ulceration

Question 1

what is an ulcer?

Answer 1

a breach in the integrity of the covering epithelium

Question 2

causes of traumatic ulceration

Answer 2

mechanical injury from the teeth
- usually seen in buccal mucosa, lateral tongue or lower lip in the occlusal plane
ill fitting dentures
habits
thermal - palate
chemical - e.g. mucosal aspirin burns

Question 3

traumatic ulcer - clinical features

Answer 3

typically painful and surrounded by erythema
tender on palpation

Question 4

traumatic ulceration - management

Answer 4

accurate history
document features
eliminate cause if possible
provide symptomatic relief

Question 5

drugs which may induce ulcers

Answer 5

cytotoxic drugs
phenytoin
nicorandil

Question 6

Minor RAS features

Answer 6

ulcers up to 10mm in diameter with yellow-grey base and halo of erythema
affects non-keratinised mucosa
individual ulcers heal without scarring after 10-14 days

Question 7

Major RAS features

Answer 7

ulcers are normally at least 10mm in diameter
persist for at least 4 weeks
can affect all mucosa
heals with scarring

Question 8

herpetfiform RAS features

Answer 8

multiple tiny/pinhead sized ulcers
resemble herpetic ulcers
healing normally occurs within 14 days
any mucosal site can be affected

Question 9

RAS aetiology

Answer 9

unknown
strong associations with:
- family history of RAS
- smoking cessation
- stress
- haematinic deficiency
- GI disease - particularly Crohn’s
- immunological disorders - Behcets

Question 10

RAS investigations

Answer 10

clinical diagnosis
full blood count and haematinics should be carried out

Question 11

RAS symptomatic relief

Answer 11

Benzydamine mouthwash or spray
Chlorhexidine mouthwash
Doxycycline mouthwash

Question 12

RAS preventative measure

Answer 12

SLS free toothpaste
avoid sharp foods e.g. crisps
treat parafunction if suspected cause
- soft bite splint