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BDS4 BAMS Oral Medicine > 2. Oral Ulceration (inc. Aphthous Ulcers) > Flashcards

2. Oral Ulceration (inc. Aphthous Ulcers) Flashcards

1
Q

What are the three features of an ulcer that might concern you as a dentist ?

A

Persisting for longer than 2 weeks,
Recurrent.
Length of ulcer free period.

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2
Q

How is a traumatic ulcer treated ?

A

Removal of the cause - restoration edge, appliance, holding aspirin in the mouth.
Should be reviewed at 2 weeks.

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3
Q

Name some causes of recurrent oral ulceration.

A

Lichen planus.
Aphthous type ulcers.
Vesiculobullous disease.
Trauma.
Recurrent viral.
Crohn’s or Coeliac disease.

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4
Q

What are the characteristics of Crohn’s related ulceration ?

A

Linear, fissured ulcer at depth of the sulcus.
Crohn’s related granulomas on biopsy.

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5
Q

How is Crohn’s related oral ulceration treated ?

A

Intralesional steroids.

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6
Q

What causes the unilateral presentation of recurrent herpetic ulceration (recurrent herpetic gingivostomatitis) ?

A

Reactivation of virus limited to one nerve branch which is lying dormant in neurological ganglion (usually maxillary nerve branch of trigeminal nerve with presentation on hard palate).

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7
Q

Patient has recurrent herpetic ulceration with pain - what virus is most likely to be involved ?

A

VZV (varicella zoster virus).

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8
Q

What viruses can cause recurrent herpetic gingivostomatitis ?

A

VZV, HSV1 and HSV2

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9
Q

What % of recurrent oral herpetic gingivostomatitis is caused by HSV1 ?

A

90%

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10
Q

What are the symptoms of recurrent herpetic gingivostomatitis ?

A

Prodromal symptoms - run down, stress.
Occur in immunosuppression.
Recurrent in same location of the mouth.
Unilateral presentation.
Usually with no pain (unless VZV).
Clusters of minor ulceration.

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11
Q

How should primary recurrent herpetic gingivostomatitis be treated in a healthy individual ?

A

Usually self limiting.
Encourage hydration and analegsia (Diflam or Chlorhexidine).
Review in two weeks if persisting.

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12
Q

How should primary recurrent herpetic gingivostomatitis be treated in a immunocompromised patient ?

A

Aciclovir 400mg 2x daily 7 day course.
Chlorhexidine & Diflam - analegsia.

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13
Q

What are the four types of recurrent aphthous stomatitis ?

A

Minor, major, herpetiform, Bechet’s.

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14
Q

What are the characteristics of minor recurrent oral aphthous stomatitis ?

A

Ulceration <10mm in diameter.
Resolve within 2 weeks.
Form on non-keratinised tissue.
Heal without scarring.

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15
Q

How should minor recurrent oral aphthous stomatitis be treated ?

A

Topical steroids - betamethasone mouthwash or inhaler.

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16
Q

What preparation of betamethasone mouthwash should be prescribed for oral ulceration ? And what patient information should be given when prescribing ?

A

55 microgram soluble tablet dissolved in 10-20mls of water.

Swirl in mouth for 5 mins and spit, don’t swallow.
Can be used up to 4x daily (after mealtimes and after brushing).

17
Q

What type of medication is betamethasone ? What preparations can it come in ?

A

Corticosteroid - works to reduce inflammation & encourage healing.
Topical - inhaler or mouthwash.

18
Q

What are the characteristics of major recurrent oral aphthous stomatitis ?

A

Last months.
Can occur +/- minor aphthae.
Can form on keratinised and non-keratinised tissue.
Heal +/- scarring.
>10mm in diameter.

19
Q

How should major recurrent oral aphthous stomatitis be treated ?

A

Intralesional steroid injections biweekly for up to 20 weeks - dexamethasone.

20
Q

What are the characteristics of herpetiform oral aphthous stomatitis ?

