ORAL MEDICINE

DIVISION OF DENTISTRY
SCHOOL OF MEDICAL SCIENCES

ORAL MEDICINE LEARNING GUIDE

3rd & 4th YEAR DENTAL STUDENTS

2020 - 2021

Edited by: Raj Ariyaratnam, Zahid Khan & Matthew Grindrod

 THANK YOU
Dr A.J. Duxbury
Senior Lecturer/Honorary Consultant Oral Medicine (Retired)

On behalf of the Oral Medicine Teaching Team a big thank you

for your invaluable contribution to the teaching and learning of
Oral Medicine at the Division of Dentistry, University of
Manchester over many years.

We wish you and your wife Jackie a very long happy and
healthy retirement.
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 CONTENTS

1. Oral Medicine……………………………………………………….. Page 4

1.1 Overall Aims & Objectives………………………………………… Page 5

1.2 Case Based & Practical (3rd Year)…………………………..……. Page 6

1.3 Clinical Sessions (4th year)………………………………………… Page 8

Learning Sources……………………………………………………. Page 9

2.0 Case Based, & Related Practicals (3rd Year)……………………... Page 10

2.1 Overview………………………………………………………......... Page 10

2.11 Case Based Sessions……………………………………….…….. Page 10

2.12 Practical Sessions…………………………………………………. Page 10

2.2 Sessional Content…………………………………………………. Page 11

Session 1. Patient History Taking & Examination……………… Page 11

Session 2. Dry Mouth……………………………………………… Page 12

Session 3. Oral and Peri-Oral Infections…………………….…… Page 17

Session 4. Red, White & Pigmented Lesions………………… Page 23

Session 5. Swellings Affecting the Oral & Peri-Oral Tissues…. Page 29

Session 6. Oral Ulceration……………………………………….. Page 36

Session 7. Facial Pain……………………………………….…… Page 42

Appendix …………………………………………………………. Page 47

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Oral Medicine Course (3rd Year and 4th Year)

Oral Medicine is the area of special competence concerned with health

of and diseases involving the oral and pan-oral structures.

It includes:

a) Principles of medicine that relate to the mouth as well as research

in biological, pathological and clinical spheres.

b) Diagnosis and medical management of diseases specific to the

orofacial tissues and of oral manifestations of systemic diseases.

c) The management of behavioral disorders (e.g. anxiety disorders

associated with Oral problems) and the oral and dental treatment
of medically compromised patients.

4
 Oral Medicine Course (3rd Year and 4th Year)

1.0 Overview

1.1 Overall Aims and Objectives

Aim

To achieve an understanding of those conditions relevant to the study of oral

medicine.

Objectives

By the end of the course students should: -

1) Have a comprehensive knowledge of the common diseases affecting the

oral mucosa, other soft tissues, the salivary glands, facial bones and the
temporo mandibular joint, and of the oral manifestations of systemic
disease.

2) Be able to diagnose facial pain of dental and non-dental origin.

3) Be able to recognise and know how to prevent potential malignancy and

malignancy.

4) Be able to carry out simple diagnostic tests appropriate to oral medicine.

5) Be able to effectively communicate with patients and to write a full and

accurate medical record of a patient visit.

The aim and objectives of this course are in part supplemented and/or
complemented by the courses in Oral Radiology, Oral Surgery and General
Medicine and Surgery.

Oral Medicine Roadmap Video

Link:
https://youtu.be/8QkA0CZRcKg

5
1.2 Case Based and Related Practical (3rd Year)

Students attend during term time on Monday, Tuesday, Thursday and Friday
afternoons.

Content:
OM S1 Seminar Patient History Taking and Examination

Practical: Introduction to Oral Medicine Clinic

Introduction to Professionalism by Senior Dental
Nurse
Recognition of normal structures

OM S2 Seminar Dry Mouth (Xerostomia)

Introduction

Case presentations

Practical Sialometry, Saliva therapeutics

Demonstration and Assessment - Nurse

OM S3 Seminar Oral and Peri-Oral Infections

Introduction

Case presentations

Practical Swabs and smears, therapeutics

Demonstration and Assessment - Nurse

OM S4 Seminar Red, White & Pigmented Lesions

Introduction

Case presentations

Practical: Biopsy tray demonstration - Nurse

Cross Infection Control/Assessment - Nurse

OM S5 Seminar Swellings Affecting the Oral & Peri-Oral Tissues

Introduction

Case presentations

Practical: Palpation and description of swellings - Tutor

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OM S6 Seminar Oral Ulceration

Introduction

Case presentations

Practical: Blood and Drugs

Blood tests – (Colour coded tube)

Demonstration - Nurse

Drugs and Therapeutics Demonstration,

Prescription writing and Assessment - Tutor

OM S7 Seminar Orofacial Pain

Introduction

Case presentations

Practical: Assessment of cranial nerve function

Demonstration and Assessment - Tutor

OM S8 Revision

Feedback from students regarding the course

7
1.3 Clinical Sessions (4th Year)

Students attend during term time on Monday, Tuesday, Thursday and Friday
mornings at the Oral Medicine clinic on the ground floor of the dental Hospital.
Sessions commence at 9.00 a.m. and are of some 3½ hours duration.
Students attending these clinics must observe the regulations in respect of
Health and Safety, Confidentiality of Information and Dress Code (it is a
Trust requirement that all those in contact with patients must be identifiable –
name badges must be worn). These sessions build on the knowledge and
skills learnt during the 3rd Year Course.

Aim
 To diagnose and plan the treatment for patients referred specifically for
conditions relevant to that area of Dentistry known as Oral Medicine.
 To be able to manage an oral medicine patient independently to the
level of a safe beginner.

Learning Outcomes - At the end of this course students should:

1. Be able to effectively communicate with patients, competently take a case

history, write detailed and accurate medical, dental and social records

2. Be able to perform an examination of oral and perioral tissues in a

methodical way by using the two mirror technique and be able to record
the findings.

3. Be able to apply their findings to make a differential diagnosis.

4. Be able to arrange appropriate special investigations through

communicating with the nursing staff and support workers

5. Wherever necessary able to execute simple special tests (swabs, swears,

sialometry, etc.) on patients.

6. Be able to write a prescription for internal and external pharmacies.

Be able to collect the prescribed medicine from the Oral Medicine

pharmacy and deliver to patients with correct instructions.

7 Be able to diagnose pain of dental and non-dental origin.

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 Learning Sources

Core reading:

1) Cawson's essentials of oral pathology and oral medicine – 9th Edition.

