Recurrent Aphthous Ulcers Flashcards
Different types of RAS
- Minor
- Major
- Herpetiforme
Characteristics of minor aphthous ulcers
Less than 10mm
Last up to 2wks
Only affect non keratinised mucosa (cheek)
Heal without scarring
Characteristics of major aphthous ulcers
Larger than 10mm
Can last for months
Can affect keratinised/non
May scar
Poorly responsive to topical steroids (intralesional more useful)
Characteristics of herpetiform apthae ulcers
Rarest
Multiple small ulcers on non-keratinised mucosa (not extending onto tongue)
Diagnosis + tx of Behcets disease
3 episodes of mouth ulcers in a year
Oral + genital
RAS management + systemic immune modulators
Cause of RAU
Cause unknown: immune reaction/allergy/genetics
Predisposing factors:
- Anaemia
- Stress
- Trauma
- Immune reaction: RAU, LP, VBD
- Vit deficiencies
- Coeliac/Crohns disease
- Allergy (SLS free)
Investigations for Aphthous Ulcers
- Blood tests (iron vitb12, folic) + rule out coeliac disease (endoscopy)
- Diet diary
- SLS free toothpaste + avoid dietary triggers
Non steroidal topical therapy or RA
For inconvenient occasional lesions:
CHX 0.2% 300ml MW
Benzydamine MW/spray
Steroid topical therapy for RA
For disabling lesions:
Betamethasone tablets
Beclomethasone inhaler
List different causes of ulcers
Trauma
Immune reaction: RAU, LP, VBD - pemphigoid/pemphigus
Viral: HSV,ZSV
GI immune: Crohns, Ulcerative Colitis
Carcinoma
Ulcer hx Qs
Site
Size/shape
Onset
Characteristics
T - >2wks
E - diet
Any in other areas
Features when examining an ulcer
Margins (raised/rolled/flat)
Base (soft/firm/hard)
Surrounding tissue (inflamed/normal)
Systemic illness (crohns/cohlitis)
Features of recurrent herpetic lesions
Limited to one nerve group
Often hard palate
List keratinised regions of the oral mucosa
Gingivae
Hard palate
Dorsal tongue
List non keratinised regions of the oral mucosa
L+B mucosa
FOM
Ventral tongue
