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5th Oral Disease -Histology Lectures > Oral Ulceration > Flashcards

Oral Ulceration Flashcards

1
Q

What is an ulcer?

A

Full thickness loss of epithelium
From basal cell layer to keratin
Exposing underlying connective tissue

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2
Q

What are the components of ulcer?

A

Ulcer covered by slough
Underlying granulation tissue
Mixed inflammatory infiltrate

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3
Q

Difference between ulcer and erosion?

A

Erosion = partial loss (e.g pempihus vulgaris)

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4
Q

What is slough made up from?

A

Fibrino-purulent

Fibrin and neutrophils

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5
Q

What is granulation tissue made from?

A

Fibroblasts and endothelial cells

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6
Q

What is in mixed inflammatory infiltrate?

A

Acute inflammation cells = neutrophils

Chronic inflammatory cells = lymphocytes/ plasma cells

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7
Q

Difference between primary and secondary ulcer?

A

Primary - begins as ulcer

Secondary - being blister/ vesicles

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8
Q

What are some possible differentials of ulcers?

A 
Neoplastic
Traumatic
Developmental
Infective
Idiopathic
Iatrogenic
Manifestation dermalogical disease
Manisfestation systemic disease
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9
Q

Give example of developmental ulcer?

A

Epidermolysis bullose

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10
Q

Give example infective ulcer?

A

Syphillis

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11
Q

Give example of idiopathic ulcers?

A

RAS

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12
Q

Give example of dermatological ulcer?

A

Lichen planus

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13
Q

What is crucial in ulcer hx?

A

If single or recurrent episodes

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14
Q

Give example of single episode ulcers - both single and multiple?

A

Single ulcer - SCC

Multiple ulcer - herpes zoster

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15
Q

Give example of multiple episode ulcer - both single and multiple?

A

Single - mucocutaneous disorders

Multiple - RAS

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16
Q

What are causes of single episode ulcers?

A

Traumatic - physical, chemical, thermal
Malignancy
Infective
Drugs

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17
Q

How to tx traumatic ulcer?

A

Reassurance
Remove cause e.g sharp cusp
Consider difflam/ corsodyl
Should improve

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18
Q

What would make you suspicious of malignancy?

A

Any ulcer that doesn’t heal within 3 weeks and has unexplained cause
Regard as malignant until proven otherwise - biopsy

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19
Q

What guidelines should be used to cancer referral?

A

NICE clinical guidelines - suspected cancer: recognition and referral

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20
Q

Give example of causes of multiple ulcers?

A 
Herpes simplex
Herpes zoster
Erythema multiforma
H,F&M
Herpangina
Iatrogenic e.g drug
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21
Q

What drugs can cause iatrogenic ulcers?

A 
Allopurinol
Cytotoxics
Gold
Indomethacin
Methotrexate
Nicorandril
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22
Q

How to diagnosis iatrogenic ulcers caused by drugs?

A

Link cause and effect
Establish cause and should see improvement in ulcer
Can lease w/ GP

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23
Q

What else can cause mucositis and iatrogenic ulcers?

A

Irradiation

Managed in hospital - hard to manage

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24
Q

What should be considered in ulcer hx?

A

Size, shape, number, location and duration

Periodicity, pain, precipitating and reliving factors

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25
Q

What should be considered in ulcer examination?

A

Size, shape, site, number, base

Edge, discharge, consistency, nodes and other features

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26
Q

What is a factitious ulcer?

A

Self-induced

Often seen in children

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27
Q

What bored of ulcer would be suggestive of malignancy?

A

Raised, rolled borders

Ulcers floor of mouth - high RF

28
Q

What is RAS?

A

Recurrent apthous stomatitis

29
Q

What are the 3 different types of RAS?

A

Minor RAS
Major RAS
Herpetiform RAS

30
Q

What are possible differentials of RAS - recurrent and multiple ulcers?

A

Behcet’s disease
Recurrent erythema multiforme
Mucocutaneous disorder

31
Q

What are the features of RAS?

A

Common -20% population affected

Painful - affected eating, drinking, speech

32
Q

What is the most common RAS ulcer?

A

Minor - 80% of RAS ulcer

33
Q

What age does minor RAS affected?

