oral ulceration Flashcards
how would you describe an ulcer
a full thickness breach of the epithelium
what causes oral ulcers
recurrent ampthous stomatitis- a benign ulcer caused by nutritional deficiency
haematinic deficiency
anaemia
leukeamia
IBS
coeliac
chemo
meds
poorly fitting denture
HIV
TB
lupus
behcets
leukaemia
erythema multiform
Steven Johnsons Syndrome
Acquired immunodeficiency
Trauma
Self-inflicted injury
Cyclical neutropenia
MAGIC PFAPA
Common childhood viral exanthem
what is difference between (recurrent) aphthous stomatitis and oral ulcers
they are essentially the same thing- both small oral ulcers but it is called RAS if the pt is otherwise healthy :. no other systemic problems e.g. iBS or HIV
what is recurrent aphthous stomatitis
a genetically predisposed condition, it is ulceration in the mouth
when there is no other system conditions in the pt e.g. leaukaemia
what are the 3 types of recurrent ampthous stomatitis
minor, major, herpetiforme
what is herpetiforme recurrent aphthous stomatitis
not originating from any form of virus
how does stress associate with ulcers
stress can cause ulcers but only if the pt has a genetic predisposition to it
tell me the male:female ratio of minor, major and herpetiforme RAS
minor- male=female
major- male=female
herpetiforme- F>M
what age does minor, major an herpetiforme RAS tend to form
minor- 5-19
major-10-19
herpetiforme-20-29
what number of ulcers to pts with minor, major and herpetiforme RAS tend to have
minor- 1-5, 1-10, 10-100
how big in mm are minor, major and herpetiforme RAS
MINOR- LESS THAN 10
major- more than 10
herpetiforme- 1-2
how long do minor, major and herpetiforme RAS last
minor- 4-14
major- more than 30
herpetiforme- less than 30
what sites do minor ulcers affect
labial mucosa, buccal mucosa, tongue and floor of mouth
what sites do major ulcers affect
labial mucosa, buccal mucosa, tongue, palate, pharynx
what site do herpetiforme ulcers affect
labial mucosa, buccal mucosa, tongue, pharynx, palate, gingivae, floor of mouth
what is a common sign for oral cancer
one single persistent oral ulcer
if you have a persistent ulcer, what could be the reason for it
SCC- squarmous cell carcinoma and :. oral cancer
-trauma
- medication related
what are the 2 types of recurrent ulcers
recurrent oral ulcer
recurrent aphthous stomatitis
what are the 3 different types of RAS (RECURRENT APHTHOUS STOMATITIS)
- minor
- major
- herpetiforme
what conditions could be related to recurrent aphthous stomatitis
-IBD
- COELIAC
-PFAPA
- BEHCETS
-CYCLICAL NEUTROPENIA
when history taking for oral ulceration, what questions should you ask
number of ulcers
size
site associations- bad breath etc
duration
frequency
pain
ulcer free period
effects on schooling
family history
medical history
dental history
medication history
what medical investigations can be done for ulcers
FBC
haematinics- this tests for deficiency in B12, folate, and ferritin (iron containing protein)
coeliac screen
serum ACE, ESR, CRP- inflammation markers can help in diagnosis of IBS
pathergy test - to test for behcets which is blood vessel inflammation
microscopy- to test for infection of a persistent or recurrent ulcer
indirect immunofluorescence
incisional biopsy
clinical signs of parafunctional oral ulcers
- pronounced buccal ridges
- scalloped edges on the tongue
- TMD secondary tp jaw clenching and grinding
what treatment would you give to someone with parafunctional oral ulcers
pain relief through topical agents difflam
2-3mm soft bite guard
what is the main cause for parafunctional oral ulcers
stress
what do you do if you suspect someone has oral cancer
put them on a 2 week wait protocol
how would you treat someone with RAS
TOPICAL GEL AND SOFT SPLINT 2-3MM BITE GUARD
In which cases would you refer an ulcer pt to oral medicine dept
- if you doubt an overdiagnosis
-Partial/non-response to simple topical treatments including topical anaesthetic mouthwashes and sprays, avoidance of SLS, provision of a biteguard (if appropriate) and even a trial of betamethasone 500 microgram tablets dissolved in 10mls of water and held in the mouth over the ulcers for 3-4 minutes then spat out QDS (ALL ACTIONS THAT A GDP IS QUALIFIED TO UNDERTAKE)
-severe presentation, rapid onset, if multiple systems are involvede.g. gut, skin,eyes - a medication or medical condition adding to the ulcer
what is the clinical presentation of herpetiforme ulcers
small, lots of them, over 100
which areas of the mouth would only herpetiforme ulcers present in
floor of mouth ,gingivae
what areas of the mouth do herpetiforme ulcers like to present on
ventral tongue, floor of mouth and lower labial mucosa
what treatment is used to treat specifically herpetiforme ulcers
doxycylcine mouthwash-100mg capsule mixed in water
what is behcets disease
a rare condition, inflammation of blood vessels and tissue but has aphthous ulceration as one of its unifying features
can be life threatening for people with neurological system e.g. strokes
what conditions can behcts lead to
oral ulceration
genital ulceration
ocular changes (retinal vasculitits)
headaches
acne form lesions
myalgia (muscle pain)
what is cyclic neutropenia
an inherited disorder where there is a depletion of neutropenia (white blood cells neutrophils)
and predisposes pts to RAS
