Mouth Ulcers

Question 1

What are symptoms of mouth ulcers?

Answer 1

1. Minor: occur in crops of one to five up to 5mm in diameter
2. white or yellowish centre with an inflamed red outer edge that can present on the gum and tongue
3. Symptoms last 5-14 days
   Major:
4. 30mm, crops of up to 10 - lips cheeks tongue, pharynx
5. healing takes 30 days

Question 2

When would you refer?

Answer 2

• any ulcer longer than 3 weeks
• ulcers >10mm in diameter
• crops of more than 5 ulcers
• weight loss
• persistent recurrent diarrhoea
• certain drugs like NSAIDS, cytoxotic drugs, sulfasalazine, feverfew herbal remedy

Question 3

What tx is used?

Answer 3

• chlorhexidine gluconate mouthwash - prevent secondary bacterial infection
• topical corticosteriods - hydrocortisone - reduce inflammation and swelling
• local analgesics are short acting but useful for pain relief - benzydamine, choline salicylate
• local anaethetics - lidocaine, benzocaine - lain relief

Question 4

What side effects can occur?

Answer 4

can cause reversible brown staining of teeth and discolouration of the tongue as well as possible taste disturbance

Question 5

what are OTC preps?

Answer 5

bonjela 
anbesol 
iglu 
cosodyl 
difflam

Question 6

Any counselling points?

Answer 6

deficiecny of iron, folate, zinc, vit B12 - increased risk of ulcers - leads to glossitis and angular stomatitis

brushing teeth before using chlohexidine may help reduce staining but rinse mouth thoroughly thereafter as toothpaste can inactivate chlohexidine

choline salicylate should not be used under 16 year olds and those taking MTX/anticoagulants