Oral Ulceration Flashcards
What is an ulcer?
Loss of epithelium
Can effect cutaneous or mucous tissue
Usually painful and may require topical drug therapy
What type of epithelium for most mucosal surfaces in the oral cavity?
Stratified squamous epithelium
- has protective functions
- protects against microorganisms from invading underlying tissue
- protects against water loss
Causes of oral ulceration?
- trauma
- immunological
- infection
- systemic
- stress
- poor diet
- virus
- allergies
- drug therapy
- familial trait
- malignancies
Occurrence
- single episode
- recurrent
Infective and non infective
Infective
- herpes
- tuberculosis
- syphilis
- measles
Non infective
- traumatic ulcers
- recurrent aphthous stomatitis (RAS)
- leukaemia
- Behçet’s disease
- HIV
- lupus eryhematosus
- pemphigus vulgaris
- erythema multiforme
Which ulcers are likely to be reactivated
Infective
Herpes types and characteristics?
Primary hermetic stomatitis
- primary infection
- single occurrence
Herpes labialis
- latent (virus becomes dormant)
- recurrent
- reactivated in 20-30% of patients
Primary herpetic stomatitis
- herpes simplex virus
- transmission - close contact
- in larger, poor communities 90% pop develop antibodies
- more affluent communities 70% pop may be non-immune (due to lack of exposure)
- more common in immunocompromised
Clinical features of primary herpetic stomatitis
Can effect any part of oral cavity
- hard palate and dorsum of tongue - common
Vesicles 2-3mm, which rupture and from shallow ulcers
Yellowish grey with red margins
Swollen gingival margins
Enlarged lymph nodes
Persist 7-10 days - longer in immunocompromised
Herpes labialis
After the primary infection it may remain latent and reactivate in 20-30%
Presents as herpes labialis - cold sores
Trigger
- common cold
- febrile infections
- sunshine
- menstruation
- stress eg dental treatment
- trauma
Tuberculosis
- oral tuberculosis is rare - it’s complication of open pulmonary tuberculosis
- typical lesion - ulcer mid dorsal surface tongue
- lip / other areas less affected
- painless early stages lmymph nodes NAD
- oral ulceration heal following drug therapy for the pulmonary infection
pulmonary tuberculosis
Tuberculous ulcer of tongue
Syphilis
- rare
- sexually transmitted
- incubation period 9-90 days
- congenital syphilis (mother has active syphilis)
- acquired syphilis…-
oral lesions differ as to the stage the infection is at
1. Primary - 3-4 weeks
2. Secondary - 1-4 months
3. Tertiary - 3+ yrs after infection
Syphilis - Primary - 3-4 weeks
- rare on lip / intro orally - usually on tongue
- commonly affects genitalia
- infective agent Treponema Pallidum
- small papule / large painless ulcer
- highly infectious
- heals 1-2 months
- tx - penicillin
Syphilis - secondary
Oral lesions present as;
- mucous patches
- split papules
- snail track ulcers
Highly infectious
Rash on pals / soles - coppery
Thx penicillin
Syphilis - tertiary
Oral lesions present as;
- Glossitis
- Gumma (mid line on palate)
Non infectious
Koplik spots
Prodromal stage of measles
- white spots in buccal sulcus and palate
- lymphadenopathy
Specific aetiology of ulcers
Local aetiology
Systemic aetiology
Ulcers that present as a chemical burn
- Caused by aspirin - non painful as aspirin is anti inflammatory
- Cocaine - tissue degeneration evident
Appearance of mechanically induced ulcers
Slightly depressed, oval shapes
Erythematous zone at the periphery which lightens with keratinisation
Centre is usually yellow/grey
Appearance of thermally induced ulcers
Erythematous and raised
Appearance of chemically induced ulcers
Less well defined with mucosal sloughing
What to do when you find an ulcer
- identify cause
- inform the dentist
- record in notes (site, shape, colour, margins, base)
- note date and monitor is 2/3 weeks
Most intra oral ulcers heal within 2 weeks
If still present with no signs of healing report to supervising clinician
Systemic aetiology of ulcers
- immunosuppressed / drug therapy
- stress
- hereditary
- nutritional
- neoplasms
