mouth ulcers Flashcards
what can contribute to likelihood of mouth ulcers?
Deficiencies of vitamin B12, folate, iron or zinc may contribute to an increased risk of
aphthous ulcers and may also lead to glossitis and angular stomatitis.
what are minor aphthous mouth ulcers?
o Make up >75% of cases
o Self-limiting
o Normally occur in clusters of 1-5 at a time
o Up to 5mm in diameter
o White/yellow middle with inflamed red edge
o Not painful
o Present on the gum around the tongue, on the inside of the lips and cheeks
what are major aphthous mouth ulcers?
o >10mm in size o Irregular border o Painful o Heal slowly over weeks o May lead to scarring o Present on the lips, cheeks, tongue, pharynx and palate of the mouth
what are Herpetiform ulcers?
o Rare
o Form irregular shapes
o Pinhead size, but can merge to form larger ulcers (of up to 100) lasting 10-14 days o More numerous than minor aphthous ulcers
o Very painful
o Present on the floor of the mouth and gums
what are the red flags of mouth ulcers?
• Any ulcer which has been present for >3 weeks duration
• Ulcers >10mm in diameter
• Crops of more than 5 ulcers
• Unexplained weight loss
• Persistent recurrent diarrhoea
o Could be a case of IBS or coeliac disease
• Failed treatment after 7 days of use
• Ulcers in places other than the mouth
• Ill-fitting dentures
o Refer to dentist • Drug-induced ulceration
o Can be caused by NSAIDs, cytotoxic drugs, carbimazole, sulfasalazine, feverfew (herbal remedy), nicorandil, sodium lauryl sulphate (in toothpastes) and oral nicotine replacement therapy
what is the lifestyle advice for mouth ulcers?
- Avoid common trigger factors which can cause mouth ulcers (e.g. hard toothbrush, stress etc.)
- If mouth ulcers appear to be caused by a sharp tooth or filling, a referral to the dentist may be advisable
- Increase water intake and maintain fluids
- Dissolving salt in water and gargling
- Smoking can worsen mouth ulcers
- Check food labels for potential allergies that may be causing ulcers
- Maintain good oral hygiene
what mouth washes can be used for mouth ulcers?
Chlorhexidine, Povidone Iodine
what would the mouth washes do?
- Can help prevent and treat secondary bacterial infections which can cause further discomfort and pain.
- Povidone Iodine should not be used for longer than 14 days in order to prevent significant iodine absorption
- Suitable in pregnancy and breastfeeding
what local analgesics can be used for mouth ulcers?
Benzydamine, Choline salicylate
what can benzydamine do?
relieve discomfort caused by mouth ulcers,
especially if they are difficult to reach with a buccal tablet or an oromucosal gel
when should benzydamine NOT be used?
o Benzydamine mouthwash is not suitable for children under the age of 12 years o Benzydamine spray is not suitable for children under 6 years
o Should not be used in patients sensitive to NSAIDs
o Should not be used in pregnant or breastfeeding women
what are some of the warnings of choline salicylate?
o It is important to emphasise to patients not to apply it more often than the product
states as this could cause salicylate poisoning
o The gel cannot be applied to dentures
o Choline salicylate gel (Bonjela) is not suitable for use in patients under the age of
16 years
o Choline salicylate is also not suitable for patients taking certain medications such
as anticoagulants and methotrexate
when would you use topical corticosteroids for mouth ulcers?
- Aid healing and provide pain relief
* Can be applied when prodromal symptoms are felt to prevent and treat
when should topical corticosteroids not be used?
- Not suitable for use in children under the age of 12 years
- Not suitable for use in pregnant or breastfeeding women
- Corticosteroids can worsen diabetes (cause hyperglycaemia)
