Oral Ulceration

Question 1

What is minor recurrent aphthous stomatitis?

Answer 1

Group of conditions where there is immunological damage to oral mucosa
Affect exclusively NON-KERATINISED mucosa
Also termed: Canker sores
Last up to 2 weeks
Usually good response to topical steroids
Usually less than 10mm in diameter

Question 2

What is recurrent oral ulceration?

Answer 2

Recurrent ulcers that affect KERATINISED mucosa - tend to be viral.

Question 3

Clinically describe what an aphthous ulcer looks like

Answer 3

Flat
Yellow/ white centre
Red erythematous surrounding tissue
PAINFUL

Question 4

What is the standard definition of an ulcer?

Answer 4

Full thickness breach in the mucosa

Question 5

Name some causes of ulcers

Answer 5

Trauma
Stress
Lack of nutrition - folate, B12, iron
Infections (Viral particularly but also bacterial and parasitic).
Cancer
Allergy/ hypersensitivity
Drug-induced

Question 6

Describe the likely clinical features of a traumatic ulcer

Answer 6

White keratotic border
Clear causative agent
Surrounding mucosa normal and ulcer soft - no hardness surrounding ulcer
Generally disappears within 2 weeks of removal of cause

Question 7

What are some clinical indications that an ulcer may be cancerous?

Answer 7

Rolled border
Hard to touch
Raised
Exophytic - tending to grow outward beyond surface epithelium from which it originates
Non-moveable
Not always painful

Question 8

Why would you choose mouthwash vs spray for an ulcer?

Answer 8

Mouthwash - when multiple ulcers throughout the mouth
Spray - when there is only one - can direct at singular ulcer

Question 9

What defines MAJOR recurrent aphthous ulcers?

Answer 9

Can affect ANY part of the mouth - keratinised and non-keratinised
Generally larger than 10mm diameter - may get smaller ones but diagnose from worst site
Poor response to topical steroids
Can last for months
Heal WITH scarring

Question 10

What is herpetiform aphthae?

Answer 10

Rarest form of aphthous ulcers
Multiple small ulcers that coalesce on NON-KERATINISED mucosa
Heal within 2 weeks

NOT ASSOCIATED WITH HERPES VIRUS

Question 11

Describe clinical features of recurrent herpetic lesions/ ulcers?

Answer 11

Ulceration limited to one nerve group/ branch - unilateral presentation
Lesion tends to recur in same location
Often hard palate
Affects KERATINISED epithelium as well as non-keratinised
Usually occurs when patient is immunosuppressed

Question 12

Describe clinical features of Chron’s ulcers?

Answer 12

Linear at depth of the sulcus
Persist for months
On biopsy - Chron’s associated granulomas

Question 13

What blood tests would you do to investigate aphthous ulcers?

Answer 13

Haematinic deficiencies - iron, B12, folic acid
Coeliac disease
HIV

Question 14

What is treatment for recurrent aphthae?

Answer 14

Minor- symptomatic relief - CHX, benzydamine spray
Steroids - topical for minor, intralesional for major - for more disabling/ frequent lesions
Correct blood deficiencies - iron, B12, folic acid
Refer for investigation if coeliac positive
Avoid allergy triggers

Question 15

What is non-steroidal treatment for infrequent aphthous ulcers?

Answer 15

CHX mouth-rinse - 0.2% send 300ml, 10ml 2x/ day for max. 2 weeks
Benzydamine hydrochloride spray 0.15%, send 30ml, 4 sprays affected area every 1.5 hours
Benzydamine hydrochloride MW 0.15% - send 300ml, rinse 15ml every 1.5hours as required

Question 16

What is Behcet’s disease?

Answer 16

PRIMARILY a vasculitis - inflammation of blood vessels
Oral and genital ulceration
Eye disease

Question 17

What is the criteria for behcet’s?

Answer 17

At least 3 episodes of mouth ulcers in a year
At least two of the following: genital sores, eye inflammation, skin ucers.

Question 18

Name some drugs that may cause oral ulceration?

Answer 18

NSAIDs e.g. aspirin
Beta blockers
Methotrexate
Cytotoxic drugs - cancer tx.
Anti-convulsants - carbamazepine
Penicillin