Intro to Oral Ulceration

Question 1

oral ulceration is

Answer 1

Common complaint
* Degree of morbidity varies
* Tailor treatment to patient’s needs

History will usually give the diagnosis
Pictures on phone can be very useful!

MUST be clear on differences between
RECURRENT ORAL ULCERATION
RECURRENT APHTHOUS STOMATITIS (recurrent aphthous ulceration)
Type of recurrent oral ulceration, but two different types so not interchangeable

Question 2

5 possible causes of oral ulceration

Answer 2

trauma

immunological

carcinoma

infections

gastrointestinal

Question 3

immunological causes of oral uclers

5

Answer 3

aphthous ulcers

lichen planus

lupus

vesiculo-bullous

erythema multiforme

Question 4

what type of infections can cause oral ulcers

3

Answer 4

bacterial
viral
fungal

Question 5

GI diseases that can cause oral ulcers

Answer 5

Crohn’s disease
Ulcerative colitis

Question 6

single episode of oral ulceration can be due to

4

Answer 6

trauma - appliance, restoration edge, denture

1st episode of recurrent oral ulceration -* characteristic appearance*

primary viral infections (coxsackie, herpes)

oral squamous cell carcinoma

Question 7

what cause this ulcer

Answer 7

trauma due to appliance

Question 8

what caused this ulcer

Answer 8

1st episode of recurrent oral ulceartion

aphthous ulcer appearance - yellow fibrous base and erythematous halo

Question 9

what cause this lesion

Answer 9

viral infection (herpes)

Question 10

what caused this ulcerative lesion

Answer 10

oral squamous cell carcinoma

present if not seen dentist in many years, ideally get before grows

Question 11

caues/types of recurrent oral ulceration

6

Answer 11

Aphthous ulceration
* Minor, major, herpetiform

Lichen Planus

Vesiculobullous lesions
* Pemphigoid, pemphigus
* Angina Bullosa Haemorrhagica
* Erythema Multiforme

Recurrent viral lesion – HSV, VZV

Trauma

Systemic disease – Crohn’s Disease ulceration

Question 12

oral uclers seen in Crohn’s disease

Answer 12

Aphthous type ulcers
* Haematinic deficiency associated
* Behave like aphthous ulcers

Crohn’s specific ulcers
* Linear at the depth of the sulcus
* Full of Crohn’s associated granulomas
* Persist for months – intralesional steroids help

Question 13

how to take a history for oral ulceration

Answer 13

Where?

Size & Shape?

Blister (burst to leave ulcer) or ulcer?

How long for?
* More than 2 weeks?
Impact tx type and need

Recurrent?
* Same site? Different Sites? (Aphthous pattern in different places depending on trigger, lichen planus related than is one site)

Painful?
* spontaneous or to touch

Bleeding?
* spontaneous or to touch

Question 14

4 things to note on examination of oral ulcer

Answer 14

Margins?
* Flat? Raised? Rolled?

Base?
* Soft? Firm? Hard?
* Covered by granulation tissue? Fibrous exudate?

Surrounding tissue
* Inflamed? Normal? White/keratotic?

Systemic Illness?
* Temperature?

Question 15

traumatic ulceration

aetiology and management

Answer 15

Common
Usually single episode, can be recurrent if cause not removed

normal or abnormal epithelium

healing
* remove cause
* heal in about 2 weeks – biopsy if not, esp if unexplained

Question 16

recurrent herpetic lesions

location and pattern

Answer 16

Ulceration limited to one nerve group/branch

Often Hard palate
* Lesion recurs in the same place \
* Patient often aware of prodrome and vesiculation which bursts
* PAIN suggests Herpes ZOSTER rather than simplex

Treat with systemic ACICLOVIR (suppress viral replication)
* Prophylactic if a severe problem (reduce risk of nerve damage)

Question 17

what is recurrent aphthous stomatitis (RAS)

Answer 17

immunological damage to oral mucosa, present in diff patterns

• minor
• major
• herpetiform
• Behçet’s syndrome

Question 18

dx of recurrent aphthous stomatitis by

Answer 18

history
examination

triggers inc haematinic deficiencies - indicative of other illness (bowel cancer, peptic ulcer disease)

Question 19

general rule for Recurrent aphthous ulcers

Answer 19

Recurrent self-healing ulcers affecting exclusively the non-keratinised mucosa are inevitably aphthae

*Keratinised mucosa that recur – viral
Trauma – from hard tissues or appliance *

Question 20

when looking at an ulcer think

3 key

Answer 20

Is the lesion on keratinized or non-keratinized mucosa
* keratinised - attached gingivae and hard palate

Are there systemic symptoms?
* Consider infection – Herpes group, Coxsackie group

Always look for a traumatic cause
* Primary – sharp edge on a tooth/appliance
* Secondary – parafunction rubbing mucosa against the teeth