Oral aphthous ulcers

Question 1

What are risk factors for oral aphthous ulcers?

Answer 1

Family history
female
<40 years old
immunocompromised
vitamin/mineral deficiencies

Question 2

What are the three types of AUs?

Answer 2

Minor
Major
Herpetiform

Question 3

Describe minor AUs

Answer 3

2-10mm, occur singly or in clusters up to 5
Oval shaped, last 7-10 days and do not scar
The only one that can be self treated

Question 4

Describe major AUs

Answer 4

> 10mm, occur in clusters of 2 or more

Irregularly shaped, last up to a month and may scar

Question 5

Describe herpetiform AUs

Answer 5

2-3mm, occur in clusters of 10-100

Irregular shape, last up to a month, may scar`

Question 6

What are two drugs that cause deficiencies that may lead to AU formation?

Answer 6

Isotretinoin

Histamine-2 receptor antagonists

Question 7

What are 5 drugs that have a direct association with the formation of oral ulcers?

Answer 7

Psychiatrics
Anticancer
Immunosuppressants
NSAIDs
Cardiac

Question 8

What are red flags that warrant referral?

Answer 8

- Major or herpetiform ulcers
Signs that the ulcer is secondary to another condition:
1st AU happened after the age of 30
Systemic symptoms
Immunocompromised
Lesions present elsewhere on the body
Severe pain
Radiation therapy
Recurs >6 times a year

Question 9

What are green flags for self treatment?

Answer 9

Minor AU
1-5 round/oval ulcers
personal history of childhood ulcers
family history of recurrent AUs
recently stopped smoking

Question 10

What are prevention methods?

Answer 10

Avoiding:
local trauma
allergens
dehydration
nutritional deficiencies
emotional stress
and managing drug-induced causes and underlying systemic disease causes

Question 11

What are some nonpharmacologic treatments of AUs?

Answer 11

removal oral trauma causing agents
avoid food/drinks that cause pain
Avoid harsh toothpastes and mouthwashes with SLS
maintain regular oral hygiene
apply ice
cleanse lesions with salt water (commercial rinses have no advantage)

Question 12

What are the first line pharmacological treatments?

Answer 12

First line- topical agents
Anesthetics: benzocaine, lidocaine. Short duration of action and may be used with a mucosal protectant
Anti-inflammatories
Mucosal protectants: orabase (hydroxypropyl cellulose, carboxymethyl cellulose)
Local oral anesthetic + mucosal protectant combinations

Question 13

What are nonprescription treatments for AUs?

Answer 13

Vitamin/mineral supplementation
Mix equal parts milk of magnesia + diphenhydramine allergy liquid
Avoid NSAIDs!

Question 14

What are prescription options for treating AUs?

Answer 14

Triamcinolone acetonide 0.1% in orabase