Oral Pathology and Oral Medicine I: Main Exam, 24 March 2025

1.

1. a) Explain the process of describing a pathological condition. (9 marks)
   Model answer

   • Definition: A systematic description of the lesion’s appearance, location, and extent.
   • History: Record onset, duration, progression and associated symptoms.
   • Clinical examination: Note colour, texture, size, shape, borders and any pain or discharge.
   • Radiographic assessment: Identify radiolucency/radiopacity, bone loss, root resorption.
   • Differential diagnosis: List possible conditions based on findings.
   • Etiology: Consider trauma, infection, genetics, or environmental factors.
   • Prognosis: Estimate likelihood of healing, recurrence or complications.
   • Treatment plan: Outline surgical, medical or restorative options.
   • Follow‑up: Schedule reassessment and monitor changes.
2. b) Identify four (4) classes of classification of cleft lip. (4 marks)
   Model answer

   • Complete cleft lip
   • Incomplete cleft lip
   • Cleft lip with cleft palate
   • Cleft lip without cleft palate
   • More answers: Other classifications include unilateral vs bilateral, and based on severity.

2.

1. a) Explain the social effects of cleft lip and palate. (6 marks)
   Model answer

   • Psychological impact: Low self‑esteem, social anxiety, and stigma.
   • Social isolation: Difficulty forming friendships and dating.
   • Educational challenges: Speech problems lead to learning difficulties.
   • Employment barriers: Bias in hiring and workplace discrimination.
   • Family stress: Financial burden and caregiver fatigue.
   • Cultural stigma: Misconceptions and myths about clefts.
2. b) Define tooth germination and give its clinical significance. (4 marks)
   Model answer

   • Tooth germination: The process where a developing tooth bud splits into two separate buds.
   • Clinical significance: Can lead to supernumerary teeth or impacted teeth requiring orthodontic or surgical intervention.

3. Differentiate between concrescence and dilaceration of teeth. (5 marks)

4. What are the conditions associated with hypodontia? (2 marks)

5. Explain the general factors which enhance structural defects of teeth. (20 marks)

6. Discuss Ludwig's angina under the following headings: (20 marks)

1. i) Predisposing factors
   Model answer

   • Dental infections – untreated dental abscesses or pericoronitis of mandibular molars provide a direct source of bacteria.
   • Poor oral hygiene – plaque accumulation and periodontal disease increase bacterial load.
   • Recent dental extractions – especially of lower third molars, create a portal for infection.
   • Immunocompromised state – diabetes, HIV, malnutrition or chemotherapy reduce host defence.
   • Alcohol and tobacco use – impair mucosal immunity and wound healing.
   • Trauma to the floor of mouth – bruising or laceration facilitates bacterial spread.
   • Systemic illnesses – chronic lung disease or renal failure predispose to severe infections.
   • Previous head‑neck radiation – damages salivary glands and mucosal barriers.
   • Obstructive sleep‑apnoea devices – can cause micro‑injury and harbour bacteria.
   • Age extremes – very young children and elderly have weaker immune responses.
2. ii) Clinical presentations
   Model answer

   • Rapid swelling of the submandibular, sublingual and submental spaces, often bilateral.
   • Firm, woody induration of the floor of mouth with elevation of the tongue (tongue protrusion).
   • Mouth opening limitation (trismus) due to involvement of the pterygoid muscles.
   • Painful dysphagia and difficulty speaking (muffled “hot potato” voice).
   • Fever, malaise and tachycardia indicating systemic infection.
   • Redness and warmth over the neck and submandibular region.
   • Crepitus if gas‑forming organisms are present.
   • Drooling due to inability to swallow saliva.
   • Neck lymphadenopathy – tender, enlarged submandibular nodes.
   • Airway compromise signs – stridor, cyanosis, use of accessory muscles.
3. iii) Management
   Model answer

   • Airway protection – place patient in semi‑recumbent position, have suction ready, consider early tracheostomy or fibre‑optic intubation if airway threatened.
   • Empirical broad‑spectrum IV antibiotics – e.g., ampicillin‑sulbactam or clindamycin + metronidazole covering aerobic and anaerobic oral flora.
   • Surgical drainage – intra‑oral incision of submandibular/submental spaces; extra‑oral incision if needed, with placement of drains.
   • Adequate hydration and nutrition – IV fluids, consider nasogastric feeding if oral intake impossible.
   • Pain and fever control – analgesics (paracetamol, NSAIDs) and antipyretics.
   • Adjunctive therapy – chlorhexidine mouth rinse, warm compresses to reduce swelling.
   • Monitoring – frequent assessment of airway, vital signs, and drainage output.
   • Culture and sensitivity – obtain pus for microbiology to tailor antibiotics.
   • Dental source control – extraction of the infected tooth or root canal treatment after acute phase.
   • Follow‑up imaging – repeat CT or ultrasound to ensure resolution of collections.
4. iv) Complications
   Model answer

   • Airway obstruction – rapid spread can cause tongue elevation, floor‑of‑mouth swelling and respiratory failure.
   • Sepsis and septic shock – systemic inflammatory response leading to multi‑organ dysfunction.
   • Mediastinitis – infection tracks down the fascial planes into the mediastinum.
   • Necrotizing fasciitis – extensive soft‑tissue necrosis requiring debridement.
   • Empyema or pleural effusion – extension into the thoracic cavity.
   • Jugular vein thrombosis – thrombophlebitis of the internal jugular vein (Lemierre’s syndrome).
   • Osteomyelitis of the mandible – infection spreads to bone.
   • Cranial nerve palsies – involvement of the hypoglossal or facial nerves.
   • Renal failure – from severe sepsis or nephrotoxic antibiotics.
   • Long‑term scarring – fibrosis of neck tissues causing restricted neck movement.