pre oral ulcers

Question 1

What is an ulcer?

Answer 1

A breach in the mucosa which may expose underlying connective tissue

Question 2

Give 4 causes of ulcers

Answer 2

Any from:
- traumatic
- nutritional/metabolic
- allergy/hypersensitivity
- infective
- inflammatory
- immunological
- drug induced (iatrogenic)
- idiopathic

Question 3

What questions should be asked about ulcers?

Answer 3

Site
Onset
Duration
Number
Texture
Appearance
Size
Pain
Predisposing factors
Relieving factors

Question 4

Describe traumatic ulcers

Answer 4

White keratotic borders
Clear causative agent eg - fractured cusps
Surrounding mucosal normal
Ulcer soft

Question 5

Describe aphthous ulcers

Answer 5

Immunologically generated recurring oral ulcers
Painful
Red border
Yellow/white centre

Question 6

What can trigger aphthous ulcers?

Answer 6

Stress
Trauma
Allergy
Sensitivity

Question 7

What are the different types of recurrent aphthous stomatitis?

Answer 7

Major
Minor
Herpetiform

Question 8

Describe major RAS

Answer 8

Can affect any part of the oral mucosa
Larger than 10mm
Long time to heal, may scar

Question 9

Describe minor RAS

Answer 9

Less than 10mm
Only affects non-keratinised mucosa
Heals within 2 weeks without scarring

Question 10

Describe herpetiform RAS

Answer 10

Multiple small ulcers that can coalesce into larger areas of ulceration
Affects non-keratinised mucosa
Heal within 2 weeks

Question 11

Give 4 causes for nutritional/metabolic ulcers

Answer 11

In children/teenagers associated with growth
In adults with GI pathology
Anaemia
Malnourishment

Question 12

Give 4 causes of inflammatory/immunological ulcers

Answer 12

Behçet’s disease
Vesiculobullous disease
Lichen planus
CT diseases eg - systemic lupus erythematous

Question 13

Name 4 infections that cause ulcers

Answer 13

Any from:
Herpes simplex virus
Varicella-zoster virus
Coxsackie virus
Epstein-Barr virus
HIV

Question 14

Give 4 iatrogenic causes of ulcers

Answer 14

Chemotherapy
Radiotherapy
GVHD
Drugs eg - bisphosphonates, NSAIDs

Question 15

What are the properties of a high risk ulcer?

Answer 15

Exophytic - grow outwards, beyond surface epithelium
Rolled borders
Raised
Hard to touch

Question 16

Give 4 common features of a neoplastic ulcer

Answer 16

Any from:
- Exophytic
- rolled borders
- raised
- hard to touch
- non-moveable
- not always painful
- sensory disturbance

Question 17

What are the local management options for oral ulceration?

Answer 17

1. Warm salty mouthwash
2. Antiseptic mouthwash - chlorhexidine, hydrogen peroxide
3. LA mouthwash/spray - benzydamine
4. Steroid mouthwash - benzydamine
5. Steroid inhaler - beclometasone
6. Onward referral

Question 18

What are the referral options for oral ulceration?

Answer 18

If suspicious of malignancy - refer urgently to OMFS
Refer to GP for FBC/haematinics/coeliac screen if aphthous appearance
Refer to oral medicine if treatment options not working