Mouth Ulcers Flashcards
What are 5 symptoms of mouth ulcers?
- Round or oval in shape
- ~ 5 - 10mm in diameter
- Yellowish-grey center
- Inflamed red outer edge
- Heals within 7-14 days
Do mouth ulcers require a counselling room?
No
What are 9 red flags for referral with mouth ulcers?
- Ulcers > 10mm in diameter
- More than 3 weeks
- Multiple ulcers (more than 5 or 6)
- Frequently recurring lesions
- Painless, non-healing ulcers with raised borders
- Irregularly shaped ulcers
- Extreme difficulty eating or drinking because of pain
- Systemic signs (for example, fever)
- Children < 2 years
Do mouth ulcers have a PSA self-care card?
Yes (Mouth Ulcers)
What is the preferred over-the-counter treatment option for mouth ulcers?
Lignocaine Gel 0.5% with salicylic acid, ethanol and tannic acid (SM-33)
What are the directions for Lignocaine Gel 0.5% with salicylic acid, ethanol and tannic acid (SM-33) in mouth ulcers?
Adult and Children over 6 months: Apply to the affected area every 3 hours
What are 2 non-preferred over-the-counter options for mouth ulcers and why?
- Choline Salicylate (Bonjela): no safety data in pregnancy, risk of Reye’s Syndrome in children
- Triamcinolone in Orabase (Kenalog): contraindicated in fungal/bacterial infections, herpetic lesions, patients with peptic ulcers, or diabetes.
Is Lignocaine Gel 0.5% with salicylic acid, ethanol and tannic acid (SM-33) safe in pregnancy?
Yes
Is Lignocaine Gel 0.5% with salicylic acid, ethanol and tannic acid (SM-33) safe in breastfeeding?
Its safety in breastfeeding is unknown.
What is the age range for Lignocaine Gel 0.5% with salicylic acid, ethanol and tannic acid (SM-33)?
Safe in infants over 6 months
What are 12 pieces of non-pharmacological advice for mouth ulcers?
- Using a soft toothbrush, brushing teeth carefully
- Avoid rough, sharp, or excessively hot, spicy or acidic foods
- Having sharp edges of teeth smoothed by dentist
- Place wax on orthodontic appliances
- Ensure dentures fit properly
- Drink plenty of fluids
- Maintain good oral hygiene
- Avoid spicy and sour foods until the ulcer heals
- Simple analgesics can help
- Eat a well-balanced nutritious diet
- Try to reduce stress to relaxation techniques and exercise might be helpful
- Use toothpaste that does not contain sodium laurel sulfate
What are the mechanisms of action of the ingredients in SM-33?
Salicylic acid and ethanol provides anti-bacterial actions, while tannic acid works as an astringent. Lignocaine is an anaesthetic
What is the recommended follow up with mouth ulcers?
Advise the patient to consult a doctor if no improvement within 2 weeks despite OTC treatment.