Odell, E. W. 2017

2) Soames' & Southam's oral pathology - Max Robinson, Keith Hunter,

Michael N. Pemberton, Philip Sloan 2018

Recommended reading:

1) Lucas's pathology of tumors of the oral tissues - Cawson, R. A., Lucas,

Raleigh Barclay 1998

2) Color atlas of oral pathology - Eveson, J. W., Scully, C. M. 1995

3) Tyldesley's oral medicine - Field, E. Anne, Longman, Lesley, Tyldesley, W.

R. 2003

4) A clinical guide to oral medicine - Lamey, Philip-John, Lewis, Michael A.

O. 2011

5) Slide interpretation in oral diseases - Scully, C. M. 1999

6) Handbook of oral disease: diagnosis and management - Scully, C. M.

2001

7) Oral disease - Scully, C. M., Cawson, R. A. 1999

8) Scully's medical problems in dentistry - Scully, Crispian 2014

9) Oral pathology - Soames, J. V., Southam, J. C. 2005

10) Evidence Based Dentistry for Effective Practice. Clarkson, J; Harrison, J.

E; Ismail, A.I; Needleman, I; Worthington, H.

11) Master Dentistry – Oral and Maxillofacial Surgery, Radiology, Pathology

and Oral Medicine. Coulthard, P; Horner, K; Sloan, P; Theaker, E.
(Second Edition – 2008) (Reprinted 2010)

12) Assessment and Management of Orofacial Pain. Zakrzewska, J. M;

Harrison, S.D (latest edition)

13) Scottish Dental Clinical Effectiveness Programme. Drug Prescribing for

Dentistry, Dental Clinical Guidance (Latest Edition)

14) Public Health England. Delivering better oral health: an evidence-based

toolkit for prevention (Latest Edition)

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2.0 Case Based, and Related Practicals (3rd Year)

2.1 Overview

2.11 Case based sessions

These sessions take place in seminar rooms 1 or 5 of the Dental Hospital. Before
each session students, working in groups of two-three, will prepare each case.
During the session following the introduction to the topic each group of students will
present, using a simple bulleted format, their interpretation of their case. Discussion,
facilitated by the tutor will follow. At the end of the session the group will identify any
points still requiring clarification and begin to set their study agenda for the next
session.

Aim
 To facilitate history taking and diagnosis, and produce an understanding of
the role of special tests. Treatment planning will be considered where
appropriate.

Learning Outcomes - At the end of these sessions students should be able to:

 Present the history of an oral problem and interpret it in a logical fashion.

 Consider and determine the relevance and importance of the medical and
social history.
 Have a reasoned approach to providing a differential diagnosis and
understand the role of special tests relevant to Oral Medicine.

2.12 Practical Sessions

These will be based on small group learning. Students will undertake practically
based work related to the session topic. This will include practice related to special
tests e.g. swabs and smears, sialometry and haematology that are designed to
facilitate the recognition of clinical features associated with the recognition of
diseases associated with oral medicine.

Aim
To achieve an understanding of those special tests of specific relevance to oral
medicine and an appreciation of the clinical features of diseases affecting the
orofacial region.

Learning Outcomes - at the end of the course students should be able to :-

 Carry out, understand or be able to interpret common special tests of

particular relevance to the practice of oral medicine.
 Recognise the normal appearance of the oral and facial tissues visible at
clinical examination.
 Recognise the typical clinical features of the common conditions relevant
to the practice of oral medicine.

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2.2 SESSIONAL CONTENT

Session 1 (OM S1) Patient History Taking and Examination

Aim
 To further develop and apply, in the context of Oral Medicine, the
knowledge and skills already acquired in terms of taking a history and
performing an examination of the oral and peri-oral tissues.

Learning Outcomes:

Knowledge:

 Be aware of their existing level of knowledge and perceived skill with

respect to the processes of taking a history and performing an
examination.
 Appreciate how this knowledge and skill can be incorporated into and
further developed during their oral medicine practice.
 Understand the significance of communication skills in the context of
obtaining a history from and carrying out an examination of a patient.

Skills:

 Be well orientated in the environment of the Oral Medicine Clinic

 Be able to demonstrate their ability to obtain a history
 Be able to demonstrate their ability to perform an examination of the oral
and peri-oral tissues
 Be able to recognise normal features of the oral mucosa

Methods

 Group discussion of the process of taking a history, content and methods,

paying particular attention to communication skills.
 Group discussion of the process of carrying out an examination, content
and methods, paying particular attention to communication skills.
 Tour of the Oral Medicine Clinic, familiarisation with equipment.
 As part of this examination students will be expected to identify normal
features.
 Students need to learn the two mirror examination technique.

Materials

Clinical photographs of normal oral structures

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Session 2 (OM S2) Dry Mouth

Aim:
 To obtain an understanding of the aetiology, clinical features, special tests
available to assist diagnosis, and the approach to treatment of the problem
of a dry mouth.

Learning Outcomes:

Knowledge:

 Have a fundamental understanding of the aetiology and differential

diagnosis of the problem of a 'dry mouth.'
 Have an understanding of the importance of the selection of appropriate
investigations in the patient suffering with a dry mouth.
 Have knowledge of normal and abnormal results, which may be found, on
investigation of patients complaining of a dry mouth.
 Have knowledge of the therapeutic strategies and agents employed in the
treatment of patients complaining of a dry mouth.

Skills:

 To recognise the appearance of a dry mouth and its associated lesions.

 To be able to perform sialometry on a patient.

Core topics

Anatomy of salivary glands, the formation and function of saliva.

Common causes of dry mouth including but not limited to:
 Age, dehydration, Sjögrens disease, drugs, systemic
diseases, obstruction of salivary glands, radiotherapy.

Possibly sequelae of dry mouth.

Investigations required to aid diagnosis.
Management of dry mouth.

Methods

 The preparation and discussion of clinical cases (OMS2i to iv) by students,

facilitated by a member of staff.

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 OM C2 Cases

Case i

A 52 year old female attends your practice complaining of having a dry mouth.

HPC Longstanding feeling of a dry mouth.

Drinks liquids frequently to help swallow dry food.
Recurrent swellings and points to the bilateral pre-auricular area.
Difficulty in wearing dentures.

PMH Arthralgia – Under Rheumatology for monitoring of connective tissue disease.

Gritty sensation in eyes.
Chilblains on hands and feet.
Renal disease.

SH Saleswoman. Smokes 20 cigarettes per day. No alcohol.

OE Extraorally - Erythema on bilateral cheeks (malar rash)

Conjunctivitis of both eyes
Digit ulcers noted

Intraorally - Edentulous
Dryness of mucosa membranes

Discussion points

 What causes of dry mouth are associated with dry eyes and how are they
classified?
 What other conditions could be associated with these symptoms?
 Comment on the significance of the findings extra-orally and her medical history?
 Comment on the significance of the swellings?
 What tests may be relevant to confirm the diagnosis?

