ORAL ULCERS LECTURE 1

Question 1

What drugs/treatments cause drug-related ulcers?

Answer 1

• Cytotoxic
• Radiotherapy
• Nicorandil (angina and does not respond to topical corticosteroids)

Question 2

Recurrent aphthous stomatitis: types + associations

Answer 2

• Major
• Minor (most common)
• Hepetiform (least common)
• RAS is a specific diagnosis and is not associated to systemic disease
• smoking related aphthous stomatitis

Question 3

Characteristics of major RAS

Answer 3

• size: of >10mm
• shape: oval/irregular
• colour: grey base and indurated
• duration: 2week-3month with scarring
• Site: any (k/non-k) esp fauces
• Ulcer crop: up to 10
• Peak age: 1st decade

Question 4

Characteristics of minor RAS

Answer 4

• size: <10mm
• shape: oval
• colour: grey base with erythematous edge
• duration: 1-2 weeks no scarring
• site: non-k esp buccal mucosa
• crop: 1-5
• peake age: 2nd decade

Question 5

Characteristics of hepetiform RAS

Answer 5

• size: 0.5-3mm
• shape: round and may coalesce to irregular
• colour: yellow base with erythematous border
• duration: 1-2weeks no scarring
• site: non-k esp ventral tongue and FOM
• crop: 1-20
• peak onset: 3rd decade

Question 6

How to manage ulcers (management= investigations + treatment)

Answer 6

INVESTIGATIONS:
-FBT, haematinics (b12, folate, ferritin), Liver function test
-Biopsy
-Scans
MANAGEMENT:
-accurate diagnosis
-eliminate aggravating factors (rough restoration)
-Control infection: topical antimicrobials/antibiotics eg. 2%tetracycline
-Control pain: 5% lignocaine ointment/ 0.15% benxydamine hydrochloride (dissolve in water)
-Control healing+symptoms: topical corticosteroid 500mcg soluble tablet in 20ml of water QDS up to 5 days
systemic corticosteroids 40mg prednisolone
-Anti-inflammation? NSAIDs

Question 7

What immumnosuppresives do you give patient who do not respond to steroids?

Answer 7

Azathioprine (steroid sparing agent)

Question 8

Erythema multiforme (aetiology, pathogenesis)

Answer 8

AETIOLOGY

• unknown
• hypersensitivity to medications (sulfonamides, penicillin, barbiturates, phenytoin) and illnesses (90% EM have HSV or mycoplasma infection)

PATHOGENESIS

• skin lesions bc skin blood vessels and skin tissue damage
• Stevens-Johnsons syndrome- severe form effect multiple body areas +mucous membranes

Question 9

Bechets disease is characterised by

Answer 9

• ROU
• genital ulceration
• skin lesions
• eye lesions (uveitis)

Question 10

What is erythema multiforme associated with

Answer 10

hypersensitivity to

• drugs-> sulfonamides, phenytoin, barbiturates, penicillin
• infections -> HIV/mycoplasma infection
• CRUSTY LIPS