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Oral Disease - Soft tissue > Oral Ulceration > Flashcards

Oral Ulceration Flashcards

1
Q

Define: erosion

A

Area of partial loss of skin or mucous membrane

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2
Q

Define: Ulceration

A

Area of total loss of epithelium and lamina propria

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3
Q

Define: atrophy

A

Loss of thickness

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4
Q

Define: plaque

A

Raised, uniform thickening of a portion of the skin/mucosa with a well defined edge

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5
Q

Define: excoriation

A

Scratch mark which has scored the epidermis

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6
Q

Define: Lichenification

A

Thickening of the prickle cell and horny layer of the epidermis with underlying inflammation

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7
Q

List the local causes of oral ulceration

A

Trauma - dentures, sharp teeth or restorations, self-inflicted or iatrogenic
Burns - chemical, thermal, electric or radiation (radiotherapy ulcers)

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8
Q

List the systemic causes of oral ulceration

A
  • haematological - anaemia, leukemia, neutropenia
  • Gastrointestinal - coeliac, crohns, ulcerative colitis
  • Dermatological - bechets, EB, EM, lichen planus, PV
  • Infections
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9
Q

List the drugs which play a role in the aetiology of oral ulceration

A
  • Cytotoxic drugs
  • Nicorandil
  • NSAIDs
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10
Q

List the differential causes of oral ulceration

A
  • Local
  • Systemic including infections
  • Drug therapy
  • Malignancy
  • Recurrent aphthous ulceration
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11
Q

List the infectious causes of oral ulceration

A

Bacterial - ANUG, TB, syphillis
Viral - HIV, VZV, HSV, coxsackie
Fungal - deep mycoses

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12
Q

Presentation of oral ulceration due to local trauma

A
  • Usually a single episode of ulceration (unless causative factor is not removed)
  • Associated with trauma prone site e.g. lip, BM, denture flange
  • Tenderness
  • Yellow-grey floor of fibrin slough with red margins
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13
Q

What is the appearance of ulcers due to chronic local trauma

A
  • Chronic trauma may lead to induration due to scarring, or keratotic margins
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14
Q

What are some presenting signs of ulcers due to anaemia

A

Pale mucosa

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15
Q

What are presenting signs for ulcers due to cyclical neutropenia

A

Pale yellow ulcers without erythema (due to reduced inflammatory response)

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16
Q

What are presenting signs of ulcers due to leukemia

A
  • Gingival swelling and bleeding associated with ulceration

- Other signs of malignancy

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17
Q

What are the characteristic lesions associated with ulcerative colitis?

A
  • Pyoderma gangernosum

- Pyostomatitis vegetans

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18
Q

What does pyostomatitis vegetans look like?

A

Lots of small yellow pustules that coalesce

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19
Q

What is the presentation of ulcers due to drugs?

A
  • Aspirin causes chemical trauma when placed on the mucosa
  • RAS-like lesions with nicorandil and methotrexate
  • Mucositis with cytotoxic agents
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20
Q

Warning signs an ulceration is malignant

A
  • > 3 weeks persistent without any other expalanation
  • Thick and indurated
  • Asymptomatic
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21
Q

Special IX for oral ulcerations

A
  • Blood tests

- Biopsies

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22
Q

Topical analgesics used for oral ulceration

A

Difflam (benzydamine hydrochloride)

