Oral ulcers Flashcards
what is an ulcer?
breach in the mucosa
oral ulceration is….
localised defect
epithelium destruction exposing underlying connective tissue
oral ulcer causes
trauma
nutritional/ metabolic
allergy
inflammatory
infective
immunological
drug induced
neoplastic
clues to cause of ulcer
site
onset
appearance
duration
pain
size
traumatic ulcer
white keratotic borders
fractured cusp?
Apthous ulcer
painful
red border
yellow white centre
Recurrent apthous stomatitis
major >1cm (long time to heal)
minor <1cm (2-3wk heal)
herpetiform (multiple small ulcers that join)
apthous ulcer trigger
stress
trauma
allergy
sensitivity
Metabolic/ Nutritonal ulceration
Aphthous ulceration
Adults w/ GI pathology
Anaemia
Inflammatory/ Immunological causes
SLE
OLP
Behcet’s (mouth, skin, genital,eyes)
Necrotising sialometaplasia
Connective tissue questions?
joint pain
photosensitive rashes
xeropthalmia
fatigue
GI Questions
abdominal pain
PR blood mucous
altered bowel motion
weight loss
infective caused
Primary or Recurrent HSV
EBV
HIV
Coxsackie virus
Primary HSV Infection
2-5years old
fever, malaise, cervical lymphadenopathy
short lasting vesicle on tongue, lip, buccal, palatal, gingival
Varicella zoster Virus
Primary VZ (chicken pox) > Virus latent in sensory ganglion > Reactivation (shingles)
Varicella zoster Virus Presentation
present over distribution of dermatome
reactivates due to immunocompromised/ acute infection
Iatrogenic cause
chemo
radio
GvsHD
Drug induced (PCB, bisphosphonates, NSAIDS, DMARDs
Neoplastic ulcer
exophytic
rolled borders
raised
hard
non mobile
no pain
ulceration management
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
blood tests for ulcer?
FBC/Haematinics/Coeliac Screen – if aphthous appearance
