Oral ulcers

Question 1

what is an ulcer?

Answer 1

breach in the mucosa

Question 2

oral ulceration is….

Answer 2

localised defect
epithelium destruction exposing underlying connective tissue

Question 3

oral ulcer causes

Answer 3

trauma
nutritional/ metabolic
allergy
inflammatory
infective
immunological
drug induced
neoplastic

Question 4

clues to cause of ulcer

Answer 4

site
onset
appearance
duration
pain
size

Question 5

traumatic ulcer

Answer 5

white keratotic borders
fractured cusp?

Question 6

Apthous ulcer

Answer 6

painful
red border
yellow white centre

Question 7

Recurrent apthous stomatitis

Answer 7

major >1cm (long time to heal)
minor <1cm (2-3wk heal)
herpetiform (multiple small ulcers that join)

Question 8

apthous ulcer trigger

Answer 8

stress
trauma
allergy
sensitivity

Question 9

Metabolic/ Nutritonal ulceration

Answer 9

Aphthous ulceration
Adults w/ GI pathology
Anaemia

Question 10

Inflammatory/ Immunological causes

Answer 10

SLE
OLP
Behcet’s (mouth, skin, genital,eyes)
Necrotising sialometaplasia

Question 11

Connective tissue questions?

Answer 11

joint pain
photosensitive rashes
xeropthalmia
fatigue

Question 12

GI Questions

Answer 12

abdominal pain
PR blood mucous
altered bowel motion
weight loss

Question 13

infective caused

Answer 13

Primary or Recurrent HSV
EBV
HIV
Coxsackie virus

Question 14

Primary HSV Infection

Answer 14

2-5years old
fever, malaise, cervical lymphadenopathy
short lasting vesicle on tongue, lip, buccal, palatal, gingival

Question 15

Varicella zoster Virus

Answer 15

Primary VZ (chicken pox) > Virus latent in sensory ganglion > Reactivation (shingles)

Question 16

Varicella zoster Virus Presentation

Answer 16

present over distribution of dermatome
reactivates due to immunocompromised/ acute infection

Question 17

Iatrogenic cause

Answer 17

chemo
radio
GvsHD
Drug induced (PCB, bisphosphonates, NSAIDS, DMARDs

Question 18

Neoplastic ulcer

Answer 18

exophytic
rolled borders
raised
hard
non mobile
no pain

Question 19

ulceration management

Answer 19

Simple mouthwash (HSMW )
2. Antiseptic mouthwash (hydrogen peroxide or CHX or doxycycline)
3. Local anaesthetic (Benzydamine Spray or Mouthwash)
4. Steroid mouthwash (Betamethasone)
5. Steroid Inhaler (Beclometasone)
6. Onward referral

Question 20

blood tests for ulcer?

Answer 20

FBC/Haematinics/Coeliac Screen – if aphthous appearance