Oral Ulceration

Question 1

What is the standard treatment for oral ulceration?

Answer 1

There is no standard treatment- it is usually tailored to needs of specific patient

Question 2

What can be useful adjuncts to coming to a diagnosis of oral ulceration?

Answer 2

Thorough history

Pictures- esp if the patient has no ulcers at present

Question 3

What are the causes of ulceration?

Answer 3

Trauma

Immunological- aphthous ulcers, lichen planus, lupus, vestibulo-bullous, erythema multiforme

Infection- viral, fungal, bacterial

Carcinoma

Gastrointestinal- Crohn’s/ulcerative colitis

Question 4

What tend to be the causes of single episode oral ulceration?

Answer 4

Trauma

1st episode of Recurrent Oral Ulceration

Primary Viral infections

Oral Squamous Cell Carcinoma

Question 5

What are the causes of recurrent oral ulceration?

Answer 5

Aphthous ulceration- Minor, major, herpetiform

Lichen Planus

Vesiculobullous lesions- Pemphigoid, pemphigus, Angina Bullosa Haemorrhagica, Erythema Multiforme

Recurrent viral lesion – HSV, VZV

Trauma

Systemic disease – Crohn’s Disease ulceration

Question 6

How long does an aphthous ulcer last?

Answer 6

No more than 2 weeks

Question 7

How do aphthous ulcers and lichen planus ulcers differ?

Answer 7

Lichen planus- ulcers happen in same place

Aphthous - different places each time

Question 8

What is the ulcer free period? What can be ascertained from this?

Answer 8

How long does patient go without ulcer
 Gives idea amount of inconvenience or pain (morbidity)
 Frequency- is there long or no breaks between ulceration

Question 9

What are the types of recurrent aphthous stomatitis

Answer 9

minor
major
herpetiform
Behçet’s syndrome

Question 10

What are the types of ulcers caused by Crohn’s?

Answer 10

Aphthous type ulcers (nutrient loss):
-> Haematinic deficiency associated- bowel cancer, PUD
-> Behave like aphthous ulcers

Crohn’s specific ulcers:
-> Linear/fissured at the depth of the sulcus
-> Full of Crohn’s associated granulomas

Question 11

What can help treat persistent Crohn’s specific ulcers?

Answer 11

Intralesional steroids

Question 12

What are the different aspects to enquire about when taking a history of ulcers?

Answer 12

Where?
Size & Shape?
Blister or ulcer?
How long for?- More than 2 weeks?
Recurrent?- Same site? Different Sites?
Painful?

Question 13

What should be checked for when examining an ulcer?

Answer 13

Margins- Flat, Raised, Rolled

Base- Soft, Firm, Hard

Surrounding tissue- Inflamed (granulation tissue/fibrin), normal

Systemic Illness

Question 14

What are the features of traumatic ulceration?

Answer 14

White/keratotic appearance

Common

Usually single episode- can recur if cause not removed

Question 15

What are the causes of traumatic ulceration?

Answer 15

Primary cause- Appliance, dentures, sharp tooth/restoration, biting while under LA

Secondary- parafunction (mucosa rubs against teeth)

Question 16

How are traumatic ulcers treated?

Answer 16

remove cause of trauma

-> should heal in 2 weeks

Question 17

Which primary viral infections can cause ulceration? What is unusual about these ulcers?

Answer 17

Coxsackie and Herpes

-> follow and are limited to one nerve group or branch

Question 18

What characteristic suggests herpetic cause of an ulcer?

Answer 18

Recurrence occurs in the same place- esp. if keratinised tissue like hard palate

Question 19

What are the differences between simplex or zoster ulceration?

Answer 19

HS1/2- discomfort on bursting of vesicles

Herpes zoster- discomfort before vesicles appear

Question 20

What is used to treat recurrent herpetic lesions?

Answer 20

Acyclovir may be required to supress viral replication

-> Esp with zoster as recurrence of lesion is associated with increasing damage to nerves (persistent nerve pain)

Question 21

What does ulceration found to be caused by oral squamous cell carcinoma suggest?

Answer 21

Advanced stage of disease
-> Ideally this would be found at the dysplastic stage

-> Be suspicious if patient not attended dentist in years