Ulceration Flashcards
What can cause ulcers
Trauma
Immunological
-aphthous ulcers
-lichen planus
-Lupus
-vesiculo-bullous
-Erythema multiforme
Carcinoma
Infections
-bacterial
-fungal
-Viral
Gastrointestinal
-Crohn’s disease
-ulcerative colitis
What falls under Single Episode Oral Ulceration
Trauma
1st episode of recurrent
Primary viral infections
Oral squamous cell carcinoma
What are crohns ulcers like
Linear at the depth of the sulcus
Full of Crohn’s associated granulomas
Persist for months
What should an oral ulceration history entail
Where?
Size & Shape?
Blister or ulcer?
How long for?
-More than 2 weeks is bad
Recurrent?
Same site or Different Sites?
Painful?
What should an ulcer examination entail
Check the Margins are they:
-Flat? Raised? Rolled?
Check the base is it:
Soft? Firm? Hard?
Check the Surrounding tissue:
Inflamed? Normal?
Systemic Illness
What are recurrent herpatic lesions
Ulceration limited to one nerve group/branch
Often Hard palate
-Lesion recurs in the same place
PAIN suggests Herpes ZOSTER rather than simplex
Treat with systemic ACICLOVIR
What is the general rule of ulcers
Recurrent self healing ulcers affecting exclusively the non-keratinised mucosa are most likely to be aphthae
If there is a recurring ulcer afecting keratinised mucosa what is the cause
Viral
What are apthous ulcers
Immunologically generated recurring oral ulcers
Follow a set pattern depending upon the ulcer type
Genetically driven with environmental modification
Multifactorial environmental triggers and variable expression
What are the 4 main forms of recurrent Aphthous Stomatitis (RAS)
Minor
Major
Herpetiform
Oro-Genital ulcer syndromes – e.g. Behçet’s syndrome
How could you diagnose RAS
History and examination (yellow/gray base with erythematous margin)W
What are minor aphthous ulcers like
Less than 10mm diameter
Last up to 2 weeks
Only affect non-Keratinised mucosa
Heal without scarring
Usually a good response to topical steroids
What is the most common recurrent ulcer
Minor aphthous
What are major aphthous ulcers like
Can last for months
Can affect any part of the oral mucosa
-Keratinised or non Keratinised or both
-May scar when healing
-Poorly responsive to topical steroids
-Usually larger than 10mm
What is herpetiform aphthae like
rarest
Multiple small ulcers on non-keratinized mucosa
Heal within 2 weeks
Can coalesce into larger areas of ulceration
Nothing to do with herpes viruses
-the early stages looks like primary herpetic gingivostomatitis
What are Oral & Genital Ulcerations like
Normally Behcets disease
Other Oro-genital ‘ulcerative’ conditions exist
-Vesiculobullous diseases
-Lichen Planus
How to diagnose Behcets disease
three episodes of mouth ulcers in a year
At least two of the following: genital sores, eye inflammation, skin ulcers, pathergy
What is Behcets disease
primarily a Vasculitis
Causes:
-Oral & genital ulceration
-Eye disease
-Anterior or posterior uveitis
-Bowel ulceration
-Heart and lungs
-Brain
-Joints
How to treat Behcets disease
Treat local oral disease or RAS
Systemic immunomodulation where multisystem involvement
-Colchicine first treatment
-Azathioprine/Mycophenolate
-Biologics – infliximab and others
Managed with help of Rheumatology
What are predisposing factors to RAS
Stress
Systemic disease
Genetics
Viral/bacterial infections
Microelement deficiencies
Hormonal level flunccuations
Mech. injuries
With aphthous ulcers when does the ulcer appear
AFTER the damage
How do you investigate Aphthous ulcers
Blood tests
-Haematinic deficiencies (Iron, B12, Folic acid)
-Coeliac Disease, TTG (tissue transgutaminase) If TTG positive test Anti-gliadin & Anti-endomysial antibodies
How do you treat aphthae
Correct blood deficiencies
-Ferritin (iron), Folic Acid, Vit B12
Refer for investigation if Coeliac positive
Avoid dietary triggers
-SLS containing toothpaste
What are drug treatments of Aphthous Ulcers
Non-Steroid Topical Therapy
-For inconvenient lesions
Steroid Topical Therapy
-For disabling lesions
