Recurrent Aphthous Ulcers Flashcards
what are MINOR aphthous ulcers?
- less than 1cm diameter
- last up to 2 weeks
- ONLY affect non-keratinised mucosa
- heal without scarring
- good response to topical steroids
COMMONEST TYPE OF recurrent oral ulceration
what are MAJOR aphthous ulcers?
- LARGER than 1cm diameter
- can last for MONTHS
- can affect ANY part of oral mucosa
- MAY scar when healing
- POOR response to topical sterois
what are herpetiform aphthous ulcers?
- RAREST FORM
- Multiple small ulcers on non-keratinised mucosa
- heal within 2 weeks
- can coalesce into larger areas of ulceration
NOTHING to do with Herpes viruses,
what is behcet’s disease?
PRIMARILY a Vasculitis - inflammation of blood vessels
Key Features:
- ORAL & GENITAL ulceration
- Inflammation of Eye
- GI involvement
- Brain/CNS involvement
- Joint involvement
how do you manage a patient with Behcet’s disease?
- treat LOCAL oral disease or RAS
- SYSTEMIC immunomodulation IF MULTISYSTEM involvement
- Managed with help of rheumatology
what are predisposing factors of getting recurrent aphthous stomatitis?
- genetic factors
- systemic disease
- stress
- mechanical injury
- hormonal level fluctuations
- nutritional deficiencies
- viral & bacterial infections
when is ulcer treatment MOST effective?
BEFORE the ulcer appears, ulcer is a sign that epithelial damage has occured.
So if you can front run that, you will get best outcome. Usually on lips it feels like tingling before an ulcer presents.
how can you investigate aphthous ulcers?
blood tests
- haematinic deficiencies
- coeliac disease
Allergy tests
how do you treat recurrent aphthae?
Management:
- correct blood deficiencies (iron, b12, folate)
- refer for investigation endoscopy if coeliac positive
- AVOID dietary triggers (use SLS free toothpaste)
following SDCEP guidance, when is NSAID topical therapy used for aphthous ulcers?
For infrequent INCONVENIENT lesions
following SDCEP guidance, when is STEROID topical therapy used for aphthous ulcers?
For more DISABLING & frequent lesions