Lidocaine gel or ointment

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23
Q

Topical steroids used for management of oral ucleration

A

Betamethasone
Fluticasone
Moometasone

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24
Q

Topical anti-inflammatory agents used for the management of oral ulceration

A

Doxycycline 100mg as mouthwash

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25
Systemic agents used for the management of oral ulceration
- Corticosteroids (prednisolone) - Dapsone - Colchicine - Tacrolims
26
Management of ulceration due to underlying disease
- Referral to GMP to investigate | - Resolving condition will resolve ulceration
27
Why are blood tests used as a special ix for oral ulceration?
- 25% of ulcers are associated with a haematological abnormality
28
Questions to ask during ulcer history taking
- What does the pt mean by an 'ulcer' - Age of onset - Noticed any changes - Duration (how long before they heal) - How long before ulcers recur - Frequency of ulcer attacks - Any associations e.g. smoking - Number, shape, size, site, symptoms, any ulcerations elsewhere e.g. skin or genitals
29
Medical history aspects relevant to ulcer history
- Age - History of malignancy - Drug history - Smoking history - Alcohol history
30
Prevalence of recurrent aphthous stomatitis
10-25%
31
What is recurrent aphthous stomatitis?
Common condition characterised by round or ovoid painful ulcers recur on the oral mucosa
32
What are the hypothesised aetiological factors of RAS
- Genetic predisposition - Infections - Immunological abnormalities - GI and haematological disorders - Hormonal disturbances - Stress - Non-smokers
33
Epidemiology of RAS
- Often childhood onset with a peak in adolescence or early adult life - Sometimes positive family history
34
When do we biopsy an ulcer?
Only if it mimics a carcinoma
35
What are the categories of RAS ulcers
Minor Major Herpetiform
36
Describe minor RAS ulcers
Oval shaped lesion <10mm diameter, often found on non-keratinised mucosa (BM) with a grey base and erythematous border - Usually around 1-5 ulcers are present
37
Describe major RAS ulcers
Irregularly shaped lesion >10mm, may occur anywhere (tends to be posterior or masticatory mucosa), grey base which may have indurated borders, may have 2-10+ ulcers
38
How long do minor RAS ulcers last?
1-2 weeks and heal without scarring
39
How long do major RAS ulcers last
2-12 weeks and heal with scarring
40
Describe herpetiform ulcers
Round (or irregular with coalescence) lesion around 0.5-3mm, found on the non-keratinised mucosa (ventral tongue common) with a yellow base and widespread, bright erythematous border
41
What are the peak ages of the RAS ulcers
Minor - 2nd Major - 1st decade Herpetiform - 3rd decade
42
What are herpetiform ulcers?
Appear like HSV ulcers, but contain no viral component
43
What is the most common management option for RAS?
- Symptomatic relief - Eliminate local factors - Promote healing of ulcers
44
Topical drugs for the management of RAS
- Corticosteroids - Betamethasone or triamcinolone paste - Tetracycline, CHX or difflam mouthwash - Salicylate preparations
45
When may systemic drug therapy be indicated in RAS?
Major apthae that are painful | Persistent and resistant to conventional treatment
46
What is the ulcer severity score?
Index used to classify ulcers based on their severity - it accounts for number of ulcers, size, duration, site, pain, length of ulcer free period and evidence of scarring
47
What conditions are characterised by oral and genital ulceration?
- Reactive arthritis - Mouth and genital ulcers with inflamed cartilage - Bechets disease
48
What is reactive arthritis?
Autoimmune condition developing 2-4 weeks after GI or genitourinary infections, which presents with non-infectious urethritis, arthritis and conjunctivitis.
49
What are the oral findings in reactive arthritis
Erythematous macules and plaques with diffuse erythema, erosions and bleeding of the mucosa - Circinate lesions on the tongue
50
Management of reactive arthritis
- Most is self limiting | - If symptomatic then NSAIDs, corticosteroids, antibiotics if the cause is chlamydia or DMARDs if NSAIDS are ineffective
51
What is mouth and genital ulcers with inflamed cartilage (MAGIC)?
Rare syndrome with probable autoimmune aetiology characterised by relapsing polychronditis and bechets and orogenital ulcers
52
Management for MAGIC
Pentoxifylline Corticosteroids Dapsone Infliximab
53
What is Bechets disease?
Chronic, relapsing, inflammatory mulisystem disease of unknown aetiology
54
Epidemiology of Bechets
- Young adult males - 20-40 | - Common in Turkey and Japan (silk road distribution)
55
Aetiology of Bechets
- Unknown but probable inflammatory reaction due to HSV or streptococci OR autoantigen in genetically predisposed individuals
56
What genetic component is associated with bechets?
HLA-B51
57
What inflammatory aspects are associated with Bechets
- T helper17 and interleukin 17 pathways are active - There are circulating immune complexes - Neutrophil activity is increased and infiltrates affected organs alongside lymphocytes
58
What are the types of Bechets disease divisions?
Mucocutaneous (orogenital ulceration Arthritic (+/- mucocutaneous) Neurological Ocular
59
How is a bechets diagnosis made?
Bechets is highly variable - diagnosis is made when there is aphthous ulcers alongisde 2 major criteria
60
What are the oral S/S for bechets
Minor RAS is common, major is also associated but herpetifom is rare
61
What are the genital S/S for bechets
Ulcers commonly associated with the scotum or labia | May occur less commonly on the vagina, or perineum
62
What are the ocular S/S for bechets
Anterior uveitis Cells in vitreous Retinal vasculitis
63
What are the skin S/S for bechets
Erythema nodosum Pseudofolliculitis or papulopustular lesions Acneiform lesions
64
What are the minor criteria for bechets
- Arthritis - DVT, PE or aortic aneurysm - CNS involvement - GI lesions
65
What are the major criteria for bechets
- Oral ulcers - Genital ulcers - Eye lesions - Skin lesions
66
Management of Bechets disease
- Initial - colchicine, topical steroids or non-steroidal mouthwash and antibiotics - Maintenance = oral steroids (azathioprine), then to infliximab or riuximab upon flare ups
67
What is steven johnsons syndrome?
Rare condition resulting from hypersensitivity to drugs or infections, or idiopathic in nature.
68
What drugs are associated with SJS?
- Barbiturates - Sulphonamides - NSAIDS - Carbemazepine
69
What infections are associated with sjs?
Herpes simplex (60%) Mycoplasma EBV HIV
70
Pathology of SJS?
immune complex formation and deposition in the microvasculature (cutaneous or mucosal)
71
S/S of SJS
- Oral ulceration or erosions in the anterior mouth - Crustation of lips (looks haemorhagic) - Skin lesions - look like targets, macules, papules, vesicles or bulla
72
Management of SJS
Supportive oral care | ICU or burns unit
73
Morality rate of SJS
10%
74
What is toxic epidermal necrolysis?
Severe form of SJS where >30% of the body surface is affected
75
Mortality rate of TENS
30%
76
What is PFAPA?
Periodic fever, aphthae, pharyngitis and cervical adenitis

Oral Disease - Soft tissue (12 decks)

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