Ulcerative Conditions-Dr. Flores

Question 1

What is an ulcer?

Answer 1

• Loss of epithelial continuity
• underlying CT exposed
• Crater fills in with Granulation tissue

Question 2

Oral Ulcers: Clinical Features

Answer 2

• Yellow necrotic center w/red halo

Question 3

What accounts for the yellow necrotic center?

Answer 3

• Fibrinopurulent membrane
  
  • covers exposed CT

Question 4

What accounts for the red halo?

Answer 4

• Granulation tissue
  
  • sometimes slightly raised

Question 5

Dx: Nonspecific Ulcer

Answer 5

• Histopathologically most ulcers look the same
• rarely biopsied
• are some exceptions

Question 6

What is the diagnosis of an ulcer primarily based on?

Answer 6

• Clinical assessment instead of histopathologic features
  
  • recognize yellow necrotic center and red halo
  • number of ulcers
  • location
  • history
    
    • is there pain
    • duration
    • previous tx

Question 7

Acute Ulcers

Answer 7

• 1 ulcer
  
  • painful
  • acute onset
  • short duration
  • on nonkeratinized tissue in an adult w/a new denture
    
    • lateral border of tongue
    • labial mucosa
• Clinical Diagnosis:
  
  • Traumatic Ulcer
• Management:
  
  • remove source of trauma
  • No biopsy
  • Adjust denture
    
    • Reeval in 2 weeks
      
      • repeat attempt to remove injury=adjust denture
    • Reeval in 2 weeks
      
      • still present=BIOPSY
  • When painful use
    
    • Topical analgesic
    • Product with protective sealer
  • NEVER use anti-inflammatory meds

Question 8

Products that contain protective sealer

Answer 8

• Zilactin, Zilactin-B
• Active ingredients-Benzyl Alcohol 10%
• Zilactin-B contains Benzocaine
• Forms a thin white layer over lesion
  
  • takes 30-60 seconds to dry
  • Alcohols cause stinging and burning

Question 9

Prescription treatments for traumatic ulcers

Answer 9

• Topical anesthetic

Question 11

Canker Sore

Answer 11

• Recurrent Aphthous Ulcers/Stomatitis
• defect in the immune system
  
  • T-cell mediated reaction that produces TNF-alpha
• can start with an abnormal apoptosis of oral epithelial cells, which can progress to secondary necrosis and passive release of cellular products/danger signals

Question 12

Systemic Disorders associated with Recurrent Aphthous Ulcers

Answer 12

• MAGIC syndrome
  
  • mouth and genital ulcers w/inflamed cartilage syndrome
• PFAPA syndrome
  
  • Periodic Fever, Aphthous tomaatitis, Pharyngitis, cervical Adenitis

Question 13

Variants of Recurrent Aphthous Ulcers

Answer 13

• Minor RAUs
  
  • Mikulicz aphthae
  • most common
  • movable nonkeratinized mucosa
  • lasts 7-10 days
  • heal on their on w/out scarring
• Major RAUs
  
  • Sutton Disease or PMNR
• Herpetiform Aphthous Ulcerations
  
  • greates number of lesions

Question 14

Recurrent Aphthous Ulcers management

Answer 14

• Anti-inflammatory agents
  
  • bc it’s an exaggerated immune response
• Corticosteroids
  
  • Triamcinolone gel
  • Fluocinonide gel
  • Dexamethesone elixir

Question 15

Herpes Simplex Virus

Answer 15

• HSV-1
  
  • spread through infected saliva or active perioral lesions
  • oral, facial, ocular ares
    
    • pharynx
    • intraoral mucosa
    • lips
    • eyes
    • skin above the waist
• HSV-2
  
  • spread through sexual contact
  • Genital area
    
    • genitals
    • skin below the waist

Question 16

Upon first exposure to Herpes Simplex virus: 1 of 3 outcomes may occur. What are they

Answer 16

• Immune system completely eliminates the virus
  
  • antibodies prtect throughout life
• Inadequate immune response
  
  • eliminates most of the virus
  • virus resides in the Trigeminal gangliion=latent infection
  • experiences episodes when virus is reactivated
• Totally inadequate immune response
  
  • develops primary herpetic gingivostomatis

Question 17

Primary Herpes

Answer 17

• aka Acute Herpetic Gingivostomatitis
• most common symptomatic primary HSV
• Cervical Lymphadenopathy, fever, chills, nausea, anorexia, irritabilty, some mouth lesions
• Pharyngotonsillitis
  
  • young adults of higher socioeconomic status

Question 18

Recurrent ORAL HSV infection

Answer 18

• aka Secondary Herpes
• Bound Keratinized tissue only
  
  • gingiva
  • hard palate
  • not tru for immunocompromised patients
• Does not crust over

Question 19

Management of Herpes Simplex Virus

Answer 19

• Herpes Labialis
  
  • topical
    
    • may help during prodrome
    • no help after vesicles form
  • Pencyclovir ointment
  • Topical acyclovir
  • Docanosol
    
    • prevents replication of the virus
    • reduced healling time by 0.7 day
• Herpes Stomatitis
  
  • Topical Analgesic
  • Acyclovir gel
    
    • Toxic if swallowed
    • don’t use after prodrome
• Prophylaxis
  
  • save for most severe cases
  • Valcyclovir 500mg
    
    • twice a day
• Prophylaxis
  *