OM - Recurrent Aphthous Ulcers Flashcards
Describe a recurrent aphthous ulcer.
Recurrent self-healing ulcers affecting exclusively the non-keratinised mucosa are inevitably aphthae
What are aphthous ulcers?
Immunologically generated RECURRING oral ulcers in the epithelium/CT – usually follow a set pattern depending upon the ulcer type
What causes recurrent aphthous ulcers?
Genetically driven with environmental modification
- Multifactorial environmental triggers are required for ulcers to appear (degree of triggers differs between patients)
- Ulcer experience may change as ‘risk factors’ change over life
What are the predisposing factors to recurrent aphthous ulcers? (7)
Key factors differ between patients although all are genetically predisposed;
- Genetic predisposition
- Systemic disease
- Stress
- Mechanical injuries
- Hormone fluctuations
- Microelement deficiencies (iron, B12, folic acid) – cause or a symptom
- Viral and bacterial infections
What are the types of recurrent aphthous stomatitis? (4)
- Minor
- Major
- Herpetiform
- Oro-Genital ulcer syndromes – e.g. Behçet’s syndrome
How do we diagnose recurrent aphthous ulcers? (2)
History – important as patient may not have ulcer when they visit
Examination – look for current ulceration or scarring = past ulceration
What is the most common recurrent aphthous ulcer?
Minor aphthous ulcer
How do minor recurrent aphthous ulcers present clinically? (3)
- Yellow/grey ulcerative base (from fibrous deposition over the exposed CT)
- Oval shape
- Erythematous halo of inflammatory change (perilesional erythematous halo)
List the characteristics of a minor recurrent aphthous ulcer. (4)
- Less than 10mm diameter
- Last up to 2 weeks
- ONLY affect NON-Keratinised mucosa
- Heal without scarring
How do we treat minor recurrent aphthous ulcers?
- Usually a good response to topical steroids
Why is it important to ask about ulcer free periods?
good guide to morbidity and treatment need;
– longer ulcer free + less morbidity
How to major recurrent aphthous ulcer present clinically? (3)
- Yellow/grey ulcerative base (from fibrous deposition over the exposed CT)
- Erythematous halo of inflammatory change (perilesional erythematous halo)
- Large lesions commonly associated with other smaller ulcers
What are the characteristics of a major recurrent aphthous ulcer? (5)
- Usually LARGER than 10mm
May get smaller ulcers alongside too – diagnose from the worst ulcer - Can last for months
- Can affect ANY part of the oral mucosa: including Keratinised OR non Keratinised or both
- Have potential to scar when healing, not always
- Poorly responsive to topical steroids
Intralesional steroids often more useful
What are the differences between minor and major recurrent aphthous ulcers? (3)
Size:
minor = less than 10mm
major = larger than 10mm
location
minor = non-keratinised mucosa
major = keratinised and non-keratinised
duration:
minor = up to 2 weeks
major = months
What are the characteristics of herpetiform aphthae? (4)
- Multiple small ulcers on non-keratinized mucosa
- Heal within 2 weeks
- Can coalesce into larger areas of ulceration
(NOTHING to do with herpes viruses)