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Case ii

A 70 year-old female attends the oral medicine clinic complaining of a dry mouth,
after being referred by her GDP. She attends very short of breath.

HPC Okay until recently. Has been seeing a lot of her G.P. in the last year. During
this period her mouth has got steadily worse.

PMH Congestive heart failure - worsening over last year

Depression - severe. Recent onset
Osteoarthritis - hands and knees
Drugs - captopril, furosemide, amitriptyline

SH Housewife. Self-caring but limited mobility

Widow (recently lost her husband)

OE Extraorally - Bony nodules on proximal interphalangeal joints

Intraorally - Edentulous
Denture stomatitis of upper denture bearing area.
Dryness of mucous membranes

Discussion points

 Discuss the possible causes of this lady’s dry mouth

 Why may she have developed denture stomatitis
 What advice for the patient may help?
 Discuss the relevance of her medical history
 What is the difference between osteoarthritis and rheumatoid arthritis?

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Case iii

A 59 year old female attends your practice complaining of a dry mouth.

HPC Severe dryness over last two years since cancer treatment

PMH Nasopharyngeal carcinoma of the left side of the mouth.

Treated with radiotherapy.
Drugs - Nil

PDH Irregular attender.

SH Saleswoman. Ex- smoker (stopped 2 years ago) Alcohol - Nil

OE Extraorally - Lesions on skin over left face

Intraorally - Dryness of mucous membranes

Widespread caries

Discussion points

 Why does this patient have a dry mouth?

 What is the difference between a dry mouth and Xerostomia?
 Discuss her current and future dental requirements, including extractions.
 Discuss methods of stimulating saliva production
 Discuss other clinical problems related to head and neck radiotherapy

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Case iv

A 7 year old boy attends your surgery accompanied by his mother. She informs you
he has been complaining of dry eyes and of having a dry mouth.

HPC Noticed for several years. Excessive thirst and frequency of micturition.
Recurrent conjunctivitis

PMH Nil
Mother had similar symptoms of dry mouth and dry eyes

PDH Regular attender. Brushes teeth twice daily. His diet was low in sugar

OE Extraorally - Dry crusted lips

Intraorally - Advanced non cariogenic tooth surface loss
Dryness of the mucous membrane

Investigations Blood tests requested

Ultrasound scan revealed absence of both the parotid and
submandibular salivary glands.

Discussion points

 What blood tests would you request?

 What is the relevance of the findings from the ultrasound scan and what is your
differential diagnosis?
 How would the symptoms of dry eyes and family history fit with this diagnosis?
 What are the other specialties that may be involved in the management of this
child?
 How would this child be managed?

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Session 3 (OM C3) Oral and Peri-Oral Infections

Aim:
 To obtain an understanding of the clinical features, special tests assisting
diagnosis, and the approach to treatment associated with the more common
oral infections (non-dental) listed below.

Learning Outcomes By the end of the session students should:

Knowledge

 Have achieved by background reading, the presentation of cases, the use

of practice spotters, and clinical practice, an understanding of: the
aetiology, clinical and diagnostic features, approach to treatment, of the
infections listed below.
 Have an understanding of the role of special tests in respect of the
diagnosis and treatment of the infections listed below.
 Have knowledge of the therapeutic strategies and agents employed in the
treatment of the infections listed below.

Skills

 Be able to recognize the clinical features associated with the infections

noted below.
 Be able to undertake swab and smear tests.
 Be able to write a prescription.

Core Topics:

Candidal infections: (Be aware of primary and secondary causes)

Acute  Pseudomembranous candidosis

 Atrophic/ Erythematous candidosis

Chronic  Atrophic candidosis (denture stomatitis) /

Erythematous candidosis (non-denture related)

 Pseudomembranous candidosis

 Hyperplastic candidosis (candidal leukoplakia)

 Mucocutaneous candidosis
Other  Angular cheilitis (may be bacterial or mixed)
candida
associated  Median rhomboid glossitis
lesions

17
Viral infections

Human Herpes  Herpes Simplex Virus (HSV 1 & 2)

Viruses  Acute herpetic gingivostomatitis
 Herpes labialis

 Varicella Zoster Virus (VZV)

 Chicken Pox
 Shingles

 Epstein-Barr Virus (EBV)

 Infectious Mononucleosis (glandular fever)
 Oral Hairy leukoplakia
 Nasopharyngeal carcinoma
 Burkitt Lymphoma

 Cytomegalovirus (CMV)

 Kapsosi’s Sarcoma Herpesvirus (previously

known as HHV-8)
Coxsackie Viruses A
(A & B)  Herpangina
 Hand foot and mouth disease
Human  Types 16 & 18 (Oropharyngeal carcinoma)
Papillomavirus  Squamous cell papilloma
(HPV)  Hecks disease (Types 13 and 32)
Paramyxoviruses  Mumps
 Measles
HIV-related  As above
infections

Bacterial:

Bacterial  NUG
 NUP
 Syphilis
 Tuberculosis
 Acute Bacterial Sialadenitis
 Actinomycoses
 Impetigo
 Gonorrhea

18
OMC3 Cases

Case i

Female 75 years of age attended the oral medicine department after being referred
by her GDP regarding redness under her denture.

C/o Soreness under the upper denture.

HPC Referred by GDP regarding an erythematous area related to the upper

denture not previously noted by the patient. Previous treatment nystatin
pastilles - no benefit. The patient reported it has been sore for a while.

PDH Current dentures loose, 15 years old and worn at night.

PMH Anaemia
Angina
Drugs - B12 injections
GTN Spray/Aspirin

SH Smokes 10 cigarettes per day, no alcohol

OE Extraorally - erythema with yellow crusting at the angles of the mouth

Intraorally - see below

Discussion points

 Relate the patient’s complaint and reason for referral to possible causes.
 What is the relevance of the extraoral observation?
 Why was the treatment provided by the GDP apparently ineffective?
 What is the relevance of the medical and social history?
 Suggest what further investigations may be undertaken and propose a treatment
plan based on your suggested diagnosis.

19
Case ii

Female 35 years of age referred by GDP to oral medicine department for a second
opinion regarding the palatal lesion. The patient was not aware of any problem.

HPC No prior treatment.

PMH Asthma
Allergies – penicillin
Drugs – Blue inhaler used occasionally. Brown inhaler used daily

SH non-smoker, 11 units of alcohol per week.

OE Extraorally NAD

Intraorally See below

Discussion points

 What simple clinical finding would be helpful in confirming a likely diagnosis?

