ulcers

Question 1

Why do ulcers occur?

Answer 1

Due to a break in the epithelium, exposing the underlying connective tissue.

Question 2

What is the difference between a primary and secondary ulcer?

Answer 2

Primary ulcers occur on their own whereas secondary ulcers occur as vesicles which then rupture to form ulcers.

Question 3

What are 6 common causes of ulcers?

Answer 3

1. Trauma
2. Malignancies
3. RAS
4. GI Disorders
5. Drug-Induced
6. Irradiation

Question 4

What kind of medication can cause traumatic ulcers?

Answer 4

Aspirin

Question 5

How would you manage a traumatic ulcer?

Answer 5

Remove the cause and review within 2 weeks to ensure healing.

Advise warm salty mouth rinses, difflam or corsodyl to help with healing.

Question 6

What would be the most common signs of a malignant ulcer?

Answer 6

• Non-healing ulcer present for over 2 weeks.
• Painless
• Irregular Border
• Predisposing RMH (smoking/alcohol)

Question 7

Where are 3 common locations for an oral malignancy?

Answer 7

1. Lateral Borders of the Tongue
2. Soft Palate
3. Retromolar Pad

Question 8

How would you manage a malignant ulcer?

Answer 8

By reviewing in 2 weeks - if this hasn’t healed, URGENT REF.

Question 9

What are the 7 principle causes of oral ulceration?

Answer 9

1. Trauma
2. RAS
3. Microbial Infections
4. Mucotaneous Diseases
5. Systemic Disorders
6. Drug Therapy
7. Squamous Cell Carcinoma

Question 10

Aetiology of traumatic ulcers?

(causes)

Answer 10

1. Physical (mechanical, thermal, electrical).
2. Chemical Trauma (aspirin or toothache remedies put directly onto oral mucosa.

Question 11

Clinical features of a traumatic ulcer:

Answer 11

1. Sore
2. Painful to touch.
3. Irregular borders with erythematous margins and a yellow base.
4. Keratotic halo developed during the healing phase.

Question 12

Treatment for traumatic ulcers.

Answer 12

1. Removal of the suspected cause.
2. Use of antiseptic mouthwash (0.2% chlorhexidine).
3. Covering agent such as orabase or oragel (benzocaine).
4. Review - if still present after 10-14 days, refer to oral med for biopsy.

biopsy to exclude SCC

Question 13

When should a traumatic ulcer be reviewed and what should you do if still present?

Answer 13

10-14 days and refer to oral med to exclude SCC.

Question 14

Most common form of RAS:

Answer 14

Minor RAS.

Question 15

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.

Answer 15

Minor RAS

Question 16

Describe Minor RAS in terms of size, number, appearance and duration.

Answer 16

• 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.

Question 17

Describe Major RAS in terms of size, number, appearance and duration.

Answer 17

• round oval ulcers
• greater than 1cm in size
• 1-5 ulcers
• heal with scarring

Last 10-40 days and reoccur frequently.

Question 18

Describe Herpetiform RAS in terms of size, number, appearance and duration.

Answer 18

• 50 + present
• 1-3mm
• increase in size and then coalesce

Last 10 days

Question 19

Management of RAS

Answer 19

1. chlorhexidine mouthwash
2. topical corticosteroids (prednesol)
3. topical anaesthetic agents
4. carbenoxolone

Question 20

Causes of a persistent solitary ulcer.

Answer 20

• trauma
• malignancy (rolled edges, contact bleeding)
• infection (herpes, chickenpox, inflammatory bowel disease)
• adverse drug reaction (nicorandil for angina)

Question 21

Causes of a single episode of multiple ulcers.

Answer 21

• viral infections (herpetic gingivostomatitis, herpes labialis)
• erythema multiforme (hypersensitivity dermatological reaction)