Oral Ulceration Flashcards
What are the causes of oral ulceration?
Traumatic
Metabolic/nutritional
Allergic/hypersensitivity
Infective
Inflammatory
Immunological
Drug induced (iatrogenic)
Neoplastic
Idiopathic
What is oral ulceration?
Localised defect where there is destruction of epithelium exposing underlying connective tissue
What should you ask about in an ulcer history?
Site
Onset
Duration
Number
Texture
Appearance
Size
Pain
Predisposing factors
Relieving factors
Describe traumatic ulcers
White keratotic borders
Clear causative agent
Don’t just look - need to feel
Surrounding mucosa normal and ulcer soft
Describe metabolic and nutritional ulcers
Aphthous like ulceration - yellow/white ulcer with a red border
If children and teenagers then associated with growth
Adults ass with occult GI/GU pathology
Malnourishment of any cause
Anaemia
Which GI diseases can cause deficiencies?
Malabsorption - Crohn’s, coeliac, ulcerative colitis, pernicious anaemia
Blood loss - peptic or duodenal ulcers, colonic polyps, colon cancer
Which GU diseases can cause deficiencies?
Menorrhagia - ulcers may be related to menstrual cycle
How does haematinic deficiency cause ulcers?
Causes atrophy of mucosa, predisposing it to ulceration, although it may have a more causative role in recurrent aphthae
What causes allergic or hypersensitivity ulcers?
Sorbate - baked goods, canned fruit and veg, cheeses, dried meats
Cinnamaldehyde - sweets and chewing gum
Benzoates - fizzy drinks, fruit juices, acidic foods
Often associated with OFG
Can cause oral lichenoid reactions
What are the causes of inflammatory/immunological ulcers?
Behçet’s disease - affects mouth, skin, genitals and eyes
Necrotising sialometaplasia
Lichen planus Vesiculobullous disease
CT diseases - SLE, rheumatoid arthritis, scleroderma
What are common features of gut diseases?
Abdominal pain
Rectal blood/mucus
Altered bowel motion
Unintentional weight loss
What are the common features of CTD?
Joint pain and stiffness
Photosensitive rashes
Xerothalmia/xerostomia
Fatigue
How does shingles come about and how can you manage it?
Primary Varicells Zoster Infection (Chicken Pox)
Virus remains latent in sensory ganglion
Reactivates resulting in VCZ infection (shingles)
Often due to immunocomromisation or other acute infection
Liaise with GP - analgesia, difflam
What are the causes of infective ulcers?
Primary or recurrent HSV
VZV
EBV
Coxsackie virus
Echovirus
Chronic mucocutaneous candidiasis
HIV
Describe primary HSV infection
Generally affects children between 2-5
Associated with fever
Headache, malaise, dysphagia, cervical lymphadenopathy
Short lasting vesicle effecting tongue, lips, buccal, palatal and gingival mucosa then forming ulceration
What are the causes of iatrogenic ulceration?
Chemotherapy
Radiotherapy
GVH disease
Drug induced - potassium channel blockers, Bisphosphonates, NSAIDs, DMARDs
Describe neoplastic ulcers
Exophytic
Rolled borders
Raised
Hard to touch
Non-moveable
Not always painful
Sensory disturbance
What malignancies commonly appear as ulcers?
Non-Hodgkin lymphoma
Kaposi’s sarcoma
How is oral ulceration managed?
Reverse the reversible
Refer for FBC, B12, folate, ferritin, coeliac screen
Simple warm salty mouthwash
Antiseptic mouthwash - hydrogen peroxide or CHX
Local anaesthetic (benzydamine or lidocaine)
Steroid mouthwash (betamethasone)
Referral to OM
What haematinic levels are associated with ulceration and anaemia?
Low B12/ferritin/folate with or without anaemia - aphthous ulceration
Low ferritin - associated with low MCV - microcytic anaemia
Low B12/folate - associated with a high MCV - normocytic anaemia