 What is the relevance of the medical history?
 What other special test would be helpful in confirming your diagnosis?
 What management would you propose?

20
Case iii

A male aged 60 years presents at your dental practice complaining of soreness on

the angle of his mouth.

HPC Problem arose 6 months ago, treated with nystatin drops by GP but this
produced only limited improvement.

PMH Hypertension
Recent deep vein thrombosis
Drugs - atenolol, warfarin (INR range 1 – 6)
Simvastatin 40mg

SH 30 cigarettes per day. 20 units of alcohol per week.

OE Extraorally - erythema angles of the mouth, node upper right cervical region

Intraorally - See below

Discussion Points

 What could be the aetiology of the white patches and how would you confirm this
on clinical examination?
 Could the palpable node be of any relevance?
 What special tests would you suggest are required; indicate the importance of
these?
 Describe what histological features could be seen?
 Was it reasonable to prescribe nystatin drops (suspension)?
 Discuss further management options

21
Case iv

A 7 year old male attends your practice as an emergency appointment. He is

complaining of severe pain from his mouth and generally feeling unwell.

HPC Problem arose 3 days ago as an 'ulcer' on the tongue. The problem spread to
involve the rest of mouth and lips. Unable to eat. Feels unwell. Sister had a
similar but mild problem recently. Treatment - taken paracetamol. Never had a
similar problem previously other than the occasional ulcer on the buccal
mucosa.

PMH NAD

SH School boy; lives with parents and 2 year old sister.

OE Extraorally - crusted lips, tender cervical and submandibular nodes. Painful

swelling affecting the tip of middle finger, nail biting.

Intraorally - see images below

Discussion Points

 What is the relevance of:

a) The problem his sister had?
b) His swollen finger?

 What is the likely diagnosis and how does the history and examination suggest
this? Why did his younger sister have mild symptoms?
 What investigations could be used to confirm your suggested diagnosis?
 What advice would you give to this patient?
 What problems may arise in the future?

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Session 4 (OM S4) Red, White & Pigmented Lesions

Aim

 To recognise normal and abnormal oral mucosa

 To classify red, white & pigmented lesions and understand their clinical
significance.
 To obtain an understanding of the clinical features of common red, white &
pigmented lesions, the special tests to achieve correct diagnosis and a logical
approach to treatment.

Outcomes: By the end of the session students should:

Knowledge

 Be able to present a simple classification of red, white & pigmented lesions

arising in the oral mucosa.
 Be able to define "leukoplakia" and “erythroplakia” and be able to
understand the different types of leukoplakias.
 Be able to understand the concept of Potentially Malignant Disorders
(PMD’s) by using examples from oral lesions.
 Be familiar with the clinical features associated with malignant
transformation and should be able to associate/correlate those with the
histopathological features.
 Be familiar with the aetiology and clinical features of common red, white &
pigmented lesions (see list below).
 Have an understanding in the role of special investigations, especially
biopsy procedures with respect to the diagnosis of red, white & pigmented
lesions.

Skills

 To be able to recognise and describe the different types of red, white and
pigmented lesions.
 To be able to identify the instruments in a biopsy tray and be able to
explain the purpose of those instruments including Punch biopsies and
sutures.
 To be familiar with the cross infection control regarding biopsy procedure.
 To be familiar with the principles of biopsy procedure including
transportation of the biopsy specimen (transport mediums for different type
of specimens, histopathology forms and biopsy leaflets).

23
Core Topics (this is not an exhaustive list):

White / Red Patches:

Normal/Reactionary/Acquired/Traumatic Infections

Keratosis/Hyperkeratosis Candida

Smokers Keratosis/Stomatitis Nicotina Viral

Chemical burns
Fordyce spots
Geographic tongue Hypersensitivity Reactions

Submucous fibrosis Lichen Planus

Leukoedema Lichenoid Reactions

Other
Leukoplakia
Erythroplakia
Squamous Cell Carcinoma

Pigmentation:

Endogenous – Acquired
Endogenous – Neoplastic
Addison’s disease (melanin)
Malignant melanoma
Drug-induced (melanin)
Post-inflammatory (melanin)
Smokers melanosis (melanin)
Melanotic macule (melanin)

Exogenous
Amalgam Tattoo
Endogenous- Developmental Heavy metal deposition
Physiological (melanin) Black hairy tongue
Peutz Jegher’s (melanin)
Haemochromatosis (haemosiderin)
Naevus (melanin)

24
OMS4 Cases

Case i

A 55 year old gentleman attends your practice for an emergency appointment after
recently moving into the area. On examination you notice a lesion on his palate.

C/o Pain and swelling from his upper right back tooth. No reported history from the
palatal lesion. The patient was not aware of its presence.

HPC Swelling which has been worsening over the past few days. Didn’t sleep last
night. Worse when he lies down. Constant throbbing pain.

PMH Type 1 diabetes

Asthma
Drugs - Insulin
- Brown and blue inhalers for asthma (Patient can’t remember the
names)

PDH Irregular attender

SH Pipe smoker

OE Extraorally - NAD

Intraorally - See view below

Discussion points

 Significance of history of problem

 Significance of medical history
 Significance of social history
 Significance of dental attendance
 Differential diagnosis
 Special investigations
 Principles of treatment
 Discuss the incidental finding on the
lower lip

25
Case ii

A 45 year old lady attended the oral medicine department complaining of having a
sore mouth, having been referred by her dentist.

HPC Referred to oral medicine clinic with the

problem of sore mouth by her GDP
Soreness of 6 months duration made
worse by eating spicy foods. Itchy rash
on her wrists.

PDH Irregular dental attender

PMH Diabetes
Arthritis

Drugs - Ibuprofen (Symptom related use)

- Tablets for diabetes taken twice a day (unsure of name)

SH Company executive, stressful job

OE Heavily restored molar teeth, old amalgam restorations

Extraorally - See image above
Intraorally - See intra-oral images:

Discussion points

 Significance of medical history

 Significance of social history
 Significance of dental history
 Significance of the lesions on forearm
 Differential diagnosis
 Principles of management
 Drugs related to Lichenoid Mucositis
 What is the significance of the lesion on the left buccal mucosa?

26
Case iii

A 50 year old lady attended your practice as an emergency complaining of having a

sore tooth on the right hand side of her mouth. She also reported soreness in her
cheeks.

HPC Constant throbbing pain from her tooth, worse on laying down and affecting
sleep. Pain in cheeks has been present for a while and difficulty in opening
her mouth. She feels her mouth opening has become limited over the past
few years.

PMH High blood pressure and ankle swelling

High cholesterol

Drugs - Water tablets (unsure of name)

SH Long standing habit of "paan" chewing,

PDH Occasional visitor to dentist.

