Mouth ulcers Flashcards
What are the causes of mouth ulcers?
Infection
Trauma
Drug allergy
Name the types of mouth ulcers
Aphthous (minor or major)
or herpetiform ulcers
Are mouth ulcers self-limiting?
> 75% of cases are minor aphthous ulcers, which are self-limiting
Presenting symptoms of mouth ulcers (not including how they look)
- dry throat
- symptoms of cold or flu: runny nose, headache, muscle aches, cough
Presenting symptoms of minor ulcers
- 1-5 at a time
- 5-6mm diameter
- White/yellow middle with inflamed red edge
- Not painful
presenting symptoms of major ulcers
- > 10mm
- painful
presenting symptoms of herpetiform ulcers
- more numerous than 1-5 at a time
- pinhead size
- very painful
Danger elimination/red flag symptoms/referral criteria
- duration >3 weeks
- ADRS (agranulocytosis, especially if taking carbimazole for hyperthyroidism)
- failed treatment
- ulcers bigger than 1cm
- painless ulcers
- unexplained weight loss
- persistent diarrhoea
- recurrent infection or rash
- ill-fitting dentures (refer to dentist)
- ulcers elsewhere other than the mouth
- refer if extremely painful, have hoarseness (>3 weeks), glandular fever, oral thrush
Why would you refer someone with mouth ulcers who also has persistent diarrhoea?
Because they may have a case of IBS or coeliac disease
Which drugs could cause the mouth ulcers?
Could be side effect of:
- NSAID like aspirin
- cytotoxic drugs
- sulfasalazine
Are mouth ulcers more common in men or women?
More common in women
What age range are mouth ulcers most frequent?
Most frequent between ages 10-40
Do mouth ulcers run in families?
Yes. Often there is a family history of mouth ulcers.
Minor aphthous ulcers often recur, with the same characteristic features
Recurrence of mouth ulcers?
Episodes of ulceration generally recur after 1-4 months
What are the different forms of medicine available to treat mouth ulcers and what are the advantages of these?
Gels/liquids are helpful for accurate application
Mouthwashes are useful when ulcers are difficult to reach
Lifestyle advice regarding mouth ulcers?
- gargle water with salt
- maintain fluid intake
- smoking can make mouth ulcers worse (oral cancer is also more common in smokers)
- check for food allergies that may be causing ulcers
- good oral hygiene
Treatment timescale for mouth ulcers
If no improvement of symptoms in 7 days, refer to GP
Summarise the types of OTC drugs available for treatment of mouth ulcers
- Chlorhexidine antibacterial mouthwash (prevents secondary bacterial infection but doesn’t prevent recurrence)
- Hydrocortisone muco-adhesive buccal tablets 2.5mg
- oral analgesics
- local anaesthetic throat sprays
- antiseptic lozenges
- difflam spray (benzydamine)
- bonjela (choline salicylate)
Specifics of chlorhexidine mouthwashes for the treatment of mouth ulcers
directions, side effects, counselling and patient populations
Directions: Rinse mouth with 10mls for 1min twice a day then spit out. Continue use for 2 days post-symptoms
Side effect: brown teeth stain
Counselling: brush teeth before using to reduce teeth staining. Rinse mouth with water afterwards.
Patients: Fine for children, elderly, adults, pregnant and breastfeeding
Specifics of hydrocortisone buccal tablets for the treatment of mouth ulcers
directions, side effects, counselling and patient populations
Do not suck, keep in close proximity to ulcers until dissolved. 1 tablet QDS.
Corticosteroids may worsen diabetes
Counselling: use as early as possible, before ulcer appears, area feels sensitive
Not suitable for under 12s or pregnant or breastfeeding women
Specifics of oral analgesics for pain caused by mouth ulcers
Paracetamol 500mg 2 tablets PRN up to QDS (max)
Must be >12
Suitable for pregnant and breastfeeding women
Specifics of lidocaine Medijel anaesthetic throat spray
Numb the tongue and throat to ease soreness and pain
Apply a green-pea sized amount to the area with a clean finger. Repeat every 20 minutes if needed.
Sprays not for those under 6 years of age.
Fine for pregnant and breastfeeding patients.
Specifics of antiseptic lozenges (benzalkonium)
adults and elderly: 1 lozenge dissolved slowly in mouth every 3 hours PRN. Max 8/24 hours
Children 7-12 years: 1 dissolved slowly in the mouth every 3 hours PRN
Not suitable for under 7s
Fine for pregnant and breastfeeding patients
Specifics of bonjela (choline salicylate)
Apply a small amount to the affected area.
Do not use more frequently than every 3 hours
Use the teething or junior version for children as this one is only for >16yrs
ok for short term use in pregnancy and breastfeeding but be very careful
