Mouth conditions, ulcers Flashcards
Probability diagnosis
Recurrent aphthous ulceration
Trauma (e.g. rough tooth, biting)
Acute herpes gingivostomatitis
Candidiasis
Serious disorders not to be missed
Cancer:
- SCC
- leukaemia
Agranulocytosis
HIV
Syphilitic: chancre or gumma
Tuberculosis
Pitfalls (often missed)
- Aspirin burn
- Inflammatory bowel disease (e.g. Crohn)
- Herpes zoster virus
- Glandular fever (EBV)
- Lichen planus
- Coxsackie virus:
- herpangina
- hand, foot and mouth disease
- Epstein–Barr mononucleosis
- Immunosuppression therapy
- Lupus erythematosus
Rarities:
- Behçet syndrome
- pemphigoid and pemphigus vulgaris
- erythema multiforme
- radiation mucositis
Masquerades checklist
Diabetes (Candida)
Drugs (see list)
Anaemia (iron-deficiency)
Is the patient trying to tell me something?
Unlikely.
Key history
Take a history of;
- trauma
- skin problems
- stress
- dental problems
- drugs
- allergy
Possible infections, including;
- herpes simplex
- Candida albicans
- sexually transmitted diseases
- Coxsackie virus infection.
Consider an immunosuppressive disorder.
Key examination
The examination should focus on;
- pt’s general health
- dental status
- characteristics of the ulcer
- cervical lymphadenopathy
- the skin in general
Key investigations
Depending on the clinical picture investigations may include:
- FBE
- ESR
- swabs for M&C
- autoantibody screen
- syphilis serology
- blood sugar
- vitamin B12 and folate levels
- biopsy.
Diagnostic tips
Non-healing ulcers warrant biopsy to exclude SCC.
Remember to enquire about medication such as;
- phenytoin
- cytotoxics
- immunosuppressants
- carbimazole.
A blood dyscrasia may be possible.
Consider IBD and coeliac disease
Aphthous ulcers
are usually 3–5 mm in diameter
minor ones
have an erythematous margin.
