Oral ulceration Flashcards
Generally what 6 things might cause ulceration in the oral mucosa?
- Trauma
- Immunological
- Infections
- Gastrointestinal disease’s - Crohn’s , ulcerative colitis
What might have caused this ulceration?
Trauma from orthodontic appliances
What viral infections can cause ulceration in the oral mucosa?
- Herpes simplex virus
- Varicella zoster virus
What two types of oral ulceration is associated with Crohn’s disease?
- Apthous type ulcers
- Crohn’s specific ulcers
What is associated with apthous type ulcers in crohn’s disease?
- Haematinic deficiency
Describe 3 characteristics Crohn’s specific oral ulceration?
- Linear at the depth of the sulcus
- Associated with granulomas
- Persist for months - intalesional steroids help
What 3 types of ulcer margins?
- Flat
- Raised
- Rolled
What is a common type of ulceration?
Traumatic ulceration , usually single episode if cause is removed
When do traumatic ulcers usually heal?
Within 2 weeks
3 Characteristics of recurrent herpetic ulceration?
- limited to one nerve branch
- Often affects the hard palate
- Recurs in the same place
What would you use to treat a herpetic ulcers?
Aciclovir
A patient present with this type of ulceration with pain, what would be the cause ?
Reactivation of varicella zoster virus
What are the 4 forms of recurrent apthous ulceration?
- Major
- Minor
- Herpetiform
- oro-genital ulcer syndromes - Behcet’s syndrome
What is a general rule for diagnosing recurrent apthous ulcers?
- Recurrent self healing ulcers that only affects the non-keratinised mucosa
What are Aphthous ulcers ?
A type of oral ulceration that is immunologically generated that is recurrent can be associated with genetics and environmental factors
How does a standart minor ulcer appear intraorally?
- Yellow or grey base with red margins
Describe the diameter, healing, area affected of minor apthous ulcers?
- Less than 10mm diameter
- Last for up to 2 weeks
- Heal without scarring
- Affect non keratinised mucosa
Describe the diameter, healing, area affected of major apthous ulcers?
- larger than 10mm
- can last for months
- may scar when healing
- affect any part of the mucosa
Explain how major and minor ulcers are treated with steroid?
Minor respond well to topical steroids while major are poorly responsive to topical steroid and may need intralesional steroid
What is the rarest form of apthous ulcers?
Herpetiform apthae
What is herpetiform apthous ulcers?
- multiple small ulcers on non keratinised mucosa
- heal within 2 weeks
- these are not related to herpes viruses
Why are herpetiform apthous ulcers named this way?
Because in the early stages they look like primary herpetic gingivostomatitis
What are the 2 criteria that should be met for the diagnosis of oral and genital ulceration?
- three episodes of mouth ulcers in a year
- at least two of the following : genital ulcers, eye inflammation, skin ulcers, pathergy
Give two other conditions other than behcet’s that may cause oro-genital ulceration?
- Vesiculobullous diseases
- Lichen planus
5 signs of behcet’s disease?
- Bowel ulceration
- Brain damage
- Joint pain
- Inflammation of blood vessels
- Eye disease
- Genital ulceration
3 steps to manage Behcet’s disease?
- Treat oral disease with steroids
- Systemic immunomodulation
- Liaise with rheumatologist
What systemic immunomodulator is used first off label for behcet’s disease?
- Colchicine
Name other 2 immunomodulators used for behcet’s?
- Azathioprine
- Mycophenolate
Give 1 drug used for biological management of behcet’s?
infliximab
4 predisposing factors of RAS other than genetics and viral infections?
- Horomonal changes
- Stress
- Trauma
- systemic diseases - Crohn’s
Immunologically , explain how apthous ulcers develop?
Immune cells cause attack basal cells resulting in lack of epithelial cells at the surface of the epithelium which results in ulceration
When is the treatment of apthous ulceration is most effective??
Ulcer prodome period
What 4 investigations would you take for apthous ulcers other than haematinics?
- Blood test for coeliac disease
- Allergy tests to benzoates, sorbate , cinammoon and chocolate
What test is carried out for coeliac screening?
TTG test ( tissue transgutaminase)
What food additives may cause allergic reaction leading to apthous ulceration?
E210 - E219
How to manage apthous ulceration after investigation?
- Correct blood deficiencies
- Refer for investigation if coeliac positive
- Avoid dietary triggers and SLS toothpaste
What would you give an apthous ulcer patient for symptomatic relief?
betamethasone mouthwash
What group of patients would you consider referral when presenting with apthous ulcers?
Children under 12
