2. Oral Ulceration (inc. Aphthous Ulcers) Flashcards
What are the three features of an ulcer that might concern you as a dentist ?
Persisting for longer than 2 weeks,
Recurrent.
Length of ulcer free period.
How is a traumatic ulcer treated ?
Removal of the cause - restoration edge, appliance, holding aspirin in the mouth.
Should be reviewed at 2 weeks.
Name some causes of recurrent oral ulceration.
Lichen planus.
Aphthous type ulcers.
Vesiculobullous disease.
Trauma.
Recurrent viral.
Crohn’s or Coeliac disease.
What are the characteristics of Crohn’s related ulceration ?
Linear, fissured ulcer at depth of the sulcus.
Crohn’s related granulomas on biopsy.
How is Crohn’s related oral ulceration treated ?
Intralesional steroids.
What causes the unilateral presentation of recurrent herpetic ulceration (recurrent herpetic gingivostomatitis) ?
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).
Patient has recurrent herpetic ulceration with pain - what virus is most likely to be involved ?
VZV (varicella zoster virus).
What viruses can cause recurrent herpetic gingivostomatitis ?
VZV, HSV1 and HSV2
What % of recurrent oral herpetic gingivostomatitis is caused by HSV1 ?
90%
What are the symptoms of recurrent herpetic gingivostomatitis ?
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.
How should primary recurrent herpetic gingivostomatitis be treated in a healthy individual ?
Usually self limiting.
Encourage hydration and analegsia (Diflam or Chlorhexidine).
Review in two weeks if persisting.
How should primary recurrent herpetic gingivostomatitis be treated in a immunocompromised patient ?
Aciclovir 400mg 2x daily 7 day course.
Chlorhexidine & Diflam - analegsia.
What are the four types of recurrent aphthous stomatitis ?
Minor, major, herpetiform, Bechet’s.
What are the characteristics of minor recurrent oral aphthous stomatitis ?
Ulceration <10mm in diameter.
Resolve within 2 weeks.
Form on non-keratinised tissue.
Heal without scarring.
How should minor recurrent oral aphthous stomatitis be treated ?
Topical steroids - betamethasone mouthwash or inhaler.
What preparation of betamethasone mouthwash should be prescribed for oral ulceration ? And what patient information should be given when prescribing ?
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).
What type of medication is betamethasone ? What preparations can it come in ?
Corticosteroid - works to reduce inflammation & encourage healing.
Topical - inhaler or mouthwash.
What are the characteristics of major recurrent oral aphthous stomatitis ?
Last months.
Can occur +/- minor aphthae.
Can form on keratinised and non-keratinised tissue.
Heal +/- scarring.
>10mm in diameter.
How should major recurrent oral aphthous stomatitis be treated ?
Intralesional steroid injections biweekly for up to 20 weeks - dexamethasone.
What are the characteristics of herpetiform oral aphthous stomatitis ?
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.
What is the key difference between recurrent herpetic gingivostomatitis and herpetiform oral aphthous stomatitis ?
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.
How should herpetiform oral aphthous stomatitis be treated ?
Chlorhexidine mouthrinse.
What is Bechet’s disease ?
HLA immunologically coded vasculitis.
What is the criteria for Bechet’s disease ?
3> mouth ulcers in one year (major and minor type aphthae).
+ two of the following - genital sores, eye inflammation or skin ulcers.
