Oral cavity

Question 1

• What is the common term for an aphthous ulcer?

- What sare some predisposing factor for an aphthous ulcer?

Answer 1

• Canker sore
• Familial tendency, trauma, hormonal factors, food or drug hypersensitivity, immunodeficiency, emotional stress, celiac disease, IBD, vitamin and mineral deficiencies (B12)

Question 2

What are the clinical features of an aphthous ulcer?

Answer 2

Found on nonkeratinized mucosa, buccal and labial mucosa, not gingiva or palate; single or multiple, recurrent

Question 3

What do aphthous ulcers look like and how long do they last?

Answer 3

1-2 mm, round with yellow-gray centers surrounded by red halos; painful stage lasts 7-10 days, healing complete in 1-3 weeks

Question 4

How do you treat an aphthous ulcer?

Answer 4

Topical steroids – triamcinolone acetonide in orabase, fluocinonide gel in orabase
Systemic steroids
Amlexanox 5% (Aphthasol)
Cimetidine maintenance therapy may be helpful with recurrent ulcers
Thalidomide - patients with severe RAS

Question 5

What are some differential diagnoses for aphthous ulcers?

Answer 5

Large or persistent areas:
  Erythema multiforme or drug allergies
  Acute herpes simplex
  Pemphigus, pemphigoid
  Bullous lichen planus
  Behcet’s disease
  Inflammatory bowel disease
  Squamous cell carcinoma

Question 6

• What is the common name for herpes gingivostomatitis?
• What usually accompanies the primary infection?
• What clinical sign accompanies gingivostomatitis?
• Where do the painful vesicular eruptions appear?

Answer 6

• Cold sores
• A 2-3 day prodromal period of malaise and fever
• Cervical adenopathy
• Oral mucosa, tongue, palate, vermilion borders, gingiva

Question 7

• What is of concern with a severe case of herpes gingivostomatitis?
• How long does it usually take to resolve?
• What are precipitating factors?

Answer 7

Oral trauma, sunburn, stress, febrile illness

Question 8

What are some potential differential diagnoses for cold sores?

Answer 8

Oral erythema multiforme
Stevens-Johnson
Aphthous lesions
   Tend to occur on movable oral mucosa
   No vesicles
Oral pemphigus
Hand-foot-mouth disease

Question 9

• How do you make the diagnosis of herpes gingivostomatitis?

- How do you treat gingivostomatitis?

Answer 9

• Clinically, viral culture, serology, immunofluorescence, tzanck prep
• Supportive care with rehydration and pain control; topical analgesics (viscous lidocaine 2%, oral antiviral - adults with primary infection)