A

Peak age 10-30

34
Q

What size would you expect a minor RAS ulcer to be and how many?

A

1-5 ulcers approx 3-8mm diameter

To be minor must be less 10mm

35
Q

How long to minor RAS ulcers last?

A

7-10 days

Variable ulcer free period

36
Q

Where do minor RAS affected?

A

Often non-keratinised mucosa
Usually front of mouth
Heal w/o scar

37
Q

Characteristic of minor RAS?

A

Less 10mm diameter
Tender to touch
Red halo w/ yellow ulcer slough

38
Q

What % of RAS ulcers are major?

A

10%

39
Q

What size are major RAS ulcers - how many?

A

1.5-2cm
Must be larger 10mm

Can be single or multiple

40
Q

How long to major RAS ulcers last?

A

3 weeks - 3 months

41
Q

Where to major RAS ulcers affect?

A

Non-keratinised mucosa but can affect masticatory

Often affect back of mouth

42
Q

What is a characteristic of major RAS not seen in minor?

A

Can heal w/ scaring

White scaring

43
Q

What % of RAS are herpetiform ulcers?

A

5%

44
Q

What is herprtiform ulcers?

A

Dozens of small ulcers that may coalesce to form large irregular ulcer
Symptomatic

45
Q

Where likely to find herpetiform ulcers?

A

Mainly floor of mouth, margin and ventral surface tongue

46
Q

How long to herpetiform ulcers last?

A

7-10days

47
Q

Are herpetiform ulcers associated w/ herpes?

A

No

48
Q

Tx of herpetiform ulcers?

A

If symptomatic doxycycline mouthwash

49
Q

What are contributory factors of ulcers?

A

Stress
Trauma
Hormone
Smoking

50
Q

Relationship w/ smoking and RAS ulcer?

A

Smokers have less problem w/ RAS

51
Q

What are predisposing factors of ulceration?

A 
Haematological deficiency
Neutropenia
Immune deficiency 
GI tract disease e.g UC
Vitamin deficiency 
Food intolerance
52
Q

What investigations could be undertaken if ulceration?

A

Blood -FBC, ferritin, B12 and folate

Coeliac screen

53
Q

What are the 3 components of tx of ulcers?

A

Preventative
Symptomatic tx
Suppressive tx

54
Q

What is preventative tx?

A

Tx underlying systemic disease/ haematological deficiency
Remove trauma
OHI
Diet advice

55
Q

What is symptomatic tx?

A

Chlorhexidine mouthwash
Difflam mouthwash
Covering agents

56
Q

What is difflam mouthwash?

A

Benzidamine = analgesic agent

57
Q

What are the types suppressive treatments?

A

Local or systemic

58
Q

Examples of local suppressive txs?

A 
Steroids -topica
Hydrocortisone pellets
Beclometasone spray
Beamethasone mouthwash
Flixonase nasals
59
Q

Examples of systemic suppressive txs?

A

Prednisolone - steroid
Thalidomide
Azathioprine

60
Q

Use of systemic suppressants and therefore the disadvantages?

A

Dampens immune response, more prone to other opportunistic infection (candida), change blood sugar, effect metabolism – weight gain

61
Q

Risk of using thalidomide?

A

Risk peripheral neuropathy

62
Q

Who is Behcet’s disease founds in?

A

Mainly young adults
Male: female = 2.3:1

Increased incidence Japan and Turkey

63
Q

What are the systemic diseases associated w/ Behcet’s?

A 
Blidness
Neurological damage
Oro-genital ulcer
Vasculitis
Death
64
Q

Criteria of Behcet’s disease?

A

Recurrent oral apthous ulceration

\+ 2 of the following:
Recurrent genial ulcer
Uveitis/ retinal vasculitis
Skin lesions
Positive pathergy test
65
Q

What are other common features associated w/ Behcet’s?

A

Arthritis
GI lesions
CNS involvement
Vascular lesion

66
Q

What are the 3 other causes of ulceration?

A

Muco-cutaneous disorders
Haematological disorders
GI disorders

67
Q

Examples of muco-cutanous disorders?

A

Lichen planus
Pemhigus
Pemphigoid
Erythema multiforme

5th Oral Disease -Histology Lectures (11 decks)

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