Oral Ulceration Flashcards
What history should you take from the patient in regards to their oral ulceration?
Where is it?
Size and shape?
Blister (bursts to form an ulcer) or just an ulcer?
How long for?- more than 2 weeks indicates it is not a simple ulcer but an aphthous type
Recurrent?- same site? different sites?
Is it painful?
How long is the ulcer free period?
What should you look for when examining an ulcer?
Margins- flat, rolled, raised
Base- soft, firm, hard
Surrounding tissue- inflamed or normal
Do they have systemic illness associated with the ulcer
What can cause single episode oral ulceration?
Trauma (from braces etc)
Primary viral infections (most commonly herpes or coxsackie)
What can recurrent oral ulceration be?
Aphthous ulceration (minor,major,herpetiform)
Lichen planus
Vesiculobullous lesions- present as blisters and burst to form ulcers
Recurrent viral lesion HSV, VZV
Trauma
Systemic disease- Crohn’s Disease ulceration
What are Crohn’s Disease Oral Ulcers?
A mixture of ulcer types
–Aphthous type ulcers
–Haematinic deficiency associated
Crohn’s specific ulcers
–Linear at the depth of the sulcus
–Persistent for months- intralesional steroids help
Patient presents with a linear fissured ulcer along depth of sulcus
What are traumatic ulceration?
Usually only a single episode
-can be recurrent if cause is not removed
-need to check that the area is healing within 2 weeks
Normal or abnormal epithelium
Remove the cause
Any ulceration lasting for more than 2 weeks that cannot be explained should be sent for biopsy to ensure that it is not an early malignancy
What are recurrent herpetic lesions?
Ulceration limited to one nerve group/branch
Most common with herpes simplex 1 or 2 but herpes zoster can also give recurrent lesions
Often found on the hard palate
–lesion recurs in the same place
–patient often aware of prodrome and vesiculation which bursts
–pain suggests herpes zoster rather simplex
How do you treat recurrent herpetic lesions?
Treat with systemic Aciclovir
Use prophylactically if it is a severe problem
(particularly with herpes zoster where recurrence of the lesion will be associated with increasing nerve damage and the possibility of persisting nerve pain after the lesion has settled)
Where do minor aphthous ulcers affect?
Only non-keratinised mucosa
Where do major aphthous ulcers affect?
Can affect both non-keratinised and keratinised tissue
How do you treat ulcers?
Beclometasone inhaler- 1-2 puffs directed onto ulcers twice daily
Betamethasone soluble tablets
Hydrocortisone oromucosal tablets
