Throat: aphthous ulcer, oral candidiasis, oral leukoplakia

Question 1

Define aphthous ulcer?

Answer 1

Ulceration of the oral mucosa.

Question 2

Diagnosis/IVx of aphthous ulcer?

Answer 2

Clinical diagnosis

If recurrent, consider testing for systemic cause e.g. HIV, coeliac disease, Crohn’s disease, vitamin deficiency.

Question 3

Management of aphthous ulcer?

Answer 3

Supportive
- avoid trigger factors (e.g. toothpaste containing sodium lauryl sulfate, coffee, chocolate)
- topical anaesthetics/analgesia/anti-inflammatory/antimicrobial agents (e.g. chlorhexidine gluconate oral solution, or doxycycline rinses).
- topical corticosteroid (e.g. hydrocortisone)

If ulceration >21days and no response to tx, refer to specialist.

Question 4

Define/causes of oral leukoplakia?

Answer 4

White plaques that cannot be scrapped away on oral mucosa.

Chronic exposure to irritants (e.g. tobacco)
Chronic infection (oral candidal infection)

Question 5

Presentation of oral leukoplakia?

Answer 5

Bright white, sharply defined patches on the oral mucosa.

Slightly raised above surrounding mucosa.

Cannot be rubbed away.

Question 6

Management of oral leukoplakia?

Answer 6

Refer to ENT for biopsy and management.

Question 7

Define/causes of oral candidiasis?

Answer 7

Overgrowth of normal GI flora yeast like fungus called Candida species.

Question 8

Presentation of oral candidiasis?

Answer 8

Local burning
Soreness
Itching
Odynophagia
Chest pain if oesophageal origin

Oral thrush on tongue
- patches of curd-like yellow/white plaques on tongue, palate or pharynx.
- easily scrapped off revealing erythematous base.

Question 9

Management of oral candidiasis?

Answer 9

Mild/localised:
- topical miconazole gel OR nystatin suspension

Severe/extensive infection:
- oral fluconazole

Advise pt to rinse mouth after using inhaled steroids -PREVENTS ORAL THRUSH