A

Multiple small ulcers.
Occurs on non-keratinised tissue.
No prodromal period or occurrence at time of immunosuppression.
Heal within 2 weeks.
HSV IS NOT THE CAUSE - SIMILAR PRESENTATION ONLY.

21
Q

What is the key difference between recurrent herpetic gingivostomatitis and herpetiform oral aphthous stomatitis ?

A

Recurrent herpetic gingivostomatitis - infection (viral) generated, occurring on keratinised and non-keratinised tissue, unilateral presentation, associated with immunosuppression and prodromal period.

Herpetiform oral aphthous stomatitis - immunologically generated (with environmental and genetic factors), occurring on non-keratinised tissue, not associated with immunosuppression and prodromal period.

22
Q

How should herpetiform oral aphthous stomatitis be treated ?

A

Chlorhexidine mouthrinse.

23
Q

What is Bechet’s disease ?

A

HLA immunologically coded vasculitis.

24
Q

What is the criteria for Bechet’s disease ?

A

3> mouth ulcers in one year (major and minor type aphthae).
+ two of the following - genital sores, eye inflammation or skin ulcers.

25
Q

What medications are used to treat Bechet’s disease ?

A

Mycophenolate or azathioprine.

26
Q

What type of drug is mycophenolate ?

A

Immunosuppressive agent used to treat immunological inflammatory conditions (such as SLE, Bechet’s, GVHD).

27
Q

What type of drug is azathioprine ?

A

Immunosuppressive agent used to treat immunological inflammatory conditions (such as RA).

28
Q

What are the histopathological features of aphthous ulceration ?

A

Immunological damage to basal cells at basement membrane, rendering them unable to produce replacement epithelial cells.
This leads to exposure of CT.

29
Q

What are the predisposing factors of aphthous ulceration ?

A

Genetic (HLA gene).
Stress.
Infection (viral).
Hormones.
Haematinic deficiency.
Systemic disease - Coeliac and Crohn’s.
Trauma.

30
Q

What investigations are appropriate for a patient who is suffering recurrent unexplained ulceration ?

A

Haemtinics, Coeliac screen, HIV screen.
Allergy.

31
Q

What antibody is present in Coeliac screen ?

A

+ TTG.

32
Q

What is the general rule of thumb for diagnosing aphthous ulcers ?

A

Recurrent, self healing ulcers affecting non-keratinised mucosa.

33
Q

What guidance should be followed for treatment of oral ulceration ?

A

SDCEP (2013)

34
Q

What analgesia can be prescribed for oral ulceration ?

A

Difflam spray - benzydamine spray (NSAID).
Chlorhexidine mouth rinse.

35
Q

What drugs can cause oral ulceration ?

A

NSAIDs (inc. aspirin), beta blockers, methotrexate cytotoxic drugs, penicillin, anticonvulsants, sulfasalazine, allopurinol.

36
Q

What is the chlorhexidine preparation used ?

A

0.2% chlorhexidine gluconate, 10ml 2x daily (hold in mouth for 1 min).

37
Q

What advice should be given to a patient with ulceration due to ill-fitting dentures ?

A

Advise the patient to use 0.2% chlorhexidine mouthwash, to keep dentures out where possible and to seek non-urgent dental care.

38
Q

What medical conditions can cause oral ulceration ?

A

Viral infections: Herpetic stomatitis, Chicken pox, Hand, foot and mouth disease, Herpangina, HIV
Bacterial infections: Syphilis, Tuberculosis
Mucocutaneous diseases: Lichen planus, Erythema multiforme, Behcet’s syndrome, Pemphigus vulgaris, Pemphigoid and variants, Chronic Ulcerative stomatitis
Haematological diseases: Anaemia, Haematinic deficiencies, Leukaemia, Neutropenia
Gastrointestinal disease:Coeliac disease, Crohn’s disease, Ulcerative colitis

BDS4 BAMS Oral Medicine (9 decks)

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