OE Extraorally - NAD
Intraorally - White patches on buccal mucosa with occasional erythematous
areas.
Dentition - attrition with sharp cusps and marked orange brown staining.

Discussion points

 Discuss the medical history

 Discuss the social history
 Discuss the dental history
 Differential diagnosis
 Principles of management
 Discuss the culture of betel nut use

27
Case iv

A 65 years old male is urgently referred by his General Dental practitioner regarding
a white patch in the floor of the mouth.

HPC The patient had attended a GDP after many years absence regarding new
dentures. At the first visit his Dentist noticed the white patch and decided to
seek a further opinion. The patient was aware but not concerned.

PMH Hypertension / Ischemic heart disease

Diabetes, diet controlled

Drugs Atenolol
Aspirin 75mg daily
GTN as required

SH Has smoked 30 cigarettes daily for 40years, 40 units of alcohol (Whiskey) per
week.

OE Extraorally - NAD
Intraorally - See view 1

View 1 View 2

Discussion points

 Significant aspects of the history of the presenting complaint

 Significance of the medical history
 Significance of the social history
 Where the biopsy should be taken from?
 Comment on the slide prepared from the biopsy (View 2)
 What other special tests might be useful
 Discuss the terms “premalignant lesion” and “potential malignant disorders”

28
Session 5 (OM S5) Swellings Affecting the Oral and Peri-
oral Tissues
Aim
 To obtain an understanding of the aetiology, clinical features and special tests
available to assist in the diagnosis of swellings affecting the oral and peri-oral
tissues.

Learning Outcomes: By the end of the session students should: -

Knowledge

 Be able to apply a surgical sieve to determine the aetiology of swellings

affecting the oral and peri-oral tissues.
 To have an appreciation of the signs and symptoms which permit a
differential diagnosis to be reached with respect to swellings of the oral
and peri-oral tissues.
 To have knowledge of the special tests appropriate to the investigation of
swellings of the oral and peri-oral tissues.
 To be able to select treatment methods appropriate to particular types of
oral and peri-oral swelling

Skills

 To experience the different textures and consistencies associated with

swellings of the oral and peri-oral tissues.
 To be familiar with the techniques used in the investigation of swellings
 To recognize the clinical features associated with the swellings of the oral
and peri-oral tissues.
 To be able to describe terms used for the consistency of oral swellings

Methods

 The preparation and discussion of clinical cases by students, facilitated by

a member of staff
 Practical based exercises in the palpation of 'swellings'

29
Core Topics (this is NOT an exhaustive list):

SOFT TISSUE Fibroepithelial polyp, squamous papilloma,

INFLAMMATORY vascular/pregnancy epulis, fibrous epulis, giant cell
epulis, pyogenic granuloma, drug induced gingival
hyperplasia

VASCULAR Haemangioma, vascular malformations

NEURAL Neuroma, neurofibroma

ADIPOSE Lipoma

SALIVARY GLAND Reactive: Mucocele, necrotising sialometaplasia

Infections: Bacterial Sialadenitis, Viral parotitis
Immune mediated: Sjogren’s syndrome
Benign tumours (adenomas): Pleomorphic adenoma
Malignant (adenocarcinomas): Mucoepidermoid
carcinoma
Other: Sialosis

ODONTOGENIC CYSTS Radicular, dentigerous, eruption, periodontal, gingival,

keratocyst etc.

DEVELOPMENTAL Nasopalatine duct, nasolabial, dermoid, epidermoid etc.

CYSTS
OTHER BENIGN Ameloblastoma
SWELLINGS
MALIGNANCY SCC, lymphoma, Kaposi Sarcoma, Mucoepidermoid
carcinoma etc.

ORAL Orofacial granulomatosis (OFG), Crohns, Sarcoid etc.

GRANULOMATOUS
SWELLINGS
OTHERS Angioedema, hereditary gingival fibromatosis etc.

30
 OM S5 Cases
Case i

A 55 year old male attends the oral medicine department following referral from his
GDP. He has been referred regarding a swelling in the floor of his mouth.

HPC Two month history of recurrent swelling and pain on the left hand side under
his tongue at meal times. Two days ago swelling arose and gradually
enlarged to present size. Feels very tender. Patient is having difficulty eating,
and has noticed a bad taste in his mouth.

PMH Rheumatoid arthritis

SH Retired due to ill health, lives alone, finds it very difficult to use public
transport.

OE Extra-orally - Swelling left submandibular region.

Firm, tender and warm on palpation.
Overlying skin reddened.
Upper cervical lymph nodes palpable, soft and tender.

Intra-orally - View 1

Generalised firm, tender swelling left side floor of mouth.

Swelling palpable bimanually.

View 1 View 2

Discussion points

 What was the cause of the recurrent swelling the patient experienced originally?
 What is the cause of her current swelling?
 What special investigations and treatment are appropriate in this case?
 Discuss what you can see on the radiograph (View 2).
 What are the additional features you would mention in your referral letter
regarding swellings in general?

31
Case ii

A 27 year old male attended the maxillofacial department following an urgent referral
from his dentist regarding a hard swelling on the lower left hand side of his jaw.

HPC Eighteen month history of slowly enlarging, hard swelling. Asymptomatic.

PMH Recently referred by his GMP to a dermatologist for investigation of an 'ulcer'

on the skin of his left shoulder

SH Married, one son aged 18 months. Plays rugby at the weekend.

OE Extra-orally - No abnormality of overlying skin

No lymphadenopathy

Intra-orally - Hard expansion of mandible extending from the

ascending ramus and anteriorly to the first molar
Overlying mucosa appears normal
No tenderness on palpation
No mobility of associated teeth

Discussion points

 Bearing in mind the clinical history and findings on examination suggest a

differential diagnosis for this swelling?
 Comment on the radiograph
 What special investigations and treatment are appropriate in this case?
 What would you advise him about playing rugby?

32
Case iii

A 40 year old female attended the oral medicine department complaining of a

swollen gum around one of her teeth.

HPC Swelling first noticed six weeks ago. Since then has gradually enlarged. Only
painful if caught with food or toothbrush. Reluctant to brush teeth in this area
as swelling bleeds on brushing. Can't think of anything that could have
caused the swelling.

PMH Chest infection three months ago, treated with antibiotics.

Drugs - Contraceptive pill

SH Lives with partner. Two children aged 20 and 18, both living away from home.
18 year old has just started university. Smokes 10 cigarettes a day and has
done so for the past 26 years. Drinks 5 units of alcohol a week.

OE Extra-orally - No abnormality detected

Intra-orally - View 1

View 1 View 2

Discussion points

 What is the most likely diagnosis in this case?

