Oral Ulceration

Question 1

Oral ulceration

Answer 1

• common complaint
• degree of morbidity varies from person to person
• tailor tx to pt’s needs
• history will usually give diagnosis
• ## pictures are useful

Question 2

Causes of mucosal ulcerations

Answer 2

• trauma
• Immunological
• carcinoma
• infections
• gastrointestinal

Question 3

Immunological causes of Ulceration

Answer 3

• aphthous ulcers*
• lichen planus*
• lupus
• vesiculo-bullous
• erythema multiforme

Question 4

Infection causes of ulceration

Answer 4

• bacterial
• fungal
• viral

Question 5

Gastrointestinal causes

Answer 5

• crohn’s disease
• ulcerative colitis

Question 6

Oral ulceration history

Answer 6

• where?
• size and shape?
• blister/ ulcer
• How long has it been for?more than 2 weeks? (if aphthous type, does not last more than 2 weeks)
• recurrent? same site? different sites?
• painful?

Question 7

Examining an ulcer

Answer 7

1. margins
   - flat/ raised/ rolled
2. base
   - soft/ firm/ hard
   - covered by granulation tissue?
3. surrounding tissues
   - inflamed/ normal
4. systemic illness?

Question 8

Why single episode oral ulceration occur?

Answer 8

• Trauma, ie: ortho appliances, denture
• 1st episode of recurrent oral ulceration
• primary viral infections
• oral squamous cell carcinoma

Question 9

1st episode of recurrent oral ulceration

Answer 9

Question 10

Primary viral infections

Answer 10

• Coxsackie virus
• Herpes virus

Question 11

Oral squamous cell carcinoma

Answer 11

Question 12

Types of recurrent ulceration

Answer 12

1. Aphthous ulceration
   - minor
   - major
   - herpetiform
2. Lichen planus
3. Vesiculobullous lesions
   - pemphigoid, pemphigus
   - angina bullosa haemorrhagica
   - erythema multiforme
4. Recurrent viral lesion
   - HSV
   - VZV
5. Trauma
6. Systemic disease - Crohn’s disease ulceration

Question 13

Recurrent Aphthous Stomatitis (RAS)

Answer 13

• minor
• major
• herpetiform
• Behcet’s syndrome

Diagnose by
- history- haematinics deficiency
- examination

Question 14

Crohn’s disease Oral ulcers

Answer 14

Mixture of ulcer types
- aphthous ulcer types
- haematinic deficiency

Crohn’s specific ulcers
- linear at depth of sulcus
- full of crohn’s associated granulomas
- persists for months and might help with intralesional steroids

Question 15

Traumatic ulceration

Answer 15

• common
• usually a single episode
• can be recurrent if not removed properly
• may have normal/ abnormal epithelium
• remove cause and will heal within 2 weeks
• should be must less prominent
• any persisiting ulcers, should be biopsy to avoid malignancy

Question 16

Chemical burn ulcer

Answer 16

Question 17

Ulcer in child (erupting)

Answer 17

Question 18

LA and pt traumatised tongue by biting

Answer 18

Question 19

Recurrent Herpetic Lesions

Answer 19

• often recurrent
• ulceration limited to one nerve group/ branch
• often hard palate
• lesions occurs in same place
• pt aware of prodrome and vesiculation which bursts

** PAIN suggests herpes zoster rather than simplex

• treat with Aciclovir to suppress viral replication
• prophylactic if severe

Question 20

General RULE

Answer 20

• recurrent self- healing ulcers affecting non- keratinised mucosa are normally aphthous
• affecting keratinised tissue are normally viral

Question 21

Summary

Answer 21

• not all ulcers are aphthous ulcers
• is it on keratinised/ non- keratinised tissues
• any systemic symptoms? Herpes/ Coxsackie (may have fever)
• traumatic causes, ie: primary/ secondary

Primary- sharp edge on tooth/ appliance
Secondary- parafunction rubbing mucosa against teeth

• if not healing after 2-3 weeks, discuss with hospital specialist and if biopsy is required