ORAL MED apthous stomatitis management

Question 1

what questions must be asked when a pt presents with aphthous ulceration?

Answer 1

is there any other site involvement?
is there any GIT symptoms or associated systemic upset?

Question 2

when a pt presents with aphthous ulceration, who may you need to liaise with and why?

Answer 2

GMP
blood tests for deficiencies

Question 3

what is the diagnostic criteria for Behcets disease?

Answer 3

at least 3 episodes of aphthous ulceration in past 12 months
plus at least 2:
- eye involvement
- recurrent genital ulceration
- skin lesions
- positive pathergy test

Question 4

what is Behcets disease?

Answer 4

multisystem vasculitis

Question 5

what is erythema nodosum?

Answer 5

painful patched on the skin that are red or darker than surrounding skin - mainly seen on lower limbs

Question 6

what is pathergy?

Answer 6

exaggerated skin condition

Question 7

what are the 2 clinical features of Behcets?

Answer 7

pathergy
erythema nodosum

Question 8

treatment for asymptomatic aphthous stomatitis?

Answer 8

no tx required

Question 9

do we treat symptomatic aphthous stomatitis?

Answer 9

match treatment to symptom severity

Question 10

generally, list the types of management for symptomatic aphthous stomatitis?

Answer 10

SLS free toothpaste
topical analgesic
topical steroid
diet modification
symptom severity measure (oral disease severity score)

Question 11

does SLS toothpaste cause aphthous ulcers?

Answer 11

no but it is thought to make them worse

Question 12

what dietary substances may trigger aphthous stomatitis?

Answer 12

benzoate and cinnamon

Question 13

under the NHS, what topical therapy is available for aphthous stomatitis?

Answer 13

analgesic mouthwashes
- benzydamine
- lidocaine
antimicrobial mouthwashes
- chlorhexidine gluconate
- doxycycline
topical steroids
- betamethasone
- beclometasone
- hydrocortisone

Question 14

for managing aphthous stomatitis, what forms is benzydamine available in?

Answer 14

0.15% mouthwash
0.15% oromucosal spray

Question 15

why is benzydamine used to manage aphthous stomatitis?

Answer 15

it has anti-inflammatory properties

Question 16

for the management of aphthous stomatitis, what forms is lidocaine available in?

Answer 16

5% ointment
10% spray

Question 17

for managing aphthous stomatitis, how would 10% lidocaine spray be used?

Answer 17

sprayed onto a cotton wool bud

Question 18

what advice is given to pts if they are using lidocaine to manage their aphthous stomatitis?

Answer 18

dont eat/ drink 30 mins after due to the area being numb and you could burn yourself

Question 19

why can doxycycline be used to manage aphthous stomatitis?

Answer 19

it has anti-inflammatory properties (normally 3 day course)

Question 20

how are pts advised to use topical steroids (specifically betamethasone) for aphthous stomatitis?

Answer 20

use as you begin to feel the ulceration developing until it heals
must be spat out - risk of adrenal suppression

Question 21

how does management of aphthous stomatitis in secondary care differ to primary care?

Answer 21

sometimes, the potency of the topical steroid is increased

a combination (triple mouthwash) - 500microg betamethasone, 100mg doxycycline, nystatin (1ml in 10ml water)

systemic medication - short course of prednisolone, colchicine, DMARDs

Question 22

give examples of DMARDS?

Answer 22

azathioprine
mycophenolate mofetil

Question 23

in secondary care, for managing aphthous stomatitis, why is nystatin prescribed alongside betamethasone and doxycycline?

Answer 23

risk of them causing candidiasis