 Discuss the possible contributing factors to formulate your diagnosis
 Suggest appropriate further investigations and treatment.

33
Case iv

A 20 year old male attended your practice after booking an appointment. He is

complaining of having a large swelling on his lower lip.

HPC Swelling first noticed a year ago. Initially seemed to gradually increase in size
over a period of about a month and then disappeared, usually after he caught
it with his teeth, only to gradually enlarge again. For past couple of months
has remained constant in size. No discomfort associated with the swelling.

PDH Regular attender. Traumatised upper incisors whilst playing football.

PMH Fit and well.

SH Single. Shares house with a group of friends. Non-smoker, drinks about 30

units of alcohol a week. Keen amateur footballer. Works as a gas fitter.

OE Extra-orally - NAD

Intra-orally - See below:

Discussion points

 Suggest a differential diagnosis for this swelling. Support this with a reasoned
explanation using the patient’s history.
 Discuss the consistency of this swelling
 How should the lesion be treated? Is it likely to recur?
 How would your diagnosis have differed if the swelling had affected the upper lip?

34
Case v:

Female aged 24 presents to a GDP complaining of her upper lip swelling and oral
ulceration.

HPC Swelling of upper lip first noticed six months ago. This was initially intermittent
but has now become persistent. Concerned regarding cosmetic appearance
of lips. Has noticed flare ups after eating certain foods. Her lips can become
dry with cracking in the corners. Occasional ulcers on cheeks and points to
lower buccal sulcus.

PMH Recently seen GP due to increased bowel movements and blood in stools.
She has also recently lost weight. Following initial blood tests, she was started
on iron therapy.

Drugs - Ferrous Sulphate, Loperamide

SH Recently left her job as a beautician. Avoids social meet ups with friends.

OE Extra-orally - view 1

Intra-orally - view 2

View 1 View 2

Discussion points

 Describe what you can see in Views 1 & 2

 What is your differential diagnosis?
 Discuss the relevance of her medical history and why she may have been
commenced on iron tablets
 Describe what other oral features may be seen with this diagnosis?
 Suggest appropriate management. What other specialties may be involved?
 Would you give any advice regarding her diet?

35
Session 6 (OM S6) Oral Ulceration

Aim
 To recognise the changes in oral mucosa with reference to ulceration, erosion
and atrophy and to obtain an understanding of principles of management of
different types of ulceration in the mouth.

Learning Outcomes: By the end of the session students should: -

Knowledge

 Be able to present a simple classification of oral ulceration.

 Be familiar with clinical presentation and range of appearance of different
types of oral ulcers.
 Should be familiar with the aetiological factors and aggravating factors of
recurrent oral ulceration.
 Be familiar with the special investigations (especially haematological
investigations) in relation to recurrent oral ulcerations and the purpose of
performing those investigations.
 Be able to understand the principles of treatment of recurrent oral
ulceration.
 Be able to differentiate primary oral ulceration from secondary oral
ulceration (e.g vesiculobullous disorders)
 Be able to appreciate that oral ulceration can be a manifestation of a
systemic disorder
 Be familiar with principles of Venepuncture

Skills

 Be able to recognise and describe accurately the different type of ulcers

and be able to differentiate the ulcerative from erosive and atrophic lesion.
 Should be able to identify the different colour coding on the tubes used for
different blood tests.
 Practical venepuncture skills will be provided at the NMGH skill lab (4th
year)
 Be familiar with different type of medications used in the treatment of
Recurrent Oral Ulceration.
 Be competent in prescribing such medications

36
Core Topics (this is NOT an exhaustive list):
Primary Oral Ulceration
(Not preceded by vesicles)
Secondary Oral Ulceration
(Preceded by vesicles)
Trauma
Infection
Recurrent Oral Ulcerations (RAS)
Immunological / Inflammatory
 Dermatoses including oral lichen planus, Lupus
erythematosus.
 Hypersensitivity reactions
Drug-Induced
Neoplasia
Infection
 Viral (Human herpes viruses)
Immunological
 Vesiculobullous disorders
o Pemphigus / pemphigoid
o Erythema Multiforme
o Others: EBA, Angina Bullosa
Haemorrhagica, Dermatitis herpetiformis,
linear IgA disease etc.
37
 OM C6 Cases
Case i

A 21 year old university student attends the emergency clinic complaining of ulcers
in his mouth.

HPC A 5-year history of repeated episodes of oral ulceration. These consisted of 2-

3 ulcers at a time affecting the undersurface of his tongue, gums and cheek.
They usually last for a week and heal by themselves. During examination time
episodes are very frequent and severe.

PMH “Allergic to brown bread”

Gluten free diet advised by GMP
Occasional skin rash

SH Recently stopped smoking, occasional drinker - 4 units per week

FH Mother suffered from mouth ulcers

OE Extraorally – palpable node right submandibular region

Intraorally – see view 1 & 2

View 1 View 2

Discussion points

 What is your provisional diagnosis?

 Significant factors in medical, social and family history
 Aggravating factors and aetiological factors
 Relevant investigations
 Treatment options
 What is the significance of smoking cessation?

38
Case ii

A 45 year old gentleman attends your practice complaining of an ulcer on his tongue.

HPC Referred to oral medicine clinic by his Dental Practitioner regarding a

persistent ulcer on the tongue. The ulcer appeared 2 months ago after he had
bitten his tongue during a mealtime. The ulcer became extremely painful and
getting bigger every week.

PMH Recent heart attack

Drugs Nicorandil

PDH Regular attendee to dentist, wearing a loose partial denture with a clasp

FH Cousin had oral cancer 5 years ago

SH Non-smoker, occasional drinker - less than one unit a week

OE Extra orally - NAD

Intra orally - See image:

Discussion point

 Significance of history of problem

 Significance of medical history
 Significance of dental history
 Differential diagnosis
 Special investigations
 Principles of treatment
 The patient is anxious and starts to get chest pain. Outline management

39
Case iii

A 65-year-old gentleman attends the emergency dental clinic complaining of

toothache.

HPC Worsening pain and coming from the upper left hand side of his mouth. Worse
when laying down and affecting sleep. After intra oral examination you note
an ulcer under his tongue. He first noticed this 2 weeks ago with mild
tenderness and then became pain free. Not responded to supermarket
mouthwash. G.M.P. prescribed antibiotics a week ago but no improvement. A
friend advised him to go to Dental Hospital.

PMH Diabetes – diet controlled

Medication - aspirin - once daily

SH Recently retired. Living alone

Smokes 20 cigarettes per day
Drinks 28 units of alcohol per week

OE See image

Discussion points

 Patients approach to problem

 Any connection between medical history and ulcer
 Connection between social history and present problem
 Differential diagnosis
 Special investigations
 Principles of treatment and sequalae

40
Case iv

A 55-year-old female attends the oral medicine having been referred from her GDP
regarding blood blisters in her cheeks and on her palate.

