Oral ulcerations Flashcards
What is an ulcer
A full thickness breach of the epithelium
What can oral ulcers be caused by
- Recurrent aphthous stomatitis
- Haematinic deficiency
- Anaemia
- Leukaemia
- Inflammatory Bowel Diseases
- Coeliac disease
- Lupus
- OFG
- Behcet’s
- Cyclical neutropenia
- MAGIC
- PFAPA
- Common childhood viral exanthem
- HSV infections
- Mucous Membrane Pemphigoid 16. Pemphigus Vulgaris
- Erythema Multiforme
- Steven Johnsons Syndrome
- Acquired immunodeficiency 20. TB
- HIV
- Trauma
- Self-inflicted injury
- Medications
- Chemotherapy
What is the first thing you need to decide when you see a patient has an ulcer
Is it recurrent or persisting
What does oral cancer usually present as
A single persistent oral ulcer
What must you do it you suspect oral cancer in a patient
You must refer the patient that day under local caner referral pathways
A patient with suspected oral cancer lesion will be seen in how much time
2 weeks
What elements of the oral ulceration do you need to note down
- Number
- Size
- Site
- Frequency
- Duration
- any Ulcer free period
- Any extra oral ulcers
- pain
What should we ask the paint in regards to the oral ulceration
- Pain
- Habits
- Any associations
- Effect on life/ schooling g
- Family history
- Medical history
- Medication history
What habits should we ask the patient about if they have an ulcer
Do you clench or grind your teeth?
Are you aware of tongue thrusting or repeatedly rubbing your tongue, lips or cheeks on your teeth?
What investigations can we take if a patient has an oral ulceration
- Full blood count
- Haemantics
- Coeliac screening
- Serum ACE, ESR, CRP
- Pathergy test
- Microscopy, culture and sensitivities
- Indirect immunofluorescence
- Incisional biopsy for H&E
Does every patient with an oral ulceration need further investigations for diagnosis
no
What do we mean by recurrent oral ulceration
References ANY cause for recurrent oral ulcers
What does RAS stand for
Recurrent aphthous stomatitis
Name the different variants of Recurrent aphthous stomatitis
- Minor
- Major
- Herpetiforme
What does the word aphthous mean
Ulcer
When do we use the term Recurrent aphthous stomatitis
When there is NO other underlying pathological process or diagnosis causing the ulcer
What does herpetiforme Recurrent aphthous stomatitis refer to
Used to describe the clinical appearance of ulcers which were said to appear as those seen in common viral illness like chicken pox
How big are ulcers found in minor Recurrent aphthous stomatitis
Less than 10mm
How big are ulcers found in major Recurrent aphthous stomatitis
Greater than 10mm
How big are ulcers found in herpetiforme Recurrent aphthous stomatitis
1-2mm
How many ulcers are often present in minor Recurrent aphthous stomatitis
1-5
How many ulcers are often present in major Recurrent aphthous stomatitis
1-10
How many ulcers are often present in herpetiforme Recurrent aphthous stomatitis
10-100
Which sites are affected by minor Recurrent aphthous stomatitis
Labial mucosa,
buccal mucosae,
tongue,
floor of mouth
Which sites are affected by major Recurrent aphthous stomatitis
Labial mucosa, buccal mucosae, tongue, palates, pharynx
Which sites are affected by herpetiforme Recurrent aphthous stomatitis
Labial mucosa, buccal mucosae, tongue, pharynx, palate, gingivae, floor of mouth
In which form of Recurrent aphthous stomatitis is scarring common
Major Recurrent aphthous stomatitis
Give some clinical signs of parafunction
- pronounced buccal ridging,
- linea albae,
- crenulated/ scalloped edges to the tongue
- concomitant TMD secondary to clenching and grinding
Where do ulcers due to parafunction habits tend to form
Along the occlusal plane on the lateral borders of the teeth and along the occlusal plane level of the buccal mucosae or lips
Oral ulcers due to parafucntion habits don’t form where
- ulcers on the palate,
2. floor of mouth or gingivae
How do we manage oral ulcerations caused by parafuncitonal habits
- Explanation or cause to patients ,
- Ask about stress levels
- pain relief through topical agents like gengigel/Gelclair/Difflam
- provision of a 2-3mm soft bite guard to protect the soft tissues
As a dentist what I you job when you identify a patient with an oral ulceration
- Identify the likely cause
- Provide patient with information
- Start simple strategies to alleviate the pain and functional problems from the ulcers
When would you refer a suspected Recurrent aphthous stomatitis patient to oral medicine
- Doubt over diagnosis
- Partial/ non response to topical treatments
- Severe presentation
- Known or suspected medical condition or medication use
List the rarest causes of oral ulceration
- Herpetiforme RAS
- Behcet’s Disease
- Cyclical Neutropenia
How common is Herpetiforme RAS
Accounts for less than 10% of all cases of Recurrent aphthous stomatitis
How can we manage Herpetiforme Recurrent aphthous stomatitis
doxycycline can work well used as a mouthwash to control Herpetiforme RAS
How much doxycycline should we prescribe to a patient with Herpetiforme Recurrent aphthous stomatitis
100mg capsules that need to be opened and the contents mixed with warm water and used as a mouthwash for at least 2 minutes QDS
What is Behcet’s Disease
Causes vasculitic changes in multiple body tissues
Apart from oral ulcerations what else can Behcet’s Disease cause
- Genital ulceration,
- ocular changes (uveitis, retinal vasculitis etc),
- acne-form lesions (papulopustular rashes),
4, headaches, - arthralgia
- myalgia.
How common is Behcet’s Disease
Prevalence of about 1 per 100,00
What is neutropenia
depletion of the white blood cell, the neutrophil
How can neutropenia be acquired
following chemotherapy or it can be seen secondary to significant infections.
What is Cyclical neutropenia
is an inherited disorder characterised by falls in neutrophil counts every 21 days
