OM - Oral Ulceration Flashcards

1
Q

List causes of mucosal ulceration. (4)

A
  • Trauma
  • Immunological
  • aphthous ulcers
  • lichen planus
  • Lupus
  • vesiculo-bullous
  • Erythema multiforme
  • Carcinoma
  • Infections
  • bacterial, fungal, Viral
  • Gastrointestinal (medical conditions)
  • Crohn’s disease
  • ulcerative colitis
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2
Q

How do we commonly diagnose mucosal ulceration?

A

Thorough history

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3
Q

What must we consider when taking a history of mucosal ulceration? (7)

A
  • 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
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4
Q

How long are aphthous ulcers usually present for?

A

no longer than 2 weeks

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5
Q

What type of mucosal ulceration commonly recurs ate the same site?

A

Lichen Planus

  • Aphthous ulcers occurs at different sites depending on the triggers
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6
Q

What aspects of mucosal ulceration do we examine? (4)

A
  • 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

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7
Q

List the possible diagnosis of single episode oral ulceration. (4)

A

trauma

1st episode of recurrent oral ulceration

primary viral infections

oral squamous cell carcinoma

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8
Q

What can cause recurrent mucosal ulceration? (6)

A
  • 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
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9
Q

What is recurrent aphthous stomatitis?

A

A group of conditions where there is immunological damage to the oral mucosa that presents in different patters

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10
Q

List the types of recurrent aphthous stomatitis. (4)

A
  • minor
  • major
  • herpetiform
    *. Behçet’s syndrome
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11
Q

What can cause Recurrent Aphthous Stomatitis?

A

Haematinic deficiency
- can possibly from other medical problems

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11
Q

What can cause Recurrent Aphthous Stomatitis?

A

Haematinic deficiency
- can be from other medical problems such as bowel cancer, PUD, crohns

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12
Q

Describe the characteristics of a crohns specific ulcer. (4)

A
  • 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
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13
Q

What must we do once we have identified a traumatic ulcer? (2)

A

remove the cause

monitor - ensure improvement/resolution within 2 weeks.

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14
Q

When should we biopsy traumatic ulceration?

A

If cause removed and it’s not healed/starting to settle within 2/3weeks
(cause is unexplained)

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15
Q

List the characteristics of recurrent herpetic lesions.(4)

A
  • Ulceration limited to one nerve group/branch
  • Lesion recurs in the same place each time
  • Patient often aware of prodrome

vesiculation which bursts

16
Q

Where do recurrent herpetic lesions usually occur?

A

hard palate

17
Q

How do we treat recurrent herpetic lesions?

A

systemic ACICLOVIR to suppress viral replication

  • Prophylactic if a severe problem
18
Q

What type of ulcers are commonly recurrent, self-healing and affect exclusively the non-keratinised mucosa?

A

Oral aphthous ulcers

19
Q

What usually causes recurrent oral ulcers on keratinised mucosa?

A

Viral cause

20
Q

What must we consider when diagnosing mucosal ulceration? (3)

A

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