HPC Recurrent blisters and ulcers on the palate and cheek and sore gums.
Problem started 6 months ago with one or two blisters on the palate.
Now the blisters have increased in number and are more frequent.
Recently the gums have become sore especially during in brushing.

PMH Hypertension
Asthma

Drugs Lisinopril
Becotide
Ventolin
Eye drops (self-prescribed)

SH Smokes 10 cigarettes per day

Occasional drinker
Likes hot coffee and hot soup

OE Intra Oral – See images

Discussion points

 Vesiculo bullous lesions

 Connection between the medical history and oral lesions
 Differential diagnosis
 Special Investigations
 Principles of Treatment
 Necessity for further referral

41
Session 7 (OM S7) Facial Pain

Aim
 To obtain an understanding of how to diagnose facial pain of dental and non-
dental origin.

Learning Outcomes: By the end of the session students should:

Knowledge:

 Have achieved by background reading the presentation of cases and

clinical practice an understanding of the aetiology, clinical and diagnostic
features of pain of dental and non-dental origin, of pain referred within and
to the orofacial region and including chronic facial pain.
 Have an understanding of the role of simple special tests and of their use
in diagnosing pain of dental origin (percussive tests, pulp vitality tests,
tests for motor and sensory activity, the use of radiographs and soft lower
splints).

Skills:

 Be able to recognise the difficulties associated with the diagnosis of pain in

the orofacial region.
 Be able to undertake simple diagnostic tests associated with the diagnosis
of dental pain and altered motor and sensory activity.

Core Topics:

Musculoskeletal Myofascial Pain Dysfunction Syndrome (MPDS). TMD,

fibrous dysplasia, Pagets

Inflammatory Sinusitis, Giant Cell Arteritis (formerly temporal arteritis)

Neurovascular Migraines, Cluster Headaches (TAC’s)

Neuropathic Trigeminal neuralgia, post herpetic neuralgia,

Glossopharyngeal neuralgia

Other Persistent Idiopathic Facial Pain (PIFP) – (formerly

known as atypical facial pain), Atypical odontalgia’s,
burning mouth syndrome

(Odontogenic pain is covered elsewhere in the curriculum)

42
 OM S7 Cases
Case i

Female aged 69 was referred to the oral medicine department complaining of a

burning sensation affecting most of the mouth.

HPC The burning sensation that the patient attributes to her dentures. Consulted
GDP on several occasions over the last 2 years, had 3 new sets of dentures
and many adjustments to these without benefit. Also seen GMP, had tests -
all satisfactory.

 Affects mainly the palate and dorsum of the tongue.

 Arose 2 years ago following death of her husband who died of cancer
 Occurs every day.
 Arises on waking and becomes progressively worse.
 Does not wake patient from sleep although a 'bad sleeper'.
 Relieved by eating. Feels very lonely and isolated in Council flat.
 Worries about the recent divorce of her son. (Wept in dental chair at
this point).

PMH Well but tired.

Medication - temazepam.

OE Extraorally - NAD

Intraorally - See image:

Discussion Points

 Could the time of onset be relevant?

 Could the problem be related to the dentures?
 What investigations should be performed (what test would the GMP probably
have carried out)?
 What is the probable diagnosis?
 Could the problem be associated with depression

43
Case ii

A 35 year old male attended the emergency dental department complaining of pain
and had been waiting for hours queuing at the entrance.

HPC
 Problem arose as twinges of pain in the region of the ULQ during a long
Friday meeting.
 That evening the pain became worse and a hot cup of tea provoked an
intense throbbing pain lasting several minutes that radiated to the left jaw and
ear.
 After two paracetamol tablets the patient went to bed but the pain woke him at
5am.
 Sitting up relieved the pain.
 By Monday the pain was better but he still had bouts of less severe pain
lasting for hours. Two molar teeth in the maxilla (left side) felt tender on biting.
The pain was still partially relieved by paracetamol.
 Three years previously he had had discomfort following scaling on the upper
jaws that resolved when the hygienist had 'painted' the teeth.

PMH NAD

SH 20 cigarettes per day and 20 units of alcohol per week.

OE Extraorally - NAD

Intraorally
UL78 no obvious problems

LL6 heavily restored, tender to

percussion

LL7 slightly tender to percussion.

Treatment
Removal of the restoration in LL6
resolved the pain.

Discussion points

 What caused the patients initial symptoms?

 What special tests would be helpful in determining the cause of the problem?
 Why were several teeth sensitive previously?
 Why did removal of the restoration in LL6 relieve pain in the ULQ?
 Why was LL6 TTP (tender to percussion)?

44
Case iii

Male aged 65 years complains of intense pain on his lower right jaw at the
emergency walk in centre. He was then referred to the oral medicine clinic.

HPC
 Started 1 year ago
 Persisted intermittently for about 6 weeks
when it resolved spontaneously.
 Recurred a fortnight ago.
 The pain seems to arise from the lower right
premolar region and extends along the body
of the mandible, it does not cross the mid-line.
 The pain is very sharp, lasting for a few
seconds but occurring about 10 times a day.
 A dull background ache is sometimes
present.

PMH Fit and well apart from recent onset of tinnitus

in his right ear

PDH Complete denture wearer for past 20 years. Current dentures about 10 years old.

SH Non Smoker, 40 units of alcohol per week, mostly consumed on Friday and
Saturday nights. Lives alone. Works as coach driver.

OE Extraorally: Nodes – nil

palpable

TMJ – NAD
Lips – NAD

No facial
asymmetry

Intraorally: See Image:

Sharp pain
induced when
light pressure
applied to
lower right
premolar region

Discussion points

 The possible causative factor(s) of the patient’s facial pain

 Any additional examination/special tests/referral that you might want to
perform or arrange
 The most appropriate immediate treatment and any issues related to the
provision of this treatment
 Other treatment options

45
Case iv

A male aged 71 years old attends your dental practice as an emergency complaining
of right sided forehead pain

HPC Worse on chewing. Has taking paracetamol with no benefit. Pt wondered if it

was related to his vision causing this problem as he feels it is possibly a
headache. Has been feeling unwell.

PMH Under Rheumatology regarding pain and stiffness on the neck and shoulders.
Was told his ‘inflammatory markers were raised’ and undergoing further
investigations.

SH Non smoker. 10 units of alcohol per week.

OE Extraorally - See image

Intraorally - Pain elicited on occlusion. Large amalgam restorations on UR6
and UR7. UR8 missing. Indirect restorations on UR4 and UR5.
Unrestored LRQ.

