OM - Oral Ulceration Flashcards
List causes of mucosal ulceration. (4)
- Trauma
- Immunological
- aphthous ulcers
- lichen planus
- Lupus
- vesiculo-bullous
- Erythema multiforme
- Carcinoma
- Infections
- bacterial, fungal, Viral
- Gastrointestinal (medical conditions)
- Crohn’s disease
- ulcerative colitis
How do we commonly diagnose mucosal ulceration?
Thorough history
What must we consider when taking a history of mucosal ulceration? (7)
- Where on the mucosa
- Size & Shape
- Blister or ulcer – is there initially a blister than forms an ulcer or is the ulcer the initial lesions
- How long ulcer present for.
- Are the lesions recurrent
- Does it recur at the same site?
- Painful
- Determines treatment/management
- Determine the ulcer free period
- Determines type and need for treatment
How long are aphthous ulcers usually present for?
no longer than 2 weeks
What type of mucosal ulceration commonly recurs ate the same site?
Lichen Planus
- Aphthous ulcers occurs at different sites depending on the triggers
What aspects of mucosal ulceration do we examine? (4)
- Margins
- Flat
- Raised
- Rolled
- Base
- Soft
- Firm
- Hard
- Covered by granulation tissue or fibrous exudate
- Surrounding tissue
- Inflamed
- Normal
- White and keratotic? (trauma)
Also consider presence of Systemic Illness in px
List the possible diagnosis of single episode oral ulceration. (4)
trauma
1st episode of recurrent oral ulceration
primary viral infections
oral squamous cell carcinoma
What can cause recurrent mucosal ulceration? (6)
- Aphthous ulceration
- Minor, Major, Herpetiform
- Lichen Planus
- Recurrent viral lesion – HSV, VZV
- Trauma
Other recurrent oral lesions produced by other conditions;
* Vesiculobullous lesions: blisters burst to form ulcers
- Pemphigoid, pemphigus
- Angina Bullosa Haemorrhagica
- Erythema Multiforme
- Systemic disease – Crohn’s Disease ulceration
What is recurrent aphthous stomatitis?
A group of conditions where there is immunological damage to the oral mucosa that presents in different patters
List the types of recurrent aphthous stomatitis. (4)
- minor
- major
- herpetiform
*. Behçet’s syndrome
What can cause Recurrent Aphthous Stomatitis?
Haematinic deficiency
- can possibly from other medical problems
What can cause Recurrent Aphthous Stomatitis?
Haematinic deficiency
- can be from other medical problems such as bowel cancer, PUD, crohns
Describe the characteristics of a crohns specific ulcer. (4)
- Linear fissured ulcers at the depth of the sulcus
- Full of Crohn’s associated granulomas
- Persist for months – intralesional steroids help
- Can be seen alongside aphthous type ulcers from the haematinic deficiency from the disease
What must we do once we have identified a traumatic ulcer? (2)
remove the cause
monitor - ensure improvement/resolution within 2 weeks.
When should we biopsy traumatic ulceration?
If cause removed and it’s not healed/starting to settle within 2/3weeks
(cause is unexplained)
List the characteristics of recurrent herpetic lesions.(4)
- Ulceration limited to one nerve group/branch
- Lesion recurs in the same place each time
- Patient often aware of prodrome
vesiculation which bursts
Where do recurrent herpetic lesions usually occur?
hard palate
How do we treat recurrent herpetic lesions?
systemic ACICLOVIR to suppress viral replication
- Prophylactic if a severe problem
What type of ulcers are commonly recurrent, self-healing and affect exclusively the non-keratinised mucosa?
Oral aphthous ulcers
What usually causes recurrent oral ulcers on keratinised mucosa?
Viral cause
What must we consider when diagnosing mucosal ulceration? (3)
Is the lesion on keratinised or non-keratinised mucosa?
Are there systemic symptoms?
- Infection: herpes, coxsackie
- Underlying systemic disease
Is there a traumatic cause?
- Primary: sharp edges of teeth/apliances
- Secondary: parafunctional rubbing mucosa on teeth
