Ulcers continued Flashcards
Minor ulcer ______ in diameter: lasts 5–10 days
and heals without scarring
<5 mm
Major ulcer >8 mm: can persist for up to _____weeks
6
Recurrent ulcers: consider ______, _____ and _____
Behçet syndrome.
Check serum iron and folate
Healing options for ulcers
________0.1% (Kenalog in Orabase) paste,
apply three times daily after meals and nocte
(preferred method but be careful of herpes
simplex ulcers).
Triamcinolone
Tx considerations for large ulcers
Consider:
injection of steroids into the base of the ulcer
and/or
oral prednisolone 25mg daily, 5–7 days
Complementary measures for ulcers
1
2
3
Teabag method.
Melaleuca (tea-tree) oil.
Acupuncture.
_______are caused by people leaving
salicylate-based tablets to dissolve against oral
mucosa.
Aspirin ‘burns’
Several drugs can induce a lichenoid drug reaction
of the oral mucosa, that is, cause shallow mucosal
erosions similar to lichen planus. The drugs
include ____, ______, _______, _____
gold, the NSAIDs, carbimazole, selected
antihypertensives and cytotoxics
Tx of herpes infection
aciclovir or similar antiviral
if seen early, e.g. 48 hours from onset;
fluids + + + ; analgesic mouth rinses, e.g.
Difflam; consider admission for IV aciclovir and
hydration
Neoplasia that can look red includes
1
2
3
squamous
cell carcinoma, Kaposi sarcoma and erythroplakia
_______ is similar in significance to leucoplakia
except for the erythematous feature. It is an
important condition to recognise since about 90% of
cases are either dysplastic or cancer
Erythroplakia
An interesting condition is ________
on the dependent floor of the mouth, which appear
white. Causes include tea-tree oil mouthwash and the
sucking of aspirin
hyperkeratotic burns
________ is any white lesion that cannot be
removed by rubbing the mucosal surface (unlike
oral candidiasis). About 5% of cases represent either
dysplasia or early SCC
Leucoplakia
This is usually tender and looks like white or yellowish
curd-like patches overlying erythematous mucosa.
Unlike lichen planus or leucoplakia, they are usually readily rubbed off and hence only the underlying red
patch may be seen.
Oral candidiasis (thrush)
The carriage rate of Candida albicans in the oral
cavity is________. The diagnosis is made clinically
but a wet preparation using _________ will
reveal spores and perhaps mycelia.
60–75%
potassium hydroxide
Tx of oral candida
nystatin suspension, rinse and swallow qid
or
miconazole oral gel (as directed by manufacturer)
or
amphotericin 10 mg or nystatin 100 000 U
lozenges dissolved slowly in oral cavity, 6 hourly,
for 7–14 days
Feature is redness, soreness and maceration of the
corners of the mouth. Usually associated with oral candidiasis
Angular cheilitis
_____________(Vincent
infection or trench mouth) caused by anaerobic
organisms is rarely seen but is more common in
undernourished or ill young adults under stress
Acute necrotising ulcerative gingivitis
Caused by plaque (bacterial biofilm) with calculus
tartar secondary to poor oral hygiene
Gingivitis
Features of gingivitis
- Red, swollen gingivae adjacent to teeth
- Bleeds with gentle probing
- Halitosis
- Usually no pain
This is a very painful form of gingivitis. Treatment is
as for gingivitis but add antibiotics e.g. metronidozole
400 mg (o) 12 hourly or tinidazole 2 g (o) single dose
and drain pus from abscess.
Acute ulcerative gingivitis
It is a sequel to gingivitis and shows periodontal ligament
breakdown with recession or periodontal pocketing
and alveolar bone loss. There is possible loosening of
teeth and periodontal abscess formation
Periodontitis
Oral dermatoses include 1 2 3 4
lichen planus, pemphigus
vulgaris (uncommon), mucous membrane
pemphigoid (uncommon) and lupus erythematosus
• affects 2% of the population, usually over 45 years
• can vary from asymptomatic to severely painful
• usually white lace-like patterns on mucosa,
cheeks and tongue
• may form superficial erosions
Lichen planus
Where are SLE oral lesions found?
usually on lateral aspects of the hard palate
Labs for painful tongue
Investigations may include an FBE, serum vitamin
B 12 , folate and ferritin levels, a swab or a biopsy of a
suspicious lesion
A miserable child with a painful mouth and
tongue is likely to have _______
acute primary herpetic
gingivostomatitis or hand, foot and mouth disease
A long history of soreness with spicy or other
foods indicates___________
benign migratory glossitis
(geographic tongue) or median rhomboid
glossitis
