ulcers Flashcards
Why do ulcers occur?
Due to a break in the epithelium, exposing the underlying connective tissue.
What is the difference between a primary and secondary ulcer?
Primary ulcers occur on their own whereas secondary ulcers occur as vesicles which then rupture to form ulcers.
What are 6 common causes of ulcers?
- Trauma
- Malignancies
- RAS
- GI Disorders
- Drug-Induced
- Irradiation
What kind of medication can cause traumatic ulcers?
Aspirin
How would you manage a traumatic ulcer?
Remove the cause and review within 2 weeks to ensure healing.
Advise warm salty mouth rinses, difflam or corsodyl to help with healing.
What would be the most common signs of a malignant ulcer?
- Non-healing ulcer present for over 2 weeks.
- Painless
- Irregular Border
- Predisposing RMH (smoking/alcohol)
Where are 3 common locations for an oral malignancy?
- Lateral Borders of the Tongue
- Soft Palate
- Retromolar Pad
How would you manage a malignant ulcer?
By reviewing in 2 weeks - if this hasn’t healed, URGENT REF.
What are the 7 principle causes of oral ulceration?
- Trauma
- RAS
- Microbial Infections
- Mucotaneous Diseases
- Systemic Disorders
- Drug Therapy
- Squamous Cell Carcinoma
Aetiology of traumatic ulcers?
(causes)
- Physical (mechanical, thermal, electrical).
- Chemical Trauma (aspirin or toothache remedies put directly onto oral mucosa.
Clinical features of a traumatic ulcer:
- Sore
- Painful to touch.
- Irregular borders with erythematous margins and a yellow base.
- Keratotic halo developed during the healing phase.
Treatment for traumatic ulcers.
- Removal of the suspected cause.
- Use of antiseptic mouthwash (0.2% chlorhexidine).
- Covering agent such as orabase or oragel (benzocaine).
- Review - if still present after 10-14 days, refer to oral med for biopsy.
biopsy to exclude SCC
When should a traumatic ulcer be reviewed and what should you do if still present?
10-14 days and refer to oral med to exclude SCC.
Most common form of RAS:
Minor RAS.
Which type of RAS is being described:
1-5 ulcers usually seen on buccal and labial mucosa, floor of the mouth or tongue.
Usually presents in clusters more anteriorly.
Minor RAS
Describe Minor RAS in terms of size, number, appearance and duration.
- most common form of RAS
- oval and flat ulcer with an erythematous border
- 2-4mm in size
- 1-6 ulcers
Last 7-10 days and reoccur at intervals of 1-4 months.
Describe Major RAS in terms of size, number, appearance and duration.
- round oval ulcers
- greater than 1cm in size
- 1-5 ulcers
- heal with scarring
Last 10-40 days and reoccur frequently.
Describe Herpetiform RAS in terms of size, number, appearance and duration.
- 50 + present
- 1-3mm
- increase in size and then coalesce
Last 10 days
Management of RAS
- chlorhexidine mouthwash
- topical corticosteroids (prednesol)
- topical anaesthetic agents
- carbenoxolone
Causes of a persistent solitary ulcer.
- trauma
- malignancy (rolled edges, contact bleeding)
- infection (herpes, chickenpox, inflammatory bowel disease)
- adverse drug reaction (nicorandil for angina)
Causes of a single episode of multiple ulcers.
- viral infections (herpetic gingivostomatitis, herpes labialis)
- erythema multiforme (hypersensitivity dermatological reaction)
A 50 year old man presents with multiple crusting lesions and ulcers on the LHS of his face. He noticed a tingling sensation beforehand and the rash has been present for a week.
Which virus is the potential cause?
Herpes Zoster
