[Intro to Oral Medicine] Ulceration Flashcards
what is an ulcer?
a breach in the mucosa where there is destruction of epithelium
what are some causes of ulceration?
Trauma
metabolic/nutrition
allergy
infective
inflammatory
immunological
drug induced
idiopathic
what can give clues to the cause of an ulcer?
site
onset
duration
number
texture
appearance
size
pain
predisposing factors
relieving factors
what do traumatic ulcers usually present as?
white keratotic borders
easy to distinguish causative agent - look where cusps touch tissues etc
what is an aphthous ulcer?
a painful lesion with a red border & yellow/white centre
in recurrent aphthous stomatitis (RAS), what is a major ulcer?
greater than 1cm, long healing time several months
in recurrent aphthous stomatitis (RAS), what is a minor ulcer?
less than 1cm in size, heals in 2-3 weeks
in recurrent aphthous stomatitis, what is a herpetiform ulcer?
lots of tiny ulceration/vesicles which are close together. Lots of small bubbling.
what are usually the main causes of metabolic/nutritional ulcers?
anaemia, malnourishment of any cause. Adults with GI pathology
what blood tests are used to investigate anaemia?
FBC
urea/electrolytes
liver function tests
vitamin b12, folate
what are some common features of gut and connective tissue disease that you would want to enquire about if you think its the cause of ulceration?
Gut:
- abdominal pain
- altered bowel movements
- any weight loss
Connective tissue disease:
- Joint pain/stiffness
- photosensitivity
- xerostomia
what are signs of a neoplastic ulcer?
exophytic (growing outwards/beyond epithelium)
rolled borders
raised
hard to touch
non moveable
not always painful
affects sensory function
what are some infection related pathogens which can cause ulceration?
herpes simplex virus
varicella-zoster virus
epstein-barr virus
coxsackie virus
T. pallidum
M. tuberculosis
Chronic candidiasis
HIV
what are some iatrogenic (medical tx causes) causes of oral ulceration?
chemotherapy
radiotherapy
drug induced ulceration (K+ channel blockers, bisphosphonates, NSAIDs, DMARDs (disease modifying antirheumatic drugs)
whats the local management for oral ulceration?
IF suspicions of malignancy - refer urgently to OMFS
if aphthous appearance - refer to GP for FBC/haematinics
Simple mouthwash
CHX
Benzydamine spray (NSAID - mw/spray/lozenge)
steroid mouthwash (betamethasone)
Steroid inhaler (beclomethasone)
