Oral Ulcerative Diseases Flashcards
What is Behçet’s Disease?
What is the clincal presentation?
A chronic autoimmune disorder characterized by recurrent oral and genital ulceration, eye lesions and skin lesions
Triad of aphthous-like oral ulcers, genital lesions, and recurrent eye inflammation
How do you manage ulcers? (4)
Eliminate local aggravating factors
- Grind down sharp tooth causing trauma
Control infection
- Topical/Systemic antimicrobials
Control pain
- Topical/Systemic analgesics
Promote healing
- Topical /Systemic steroids
List characteristics of herpetiform RAS:
Size
Shape
Colour
Duration
Site
Ulcers number/crop
Peak age of onset
Size - 0.5-3 mm diameter
Shape - round - may coalesce to irreg.
Colour - yellow base, erythematous border
Duration - 1-2 weeks
Site - non-keratinised tissue (especially ventral of tongue, FoM)
Ulcers number/crop - 1 to 20
Peak age of onset - 3rd decade
No scarring
*coalesce = join to make a bigger ulcer
What systemic analgesics can be prescribed for oral ulcerations?
Aspirin 300-600mg
Paracetamol 500-1000mg
Dihydrocodeine 30mg
Ibuprofen 400mg
At what age does Behçet’s Disease normally present?
3rd to 4th decade
What are the two local types of ulcers?
In response to trauma (Chemical, electrical, thermal, radiation)
Recurrent Aphthous Stomatitis
What is an erosion in regards to the mucosa and epithelium?
Area of partial loss of skin or mucous membrane
Epethelium is intact
If a patient has had ulcers once and then it went away what condition could this be and what may have triggered the ulcer?
Single episode ulcer
Ulcerations in response to:
Infection
Trauma
Drug reaction
What drugs/treatments can cause ulcers?
Cytotoxic drugs
Radiotherapy
Nicorandil (Treatment for stable angina)
What fungal infections can cause ulcers?
Candidiasis
Histoplasmosis
Aspergillosis
What viral infections can cause ulcers?
Chicken pox
Herpes simplex
Herpes zoster
HIV
What topical steroid can be prescribed to a patient with severe oral ulcerations?
Betamethasone sodium phosphate tabs 500 mcg as mouthwash
(use for 3 mins daily)
What connective tissue diseases can cause ulcers?
Lupus erythematosus
Wegener’s granulomatosis
What is relevant to tell a patient if they have smoking related aphthous stomatitis?
Ulcers in response to smoking cessation
Ulcers will not go away if they start to smoke again
This is a response to a change in the heat shock proteins in the body
It will settle with time
What blood disorders can cause ulcers?
Anaemia
Leukaemia
Neutropenia
Myelodysplastic syndromes
What bacterial infections can cause ulcers?
TB
ANUG
Syphilis
What is stevens-Johnsons syndrome?
Erythema Multiforme with severe systemic symptoms and extensive lesions involving multiple body areas, especially the mucous membranes
If a patient has long lasting ulcers that heal to only have a new one begin forming what condition could this be?
Ulcerations secondary to sytemic disease (E.g. lichen planus)
Recurrent/persistent ulcerations
What GI disorders can cause ulcers?
Coeliac disease
Crohn’s disease
Ulcerative colitis
What topical analgesics can be prescribed for oral ulcerations?
Lignocaine 5% ointment
Lignocaine 2% gel
Prilocaine 4% max in 10mls
Benzocaine 10mg lozenges
Choline salicylate (bonjela)
What are the three types of Recurrent Aphthous Stomatitis?
Major
Minor
Herpetiform
List characteristics of Minor RAS:
Size
Shape
Colour
Duration
Site
Ulcers number/crop
Peak age of onset
Size - < 10 mm diameter
Shape - oval
Colour - grey base, erythematous border
Duration - 1-2 weeks
Site - non-keratinsed mucousa (especially BM)
Ulcers number/crop - 1 to 5
Peak age of onset - 2nd decade
No scarring
What skin conditions can cause ulcers?
Erosive Lichen Planus
Pemphigus
Pemphegoid
Erythema multiforme
If a patient has a single non healing ulcer in their mouth for a long time what could this be?
Even with treatment
Neoplastic cancerous ulcer
Single persistent ulcer
Define atrophy when referring to the epithelium
Loss of thickness
When diagnosing RAS what investigations need to be done?
Blood tests
- Flood blood picture
- Haematinics - B12 / Folate / Ferritin
- Liver function test
Biopsy
- In the hospital, if malignancy suspected
Define plaque when referring to the mucosa and epithelium
Raised uniform thickening of a portion of skin / mucosa with a well defined edge
If a patient has crops of ulcers that heal completely and then they come back what conditions could this be?
Recurrent Aphthous Stomatitis
Erythema multiforme
Recurrent ulcerations
List the characteristics of Major RAS:
Size
Shape
Colour
Duration
Site
Ulcers number/crop
Peak age of onset
Size - > 10 mm diameter
Shape - Irregular/oval
Colour - Grey base +/- indurated (firm) edge
Duration - 2-12 weeks
Site - Any surface (especially back of mouth)
Ulcers/crop - Up to 10
Peak age of onset - 1st decade
Scar on healing
What is an ulcer in regards to the mucosa?
Area of total loss of epethelium
(Skin and Epethelium)
If a patient has a single non healing ulcer in their mouth for a long time what could this be?
Even with treatment
Neoplastic cancerous ulcer
Single persistent ulcer
What relevant questions needed to be asked in the medical/social history of a patient with ulcers?
Age
Other malignant disease (past or present)
Smoking - pack years (risk x10)
Alcohol - units per week (risk x4)
Areca nut/Betel nut chewing
Smoking and alcohol (risk x40)
