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4th yr- CMS- The Oral Cavity > Oral ulcerations > Flashcards

Oral ulcerations Flashcards

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Introductory Sommelier Exam (CMS) flashcards
1
Q

What is an ulcer

A

A full thickness breach of the epithelium

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2
Q

What can oral ulcers be caused by

A
  1. Recurrent aphthous stomatitis
  2. Haematinic deficiency
  3. Anaemia
  4. Leukaemia
  5. Inflammatory Bowel Diseases
  6. Coeliac disease
  7. Lupus
  8. OFG
  9. Behcet’s
  10. Cyclical neutropenia
  11. MAGIC
  12. PFAPA
  13. Common childhood viral exanthem
  14. HSV infections
  15. Mucous Membrane Pemphigoid 16. Pemphigus Vulgaris
  16. Erythema Multiforme
  17. Steven Johnsons Syndrome
  18. Acquired immunodeficiency 20. TB
  19. HIV
  20. Trauma
  21. Self-inflicted injury
  22. Medications
  23. Chemotherapy
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3
Q

What is the first thing you need to decide when you see a patient has an ulcer

A

Is it recurrent or persisting

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4
Q

What does oral cancer usually present as

A

A single persistent oral ulcer

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5
Q

What must you do it you suspect oral cancer in a patient

A

You must refer the patient that day under local caner referral pathways

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6
Q

A patient with suspected oral cancer lesion will be seen in how much time

A

2 weeks

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7
Q

What elements of the oral ulceration do you need to note down

A
  1. Number
  2. Size
  3. Site
  4. Frequency
  5. Duration
  6. any Ulcer free period
  7. Any extra oral ulcers
  8. pain
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8
Q

What should we ask the paint in regards to the oral ulceration

A
  1. Pain
  2. Habits
  3. Any associations
  4. Effect on life/ schooling g
  5. Family history
  6. Medical history
  7. Medication history
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9
Q

What habits should we ask the patient about if they have an ulcer

A

Do you clench or grind your teeth?

Are you aware of tongue thrusting or repeatedly rubbing your tongue, lips or cheeks on your teeth?

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10
Q

What investigations can we take if a patient has an oral ulceration

A
  1. Full blood count
  2. Haemantics
  3. Coeliac screening
  4. Serum ACE, ESR, CRP
  5. Pathergy test
  6. Microscopy, culture and sensitivities
  7. Indirect immunofluorescence
  8. Incisional biopsy for H&E
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11
Q

Does every patient with an oral ulceration need further investigations for diagnosis

A

no

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12
Q

What do we mean by recurrent oral ulceration

A

References ANY cause for recurrent oral ulcers

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13
Q

What does RAS stand for

A

Recurrent aphthous stomatitis

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14
Q

Name the different variants of Recurrent aphthous stomatitis

A
  1. Minor
  2. Major
  3. Herpetiforme
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15
Q

What does the word aphthous mean

A

Ulcer

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16
Q

When do we use the term Recurrent aphthous stomatitis

A

When there is NO other underlying pathological process or diagnosis causing the ulcer

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17
Q

What does herpetiforme Recurrent aphthous stomatitis refer to

A

Used to describe the clinical appearance of ulcers which were said to appear as those seen in common viral illness like chicken pox

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18
Q

How big are ulcers found in minor Recurrent aphthous stomatitis

A

Less than 10mm

19
Q

How big are ulcers found in major Recurrent aphthous stomatitis

A

Greater than 10mm

20
Q

How big are ulcers found in herpetiforme Recurrent aphthous stomatitis

A

1-2mm

21
Q

How many ulcers are often present in minor Recurrent aphthous stomatitis

A

1-5

22
Q

How many ulcers are often present in major Recurrent aphthous stomatitis

A

1-10

23
Q

How many ulcers are often present in herpetiforme Recurrent aphthous stomatitis

A

10-100

24
Q

Which sites are affected by minor Recurrent aphthous stomatitis

A

Labial mucosa,
buccal mucosae,
tongue,
floor of mouth

25
Q

Which sites are affected by major Recurrent aphthous stomatitis

A 
Labial mucosa, 
buccal mucosae, 
tongue, 
palates, 
pharynx
26
Q

Which sites are affected by herpetiforme Recurrent aphthous stomatitis

A 
Labial mucosa, 
buccal mucosae, 
tongue, 
pharynx, 
palate, 
gingivae, 
floor of mouth
27
Q

In which form of Recurrent aphthous stomatitis is scarring common

A

Major Recurrent aphthous stomatitis

28
Q

Give some clinical signs of parafunction

A
  1. pronounced buccal ridging,
  2. linea albae,
  3. crenulated/ scalloped edges to the tongue
  4. concomitant TMD secondary to clenching and grinding
29
Q

Where do ulcers due to parafunction habits tend to form

A

Along the occlusal plane on the lateral borders of the teeth and along the occlusal plane level of the buccal mucosae or lips

30
Q

Oral ulcers due to parafucntion habits don’t form where

A
  1. ulcers on the palate,

2. floor of mouth or gingivae

31
Q

How do we manage oral ulcerations caused by parafuncitonal habits

A
  1. Explanation or cause to patients ,
  2. Ask about stress levels
  3. pain relief through topical agents like gengigel/Gelclair/Difflam
  4. provision of a 2-3mm soft bite guard to protect the soft tissues
32
Q

As a dentist what I you job when you identify a patient with an oral ulceration

A
  1. Identify the likely cause
  2. Provide patient with information
  3. Start simple strategies to alleviate the pain and functional problems from the ulcers
33
Q

When would you refer a suspected Recurrent aphthous stomatitis patient to oral medicine

A
  1. Doubt over diagnosis
  2. Partial/ non response to topical treatments
  3. Severe presentation
  4. Known or suspected medical condition or medication use
34
Q

List the rarest causes of oral ulceration

A
  1. Herpetiforme RAS
  2. Behcet’s Disease
  3. Cyclical Neutropenia
35
Q

How common is Herpetiforme RAS

A

Accounts for less than 10% of all cases of Recurrent aphthous stomatitis

36
Q

How can we manage Herpetiforme Recurrent aphthous stomatitis

A

doxycycline can work well used as a mouthwash to control Herpetiforme RAS

37
Q

How much doxycycline should we prescribe to a patient with Herpetiforme Recurrent aphthous stomatitis

A

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

38
Q

What is Behcet’s Disease

A

Causes vasculitic changes in multiple body tissues

39
Q

Apart from oral ulcerations what else can Behcet’s Disease cause

A
  1. Genital ulceration,
  2. ocular changes (uveitis, retinal vasculitis etc),
  3. acne-form lesions (papulopustular rashes),
    4, headaches,
  4. arthralgia
  5. myalgia.
40
Q

How common is Behcet’s Disease

A

Prevalence of about 1 per 100,00

41
Q

What is neutropenia

A

depletion of the white blood cell, the neutrophil

42
Q

How can neutropenia be acquired

A

following chemotherapy or it can be seen secondary to significant infections.

43
Q

What is Cyclical neutropenia

A

is an inherited disorder characterised by falls in neutrophil counts every 21 days

4th yr- CMS- The Oral Cavity (6 decks)

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