive serologic test for syphilis in a mucous patch
d) all of the above

20. The form of candidosis caused by dentures is

a) pseudomenbranous
b) erythematous
c) hyperplastic
d) angular cheilosis

21. Candidosis as manifested by white curd-like lesions can easily be removed with a tongue blade or gauze in all of the following cases except

a) pseudomembranous
b) erythematous
c) hyperplastic

22. All of the following are local factors that predispose a patient to develop candidosis except

a) xerostomia
b) dentures
c) smoking
d) antibiotic therapy
e) poor oral hygiene

23. All of the following are systemic factors associated with the development of candidosis except

a) steroid therapy
b) diabetes
c) hypertension
d) malabsorption and malnutrition
e) cancer chemotherapy

24. Oral candidosis is most often treated with topical antifungal agents. In general, oral preparations in the form of troches are more effective than rinses.

a) True
b) False

25. Foods associated with triggering recurrent apthous ulcers include all of the following except

a) sugar
b) bovine milk protein
c) glutens
d) cinnamon
e) spices

26. The most commonly used medications reported to cause intraoral apthous-like lesions are

a) topical steroids
b) nonsteroidal antiinflammatory drugs
c) both of the above
d) none of the above

27. Topical steroids are frequently used for the treatment of minor recurrent aphthous ulcers. Select the incorrect statement from the following:

a) Chronic use of topical steroids may result in mucosal atropy as well as systemic absorption of the steroid.
b) Topical steroid medications should not be used on virally-induced lesions.
c) Continue topical steroid therapy until apthous ulcers disappear.
d) Discontinue topical steroid use for at least 2 weeks before reinstituting therapy for a recurrence of lesions.

28. The herpes simplex virus has two distinct serotypes, HSV-I and HSV-II. The virus primarily associated with oral and perioral lesions is

a) HSV-I
b) HSV II

29. Acute primary herpetic oral infections are generally self-limiting and last approxi- mately 10-14 days.

a) True
b) False

30. Medications used to treat herpetic infections include all of the following except

a) penciclovir
b) acyclovir
c) fluocinonide

31. The use of over-the-counter products in treating oral lesions is largely palliative.

a) True
b) False