Discussion points

 Describe the image above.

 What is your differential diagnosis?
 Discuss the investigations and management.
 Is there any link to his facial pain and visual disturbances?
 How would you manage this patient if they attended your dental practice?
 If the patient mentioned of pain and ulceration on the right aspect of his
tongue on his initial visit, what else would you consider?

46
 Appendix
Page

1. Sialometry and Schirmer’s test practical guide. 48

2. Swab and smear practical guide 49
3. Cross infection control guidelines 51
4. Biopsy Tray 52
5. Post-operative Instructions 55
6. Specimen pots 56
7. Biopsy Consent Form 57
8. Biopsy Leaflet 58
9. Internal Prescription Form 59
10. Outside (External) Prescription Form 60
11. NHS Dental Referrals: Oral Medicine 61
Form
12. NHS Dental Referrals: Head and Neck 62
Cancer Referral Form

13. Oral Medicine Tutors Feedback Form 64

14. Oral Medicine Nurses Feedback Form 66
15. Oral Medicine Student Feedback Form 68
16. Notes 70

47
 Sialometry and Schirmer’s test Practical Guide
Saliva flow test – sialometry

This test is carried out to determine if the patient has dry mouth.

Both un-stimulated and stimulated tests are carried out over 5 minutes.

Stimulated – is carried out whilst the patient is either chewing sugar free gum or
sucking a saliva stimulating tablet. Any saliva that is produced is to be dribbled into a
dry specimen pot.

Un-stimulated – Is carried out naturally encouraging the patient to dribble (not

forced) any saliva into a dry specimen pot.

The following tools are used for the test;

Clinical Xerostomia diagnostic values:

Unstimulated Saliva Flow <0.5ml / 5 mins

Stimulated Salivary flow <1.5ml / 5 mins

A 5ml syringe is used to measure the saliva and then discarded after use. The timer
is used to time 5 minutes.

Schirmer’s test

Place graduated or plain filter paper strip over lower eye lid. This technique
measures tear function.

Video link: https://youtu.be/FX0uS9iMCXM

Normal 15mm + / 5 mins

Mild 9-14mm / 5 mins
Moderate 4-8mm / 5 mins
Severe <4mm / 5 mins

48
Oral Swab and Smear Practical Guide

Swabs

 Ensure the swab is labelled with a patient sticker

 Do not touch the bud end of the swab

 Snap the lid off the tube

 Take a swab from the lesion

 Place the bud straight back into the tube without touching

 Give the swab to a member of the nursing team, who will generate
a form on the computer and send it to the lab.

49
Smears
 On the frosted part of the glass with a pencil write the patients name, hospital
number & DOB

 Using the bevelled end of the composite spatula take a smear and spread it
on the glass slide.

 Spray the smear once with the cytology fixative

 Place the slide inside the glass holder, and place a patient sticker on the
holder. Ensure a histopathology form is completed and sent with the smear.

50
Cross Infection Control

Prepared and edited by

Kate Walsh
(Senior Oral Medicine
Nurse)

Link: https://www.nhs.uk/live-well/healthy-body/best-way-to-wash-your-hands
(or https://tinyurl.com/NHShandwashvid)
51
Biopsy Tray

 2 x Dental mouth mirror and handle

 Straight probe
 College dressing tweezers
 Swan Morton blade handle
 Spencer wells (mosquitoes, artery forceps)
 Osteo Mitchell’s trimmer
 Gillies rat toothed tweezers (tissue dissecting
forceps)
 Wards needle holders or Crile wood needle holder
 Iris suture scissors (straight or curved)

52
Extra items to add to tray

 Suction tubing
 Yankeur sucker
 Swan Morton blade (15)
 4.0 vicryl suture
 Sterile paper towel
 Sterile drape
 Sterile gloves
 Sterile gauze
 Local anaesthetic
 Safety syringe and handle

All of these items are single use disposable items

.

53
Other items that may be used

Biopsy punches come in Silver nitrate sticks can be

various sizes; they can be used to cauterise surgical sites
used when there is a specific especially in sites that are
width, depth, area to be difficult to suture (e.g gingivae
biopsied. and palate)

Coe pack

Coe pack is a periodontal dressing that can be used instead of

suturing over an area that may be difficult to suture.

54
Post-operative instructions

Written and verbal instructions need to be given to the patient.

55
 Specimen pots

Formalin pot

Gel pot for direct

immunofluorescence

Practical Guides were prepared by: Kate Walsh, Rachel Power, Kay Gledhill
& Sam Clough (Oral medicine nursing team)

56
Biopsy Consent Form

57
Biopsy Leaflet

58
Internal Prescription Form

59
Outside (External) Prescription Form

60
61
62
63
 ORAL MEDICINE

3rd YEAR SEMINAR (CBL) TUTORS FEEDBACK FORM 2020-2021

Student Name: Student Number:

Below expected Borderline Standard Exceeds expected

standard standard
1 2 3 4 5 6

Knowledge Tutor Feedback/ Staff

DATE TOPIC Professionalism Knowledge application Comments Signature
(CBL)

Designed by Dr. S. Ariyaratnam 2012

64
65
 ORAL MEDICINE

3rd YEAR SEMINAR (CBL) NURSES FEEDBACK FORM 2020-2021

Student Name: Student Number:

Please tick relevant boxes:

Below expected Borderline Standard Exceeds expected

standard standard
1 2 3 4 5 6

Knowledge Tutor Feedback/ Staff

DATE TOPIC Professionalism Knowledge application Comments Signature
(CBL)

Designed by Dr. S. Ariyaratnam 2012

66
67
 ORAL MEDICINE
3rd YEAR STUDENTS FEEDBACK FORM 2020-2021

Strongly Agree Neither Disagree Strongly

Agree Disagree
1 The course covered what the course
outline said it would
2 The course activities related to learning
objectives
3 The work load was relatively reasonable
4 The learning objectives of the course
were clear
5 Student participation and questions were
encouraged
6 Good feedback was received from the
tutor
7 The course was relevant to your current
studies
8 The length of each session was
sufficient
9 The length of the course was sufficient
10 New skills were developed from the
course
11 The layout of the course was better than
previous PBL
12 The practical sessions were informative
13 The discussions were more comfortable
for the students
14 Student presentations were very useful
to the learning experience
15 The contribution of the tutor was very
valuable
16 Overall, I had a good learning
experience in this course
17 What are the major strengths of this course?

18 What do you think needs improving?

Thank you
68
69
NOTES

70
NOTES

71
NOTES

72
NOTES

73
NOTES

74
NOTES

75