Recurrent Ulceration Flashcards
What should include in ulcer specific history?
Frequency
Rate of healing
If any scarring
How many ulcers
Ulcers else where on body
Previous tx and success
What medical history should take for ulcer?
Has she been generally unwell
Stress levels
Vitamin deficiencies
History of immunosuppression
Medications taking
GI symptoms
Why is ulcers on body relevant?
May be related to disorders e.g vestibullous disorders. Behcets syndrome
What other social history question is relevant to ulceration?
Diet
How to do ulcer exam?
Examine ulcer for size, shape and consistency
Oral cavity - ulcers, scaring, sharp teeth, broken restorations
Palpate for induration or underlying mass
What is most likely cause of single recurrent ulcer >10mm in size?
Recurrent apthous ulcers - Major RAS
What are differential dx for ulcers?
Malignancy - SCC, non-hodgkins lymphome
Trauma
Infective - EBV/ TV
Autoimmune - lichen planus/ pemphigus
Drug induced
Malabsorption
Hypersensitivity
Smoking
What are autoimmune causes of ulcers?
Lichen planus, Behcets syndrome, pemphigus, pemphigoid
What drugs cause ulcers?
Nicorandril, gold, NSAIDs
Haematological causes of ulcers?
B12, folate and ferritin
What malabsorption diseases can cause ulcers?
Crohns, coelaic, UC
What is aetiology of RAS?
Unknown, possible family run
What are predisposing factors of RAS?
Oral trauma, stress, foods
What are protective factors of ulcers?
OCP, pregnancy, tobacco, smokeless tobacco, nicotine-containing tablets
When to refer ulcers?
When incisional biopsy is required to exclude neoplasia or vesiclubullous disorers
When prolonged, not responding to tx, suspicious appearnace
What special investigations might be carried out for pt w/ ulcer?
Incisional biopsy
Blood test - exclude vitamin deficiency
3 types of RAS?
Minor, major and herpitiform
Appearance of minor RAS?
Less 5mm wide, 1-5 at time, heal 1-2 weeks and heal w/o scarrirng
Appearance of major RAS?
> 10mm, usually singular, back of mouth, last 2-6 weeks, may heal w/ scar
Appearance of herpetiform ulcers?
1mm in size, many ulcers which coalesce, last 10 days, no scarring
How manage pt w/ RAS
Topical agents
SLS free toothpaste
Food diary
Remove areas of trauma
Look into vitamin deficiencies
Examples of topical agents used in RAS?
Difflam - benzydamina mouthwash - topical anaesthetic
