OTC - mouth ulcer

Question 1

Symptoms?

Answer 1

• minor apthous ulcers
• white/yellow centre with outer inflammed red ring; appears on tongue, lips and cheeks, occurs in crops of one to five up to 5mm in size

Question 2

Referral criteria?

Answer 2

• > 3 weeks (cancerous lesion in smokers?)
• painless (cancerous?)
• > 10mm in diameter (major apthous ulcers - common in UC)
• crops of >5 ulcers: major apthous ulcers? - large up to 30mm, also appears on pharynx and palate
• herpetiform ulcers? - small and numerous (up to 100) coalesces together, also affects mouth floor/gums
• assoicated weight loss (cancer/IBD?)
• associated recurrent diarrhoea (IBD?)
• medication ADR (NSAIDS, sulfasalazine, MTX)

Question 3

OTC products?

Answer 3

• chlorhexidine - prevents bacterial infection (corsodyl mouthwash); causes reversible brown staining of teeth and tongue
• local analgesics - pain relief (benzydamine - difflam oral rinse 12+, choline salicylate - bonjela adult 16+)
• local anaesthetics - pain relief (lidocaine, benzocaine - iglu, bonjela, oragel)
• topical corticosteroids - anti-inflammatory (hydrocortisone buccal pellets 12+)

Question 4

Advice?

Answer 4

• avoid spicy, salty acidic or hot food and drink until the ulcer heals
• iron, folate, zinc, b12 deficiency: increased risk of mouth ulcer, glossitis and angular cheilitis. especially common in IBD and malabsorption syndromes
• brush teeth before chlorhexidine: help reduce staining but rinse mouth thoroughly thereafter as toothpase can inactivate chlorhex