Lecture 10 - Oral Ulcers Flashcards
Two Types of Causes of Oral Ulcers
Local and Systemic
Local causes of oral ulcers
Burns, trauma Aphthous stomatitis (canker sores) Malignant neoplasms Drugs Infectious diseases
Systemic causes of oral ulcers
Mucocutaneous disease Blood disorders GI disease (Crohn's, ulcerative colitis, Celiac) Rheumatic disease Vasculitides Endocrine disorders (diabetes) Drug reactions (chemotherapy)
Approach to Diagnosis of Oral Ulcers
Recurrent? How many? How long? Medical history History of trauma Clinical appearance Lab tests
Findings that suggest Systemic cause
Skin lesions Ocular lesions Anogential lesions Purpura Fever Lymphadenopathy Splenomegaly Chronic cough Weight loss Fatigue GI complaints
Most common ulcers
Trauma or aphthous stomatitis
Infectious diseases that cause ulcers
Syphilis TB Viral infections Deep fungal infections ANUG (Acute Necrotizing Ulcerative Gingivitis) HIV
Systemic Mucocutaneous diseases that cause ulcers
Lichen planus
Pemphigus
Pemphigoid
Erythema multiforme
Systemic Blood disorders that cause ulcers
anemia
leukemia
neutropenia
myelodysplastic syndromes
Recurrent Aphthous Stomatitis
Canker sores
Very common - 20-66% prevalence
Usually younger patients
RAS Risk Factors
Males
Low serum insulin
Family history
Less common in non-Hispanic Black population
RAS Clinical Features
Recurrent
Painful ulcers on movable mucosa
Last 7-14 days
RAS Classic Classification
Frequency, Ulcer size, and Duration
Minor - most common
Major
Herpetiform - rare (4%)
RAS Alternative Classification
Based on duration only
Type A: lesions last a few days, a few times a year
Type B: Painful lesions occur monthly, last 3-10 days
Type C: Painful, chronic lesions
Minor Aphthous
55-70%
Recur every 2-3 months
Prodrome <1cm Painful Well defined oval lesion with gray-yellow necrotic center and erythematous periphery Heals in ~10days without scar Lymphadenopathy
