Oral Aphthous ulcers Flashcards
whar are apthous ulcers
AKA Canker Sores, Aphthous Stomatitis or Recurrent Aphthous Stomatitis
- recurrent, painful, inflammatory, non infectious, non vesicular, immunologically mediated mucosal disease
- occurs on nonkeratinized oral mucosal surfaces (tongue, floor of mouth, soft pallet NOT onf hard pallet or lips
Epidemiolgoy of canker sores
- most prevalent oral lesion
- occurs in 25%of population, 50% recurrence within 3 motnhs
- first ocurnece 10-20 years old: more common in childhood and early adulthood
- freq and sevarity decrease ith age
- populations with higher freq = women under 40, family history of AU, middle and upper middle socioeconomic groups
etiology of canker sores
- local trauma (mucosal injury): biting cheek, braces
- stress
- systemic conditions
- allergy/senstitiy
- food
- immunologic states
- nutrional deficienies: Ca and Vit B
- cessation or restating tobacco use
- genetic predisposion
- mediaction: NSAIDS
maybe hormonal changes
risk factors for AU
- family history
- female
- less than 40
immunocompromised (HIV, transplant)
- vitamin and mineral deficiencies
clinical presentation of canker sores
- one or more shallow sores with a white or cream colours coating
- erthematous “halo” of infalmed tissue around ucler
=painful
-history of recurrent episodes
what are thet ypes of canker sores
- Minor
- 2-10 mm, oval shape
- occurs singly or in clusers <5
- 7-10 days
- no scarring
- Major
- >10mm, deeper and occurs in clusters of 2 or more
- irregualr shape
- may persit for weeks
- scar potential
- Herpetiform
- 2-3mm
- occur in clusters of 10-100, irregualr shape
- 7-30 days
- scar potential
differential diagnosis of AU
(thigns it can be mistaken for
- Behcet syndome: mouth sores 1st preseting symptom
- IBS (Chrons): will have other GI symptoms
- Lupus erthematosus
- Leukoplaia: pre cancerous, common in smokers
- viral ifnections: herpes, varicella sozter, mono, will also present w/ fever
- Treponemal infections (syphilis)
- fungal infections (thrush): will get a white coating
- hematologic disease (cyclic neutropeia)
- neoplasms (squamous cell carcinoma): not inside mouth
classes of drugs that can cause drug induced oral ulcers
- NSAIDs, cadiology, immunosepressant, anticancer agents, psychiatry agents
* if on PPI or iron def meds, prob have a nutritional deficiency that may cause it
what are med falgs for major or herpetiform apthae
- Ulcer diameter >10 mm
- Ulcer duration >14 days
- >5 ulcers present
- multiple clusters of ulcers that may have coalesced
- difficulty chewing or swallowing due to pain
- History of having ulcers that last >14 days, heal with scarring and recur 6-12 times/year
what are red falcts for AU that could indicate ulcers are from a secondary condition
- first AU was after age 30
- systemic illness symptoms (fever_
- immunocomprised due to meds or disease state
- lesions present elsewhere on body
- severe pain
- radiation theapy
recurrences > 6x per year(underlying cause triggering it
who are self care candidates for AU
- 1-5 round or oval mouth ulcers that are :
Painful
Located on nonkeratinized mucosal surfaces of movable mouth parts
Flat or crater-like with an erythematous “halo” margin
White/yellow/grey centre
Each lesion ≤ 10mm in diameter
*also if have personal history of childhoos ulcers, family histroy of recurrent or recently stopped smoking
goals of therapy for AU
- relive local pain and dsicomfort
- restore functiona nd oral hygeine practices (speaking swallowing)
- ensure adequate nutritoinal intake
- reudce duration of ulceres
- decrease frequency and severity of recurrences (cant be cured)
- prevent complication
prevention measures for AU
- avoid local traume (self biting, shapred edge foods, replace tooth brush heads early)
- avoid allergens
- avoid dehydration
0 avoid nutritoinal deficiencies
- minimize emotional distress
- manage drug induced causes
- maange underlying systemic disease causes
non pharmacologic treatment for AU
Repair or remove oral trauma-causing agent
Avoid food & drinks that cause pain
Avoid using harsh toothpastes and mouthwashes with SLS
Maintain regular daily oral hygiene
Ice application
Cleanse the lesion(s)
• Rinse the mouth with salt water (2.5-5 mL table salt per 250 mL warm water) several times a day, especially after meals
