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BDS4 Oral Medicine > Ulceration > Flashcards

Ulceration Flashcards

1
Q

What is ulceration

A
  • localised deffect of surface mucosa
  • results in area of exposed connecitve tissue
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2
Q

What is the different between ulcer and erosion

A

erosion is more superficial

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3
Q

What are the main causes of ulceration

A
  • infective
  • traumatic
  • idiopathic
  • associated with systemic disease
  • associated with dermatological diseases
  • neoplastic
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4
Q

What viruses can be linked to ulceration

A

Most commonly herpes & coxsackie

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5
Q

What herpes viruses can cause oral ulceration

A

Herpes simplex
Ebstein-barr virus
Varicella zoster virus

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6
Q

When herpes reactivates and causes oral ulceration, what is this referred to as

A
  • recurrent herpetic lesions
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7
Q

What viruses can cause the recurrent herpetic lesions

A

HSV1, HSV2, Zoster (shingles)

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8
Q

How does the recurrent herpetic lesions present

A
  • ulceration is limited to one nerve group/branch on one side
  • usually in hard palate
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9
Q

How can you differentiate the viral cause in recurrent herpetic lesions

A
  • pain suggests shingles –> tend to experience discomfort before vescicles burst
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10
Q

What should we use to treat recurrent herpetic lesions

A

*aciclovir (systemic)
give prophylactially if severe issue

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11
Q

What is the aciclovir prescription for HSV

A
  • for immunocompromised & severe infections
  • 200mg, 5 times daily, 5 day regiment
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12
Q

What is the aciclovir prescription for herpes zoster - shingles

A

800mg
5 times daily
5 day regimen

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13
Q

What disease does coxsackie virus cause

A

hand foot and mouth disease
common childhood illness

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14
Q

What bacterial conditions result in ulceration

A

NUP/NUG

P.intermedia, fusobacterium and more associated

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15
Q

What is the most common traumatic cause for ulcers

A

mechanical e.g sharp cusp

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16
Q

What criteria should be fulfilled to be certain an ulcer is caused by trauma

A
  • identify cause of trauma
  • does the cause fit the size, shape and site of the ulcer
  • on removal of the cause, there should be signs of healing within 10 days
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17
Q

When is a biopsy indicated for traumatic ulcer

A

no healing seen within 10 days

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18
Q

What are the types of trauma other than mechanical that could result in ulceration

A
  • chemical
  • acute thermal trauma - common in palate
  • radiotherapy
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19
Q

Should traumatic ulcers be recurrent

A

should be single episode
unless source not removed

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20
Q

What is recurrent apthous stomatitis

A
  • particular type of ulceration which is recurrent and generated by an immunological process in the epithelium and connective tissue
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21
Q

What are the 3 types of ulcers

A
  • minor apthous
  • major apthous
  • herpetiform

diagnose based off worst ulcer

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22
Q

What size are minor apthous ulcers

A

<10mm

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23
Q

How long do minor apthous ulcers usually last

A

2 wks
usually heal with no scarring

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24
Q

What tissues do the minor apthous ulcers effect

A

Non keratinized
* cheek
* ventral surface of tongue
* floor of mouth
* lip
* soft palate

25
What is the presentation of the minor apthous ulcer
grey/yellow base with erythematous margins
26
Do minor apthous ulcers respond to topical steroids
yes good response
27
If a patient asks for the prognosis of their minor apthous ulcers, what can you advise
the longer they are ulcer free the lower hte morbidity
28
What is the most common type of apthous ulcer
minor
29
What size are major apthous ulcers
>10mm
30
Where do major apthous ulcers appear
* keratinized and non keratinized tissue effected * can occur anywhere
31
How do the major apthous ulcers heal
may heal with scarring tend to extend into deeper tissues tend to recur in less than monthly intervals meaning less time ulcer free
32
How do major apthous ulcers present
crater like ulcers rolled margins margins are indurated on palpation due to underlying fibrosis
33
How do major apthous ulcers respond to topical steroids
poor response
34
What is herpetiform ulceration
multiple small pinhead sized ulcers (1-2mm)
35
How long do herpetiform ulcers take to heal
2 weeks
36
Why can herpetiform ulcers be difficult to diagnose
the small ulcers can join together to resemble large ulcers in the early stages it can resemble primary herpetic gingivostomatits
37
Where does herpetiform ulceration occur
only on non keratinized
38
How can you diffentiate herpetiform ulceration and primary herpetic gingivostomatits
PHG involves keratinized and non-keratinized tissues HU only non-keratinized
39
What are predisposing factors for apthous ulcers
* genetic predisposition * systemic disease * stress * mechanical injury * deficiency - haematinic deficiency often implicated * viral/bacterial infection e.g streptococci, adenovirus & VZV * hormones
40
Describe the immunopathology for apthous ulcers
* the process occurs at the epithelium/connective tissue junction i.e the basement membrane * the ulcers occur as the basal cells are damaged and dont produce further epithelial replacement cells * the existing cells move up the surface and an ulcer will appear as no new cells are present
41
What investigations may you do for an ulcer
* blood test * allergy test
42
What things would you test in the blood
* haematinics * coeliac disease
43
What is the management of ulcers
* correct any deficiency * refer for investigation if coeliac is positive * avoid dietary triggers and SLS toothpaste * prescription
44
What can you prescribe to a patient with ulcers
* chlorhexidine/hydrogen peroxide mouthwash - for OH when pain prevents * tetracycline mouthwash can be useful in RAS * benzydamine mouthwash/spray or lidocaine ointment/spray for LA * topical steroids
45
What is the prescription for tetracycline mouthwash
doxycycline tablets dissolve in water to create mouthwash
46
Who should tetracycline mouthwash not be prescribed to
<12 pregnant women hepatic problems warfarin px
47
Who should steroid therapy be prescribed to
* those with disabling lesions
48
What steroids can be prescribed to px with ulcers
* beclometasone pressurised inhaler * betamethasone tablets (mouthwash) * hydrocortisone oro-mucosal tablets
49
When can children commonly experience apthous ulcers
* periods of rapid growth * 8-11 and 13-16 most common ages * usually respond to iron
50
What is Behcets syndrome characterised by
RAS & at least two of the following * genital ulcers * eye lesions * skin lesions * rapid acute inflammation to minor trauma * joint problems
51
What is the management of behcets
* tx RAS * systemic immunomodulators * involve rheumatology
52
How does crohn disease ulcers present
* mixture of ulcer types * apthous type ulcers associated with haematinic deficiency * linear ulcers present at depth of sulcus * full of crohn's associated granuloma * persist for months
53
What is the ulcer history
* where * size/shape * blister or ulcer * how long for? Each individual ulcer should not last >2 wks * recurrent? * painful?
54
What should you look at in examination
* margins * base * surrounding tissue * systemic illness/any other symptoms
55
How can the margins of an ulcer appear
* flat * raised * rolled
56
How can the base of an ulcer appear
* soft * firm * hard
57
How can the surrounding tissue of an ulcer appear
inflamed keratotic normal
58
When should you refer a px with ulcers
* try to arrange simple investigations in primary care * give topical tx (non steroidal for infrequent ulcers and steroid based for more disabling lesions) * refer after these have been achieved with no good result or if they are <12 YO

BDS4 Oral Medicine (17 decks)

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