Oral Ulceration Flashcards
What is the standard treatment for oral ulceration?
There is no standard treatment- it is usually tailored to needs of specific patient
What can be useful adjuncts to coming to a diagnosis of oral ulceration?
Thorough history
Pictures- esp if the patient has no ulcers at present
What are the causes of ulceration?
Trauma
Immunological- aphthous ulcers, lichen planus, lupus, vestibulo-bullous, erythema multiforme
Infection- viral, fungal, bacterial
Carcinoma
Gastrointestinal- Crohn’s/ulcerative colitis
What tend to be the causes of single episode oral ulceration?
Trauma
1st episode of Recurrent Oral Ulceration
Primary Viral infections
Oral Squamous Cell Carcinoma
What are the causes of recurrent oral ulceration?
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
How long does an aphthous ulcer last?
No more than 2 weeks
How do aphthous ulcers and lichen planus ulcers differ?
Lichen planus- ulcers happen in same place
Aphthous - different places each time
What is the ulcer free period? What can be ascertained from this?
How long does patient go without ulcer
Gives idea amount of inconvenience or pain (morbidity)
Frequency- is there long or no breaks between ulceration
What are the types of recurrent aphthous stomatitis
minor
major
herpetiform
Behçet’s syndrome
What are the types of ulcers caused by Crohn’s?
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
What can help treat persistent Crohn’s specific ulcers?
Intralesional steroids
What are the different aspects to enquire about when taking a history of ulcers?
Where?
Size & Shape?
Blister or ulcer?
How long for?- More than 2 weeks?
Recurrent?- Same site? Different Sites?
Painful?
What should be checked for when examining an ulcer?
Margins- Flat, Raised, Rolled
Base- Soft, Firm, Hard
Surrounding tissue- Inflamed (granulation tissue/fibrin), normal
Systemic Illness
What are the features of traumatic ulceration?
White/keratotic appearance
Common
Usually single episode- can recur if cause not removed
What are the causes of traumatic ulceration?
Primary cause- Appliance, dentures, sharp tooth/restoration, biting while under LA
Secondary- parafunction (mucosa rubs against teeth)
How are traumatic ulcers treated?
remove cause of trauma
-> should heal in 2 weeks
Which primary viral infections can cause ulceration? What is unusual about these ulcers?
Coxsackie and Herpes
-> follow and are limited to one nerve group or branch
What characteristic suggests herpetic cause of an ulcer?
Recurrence occurs in the same place- esp. if keratinised tissue like hard palate
What are the differences between simplex or zoster ulceration?
HS1/2- discomfort on bursting of vesicles
Herpes zoster- discomfort before vesicles appear
What is used to treat recurrent herpetic lesions?
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)
What does ulceration found to be caused by oral squamous cell carcinoma suggest?
Advanced stage of disease
-> Ideally this would be found at the dysplastic stage
-> Be suspicious if patient not attended dentist in years
