Oral Ulcers Flashcards
RAS associated factors
Positive family history
Non smoker
Traumatic
Haematinic deficiency
Age <30yrs
Strong associated features of RAS
Females
High socioeconomic status
Hugh stress
Hormone imbalance
Food intolerance
SLS toothpaste and drugs
Predisposing factor of RAS
Cytokine polymorphism
Diagnosis of RAS
Clinical diagnosis
Ulcer hx
Medical hx
Medications
System enquiry
Questions to ask about ulcer history?
Onset
Number
Pattern
Location
Size
Pain
Prodrome
Triggers
Systems ususally involved with RAS
Skin
Eyes
Genitals
Gastrointestinal
Signs of GI involvement for RAS
Weight loss
Constipation
Diarrhoea
Bloating
Reflux
Blood in stool
Clinical findings of RAS
Round/ avoid shape
Grey base
Erythematoua halo
Minor RAS
Less than 1cm
7-10 days
Non keratinised mucosa
Heals with no scarring
Major RAS
Greater than 1cm
Last longer than 2-3 weeks
Can affect all mucosa
Heals with scarring
Herpetiform RAS
Multiple tiny ulcers
Resemble hermetic ulcers
Can coalesce (join)
Keratinised and non keratinised surfaces
Investigations for RAS
- Bloods
Standard (FBC, haematinics, coeciliad screen)
Additional (ESR, ANA, Viral screens for HSV, EBV, HIV
-REFERRAL
-Biopsy
Is it RAS or ALU (aphthous like ulceration )?
Oral and genital
- could be complex apthosis or Behcets
GI
- could be IBD and Coeliac
What is Behçet’s disease?
Chronic , relapsing , multisystem inflammatory vasculitis
Affects large and small vessels
Common sites are: oral, genital, skin, GI tract
How to grade Behçet’s disease?
ISG 1990
International Criteria for Behçet’s disease - score of 4 indicates disease
What is the 1st line management?
Change diet
Investigate trauma
Toothpaste (SLS Free)
Topical:
-Benzydamine
-Lidocaine
-Covering agents
-CHX
What is 2nd line management?
Topical corticosteroids (creams/gel/sprays/mw)
-check potency of steroid
Topical antibiotics
- dissolve contents of doxycycloine 100mg in 10ml water
- hold for 4 mins over ulcer
- spit
- don’t eat/ drink for 20 mins after
Vitamin B12
- Suggest 100mcg sublingual nugget
What is the 3rd line management?
Corticosteroids
Colchicine
Pentoxyphilline
Thalidomide
Azathioprine
Mycophenolate
Biologics
What is TUGSE?
Traumatic ulcerative granuloma with stromal eosinophillia
Explain TUGSE
Rare, benign and self limiting oral ulceration
Usually in complex MH, dry mouth, persistant ulcers
Resolution following biopsies
Medication causing TUGSE?
Methotrexate - cytotoxic drug
NSAIDs
Nicorandil (angina) - inhibits cell migration needed for healing
