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ADH - Oral Pathology > Oral Ulceration > Flashcards

Oral Ulceration Flashcards

1
Q

What is an ulcer?

A

Loss of epithelium
Can effect cutaneous or mucous tissue
Usually painful and may require topical drug therapy

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2
Q

What type of epithelium for most mucosal surfaces in the oral cavity?

A

Stratified squamous epithelium
- has protective functions
- protects against microorganisms from invading underlying tissue
- protects against water loss

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3
Q

Causes of oral ulceration?

A
  • trauma
  • immunological
  • infection
  • systemic
  • stress
  • poor diet
  • virus
  • allergies
  • drug therapy
  • familial trait
  • malignancies
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4
Q

Occurrence

A
  • single episode
  • recurrent
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5
Q

Infective and non infective

A

Infective
- herpes
- tuberculosis
- syphilis
- measles

Non infective
- traumatic ulcers
- recurrent aphthous stomatitis (RAS)
- leukaemia
- Behçet’s disease
- HIV
- lupus eryhematosus
- pemphigus vulgaris
- erythema multiforme

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6
Q

Which ulcers are likely to be reactivated

A

Infective

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7
Q

Herpes types and characteristics?

A

Primary hermetic stomatitis
- primary infection
- single occurrence

Herpes labialis
- latent (virus becomes dormant)
- recurrent
- reactivated in 20-30% of patients

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8
Q

Primary herpetic stomatitis

A
  • 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
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9
Q

Clinical features of primary herpetic stomatitis

A

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

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10
Q

Herpes labialis

A

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

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11
Q

Tuberculosis

A
  • 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
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12
Q

pulmonary tuberculosis

A

Tuberculous ulcer of tongue

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13
Q

Syphilis

A
  • 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
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14
Q

Syphilis - Primary - 3-4 weeks

A
  • 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
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15
Q

Syphilis - secondary

A

Oral lesions present as;
- mucous patches
- split papules
- snail track ulcers

Highly infectious
Rash on pals / soles - coppery
Thx penicillin

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16
Q

Syphilis - tertiary

A

Oral lesions present as;
- Glossitis
- Gumma (mid line on palate)

Non infectious

17
Q

Koplik spots

A

Prodromal stage of measles
- white spots in buccal sulcus and palate
- lymphadenopathy

18
Q

Specific aetiology of ulcers

A

Local aetiology

Systemic aetiology

19
Q

Ulcers that present as a chemical burn

A
  1. Caused by aspirin - non painful as aspirin is anti inflammatory
  2. Cocaine - tissue degeneration evident
20
Q

Appearance of mechanically induced ulcers

A

Slightly depressed, oval shapes
Erythematous zone at the periphery which lightens with keratinisation
Centre is usually yellow/grey

21
Q

Appearance of thermally induced ulcers

A

Erythematous and raised

22
Q

Appearance of chemically induced ulcers

A

Less well defined with mucosal sloughing

23
Q

What to do when you find an ulcer

A
  • 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

24
Q

Systemic aetiology of ulcers

A
  • immunosuppressed / drug therapy
  • stress
  • hereditary
  • nutritional
  • neoplasms
25
Q

Recurrent aphthous stomatitis RAS

A

Non traumatic, recurring episodes of ulcerations

  • single or crops of multiples ulcers
  • children and young adults
  • smokers less affected
  • ovoid/round shape
  • yellowish centre
  • inflammatory halo
26
Q

Recurrent aphthous stomatitis RAS aetiology?

A
  • unknown 90%
  • menstruation
  • food allergy?
  • 20% pt with RAS have nutritional deficiencies
  • folic acid, iron, vit B12 deficiency
27
Q

Recurrent aphthous stomatitis RAS

RAS 1- Minor aphthae

A
  • 1-5 present
  • less than 10mm
  • labial and buccal mucosa
  • heal with no scarring
28
Q

Recurrent aphthous stomatitis RAS

RAS 2 - Type 2 Major aphthae

A
  • exaggerated variant of minor
  • larger, more destructive, last longer
  • bigger than 10mm
  • soft palate, tonsillar fauces, labial/buccal mucosa, tongue
  • red raised border with deep erosion of tissue
  • heal with scarring
29
Q

Recurrent aphthous stomatitis RAS

RAS 3 - Type 3 herpetiform aphthae

A
  • recurrent focal ulceration, resembles herpes
  • numerous pin head size grey-white erosions that enlarge and coalesce become ill defined
  • 1-2mm in clusters of 10-100
  • adjacent mucosa is Erythematous
  • any part of oral cavity can be affected
  • may or may not scar
30
Q

Treatment

Recurrent aphthous stomatitis RAS

A
  • all benefit from chlorhexidine 0.2% m/w
  • good OH

Type 1 minor - self healing

Type 2 major-
antibiotics to prevent secondary infection
Corticosteroids

Type 3 - herpetiform
If large surfaces affected treat as type 2

31
Q

Oral cancer - where is 70% found?

A
  • lower lip most frequent site
  • lateral borders of the tongue
  • floor of mouth

May Preston as oral ulcer, red path, white patch or atrophic area

32
Q

Leukaemia effects?

A

Major effects
- raised susceptibility to infection
- bleeding tendencies

Oral and peri oral effects
- gingival swelling
- mucosal ulceration
.. cytotoxic drugs,, immunodeficiencies
- purpura
- cervical lymphadenopathy

33
Q

Behcets syndrome

A
  • rare in uk common in turkey japan
  • more males
    20-40 yrs

General effects
- genital lesions
- ocular disease
- skin lesions
- arthritis

Oral and peri oral effects
- oral ulcerations - recurrent

34
Q

Who is more susceptible to RAS

A
  • HIV patient
  • Candida infection
  • hairy leukoplakia
  • NUG
35
Q

Lupus Erythematosus

A

Disease of connective tissues
2 types
Both can present as oral lesions

Systemic - oral lesions 20%
- rashes
- joint pain
- TRT systemic steroids

Discoid - oral lesions in up to 25%
- skin disease
- TRT topical corticosteroids

36
Q

Pemphigus vulgaris

A
  • autoimmune disease
  • uncommon
  • vesicles on skin and mucous membrane
  • first lesions appear in mouth
  • fatal if untreated
  • more females
  • 40-60 yrs
37
Q

Erythema multiforme

A

Mucocutanious disease (aetiology unknown)
Oral lesions - most prominent
General lesions - body rashes, ocular damage, blindness, renal failure

  • lasts for 3-4 weeks with recurrence of several months over a 1-2 yr period
  • runs a limited course
  • TRT - systemic corticosteroids and antibiotics
38
Q

Chemotherapeutic drugs

A

Immunosuppressants (cyclosporin)
- liver and heart transplants

Antimetabolites (methotrexate)
- cancer drugs, tumours, leukaemia, meninges cancer

Alkaloids (morphine)
- nitrogen containing substances

ADH - Oral Pathology (4 decks)

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