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BDS 4: Oral Medicine > Oral Ulcerative Diseases > Flashcards

Oral Ulcerative Diseases Flashcards

1
Q

What is Behçet’s Disease?

What is the clincal presentation?

A

A chronic autoimmune disorder characterized by recurrent oral and genital ulceration, eye lesions and skin lesions

Triad of aphthous-like oral ulcers, genital lesions, and recurrent eye inflammation

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2
Q

How do you manage ulcers? (4)

A

Eliminate local aggravating factors
- Grind down sharp tooth causing trauma

Control infection
- Topical/Systemic antimicrobials

Control pain
- Topical/Systemic analgesics

Promote healing
- Topical /Systemic steroids

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3
Q

List characteristics of herpetiform RAS:

Size
Shape
Colour
Duration
Site
Ulcers number/crop
Peak age of onset

A

Size - 0.5-3 mm diameter
Shape - round - may coalesce to irreg.
Colour - yellow base, erythematous border
Duration - 1-2 weeks
Site - non-keratinised tissue (especially ventral of tongue, FoM)
Ulcers number/crop - 1 to 20
Peak age of onset - 3rd decade

No scarring
*coalesce = join to make a bigger ulcer

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4
Q

What systemic analgesics can be prescribed for oral ulcerations?

A

Aspirin 300-600mg
Paracetamol 500-1000mg
Dihydrocodeine 30mg
Ibuprofen 400mg

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5
Q

At what age does Behçet’s Disease normally present?

A

3rd to 4th decade

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6
Q

What are the two local types of ulcers?

A

In response to trauma (Chemical, electrical, thermal, radiation)
Recurrent Aphthous Stomatitis

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7
Q

What is an erosion in regards to the mucosa and epithelium?

A

Area of partial loss of skin or mucous membrane
Epethelium is intact

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8
Q

If a patient has had ulcers once and then it went away what condition could this be and what may have triggered the ulcer?

A

Single episode ulcer

Ulcerations in response to:
Infection
Trauma
Drug reaction

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9
Q

What drugs/treatments can cause ulcers?

A

Cytotoxic drugs
Radiotherapy
Nicorandil (Treatment for stable angina)

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10
Q

What fungal infections can cause ulcers?

A

Candidiasis
Histoplasmosis
Aspergillosis

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11
Q

What viral infections can cause ulcers?

A

Chicken pox
Herpes simplex
Herpes zoster
HIV

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12
Q

What topical steroid can be prescribed to a patient with severe oral ulcerations?

A

Betamethasone sodium phosphate tabs 500 mcg as mouthwash
(use for 3 mins daily)

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13
Q

What connective tissue diseases can cause ulcers?

A

Lupus erythematosus
Wegener’s granulomatosis

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14
Q

What is relevant to tell a patient if they have smoking related aphthous stomatitis?

Ulcers in response to smoking cessation

A

Ulcers will not go away if they start to smoke again
This is a response to a change in the heat shock proteins in the body
It will settle with time

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15
Q

What blood disorders can cause ulcers?

A

Anaemia
Leukaemia
Neutropenia
Myelodysplastic syndromes

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16
Q

What bacterial infections can cause ulcers?

A

TB
ANUG
Syphilis

17
Q

What is stevens-Johnsons syndrome?

A

Erythema Multiforme with severe systemic symptoms and extensive lesions involving multiple body areas, especially the mucous membranes

18
Q

If a patient has long lasting ulcers that heal to only have a new one begin forming what condition could this be?

A

Ulcerations secondary to sytemic disease (E.g. lichen planus)

Recurrent/persistent ulcerations

19
Q

What GI disorders can cause ulcers?

A

Coeliac disease
Crohn’s disease
Ulcerative colitis

20
Q

What topical analgesics can be prescribed for oral ulcerations?

A

Lignocaine 5% ointment
Lignocaine 2% gel
Prilocaine 4% max in 10mls
Benzocaine 10mg lozenges
Choline salicylate (bonjela)

21
Q

What are the three types of Recurrent Aphthous Stomatitis?

A

Major
Minor
Herpetiform

22
Q

List characteristics of Minor RAS:

Size
Shape
Colour
Duration
Site
Ulcers number/crop
Peak age of onset

A

Size - < 10 mm diameter
Shape - oval
Colour - grey base, erythematous border
Duration - 1-2 weeks
Site - non-keratinsed mucousa (especially BM)
Ulcers number/crop - 1 to 5
Peak age of onset - 2nd decade

No scarring

23
Q

What skin conditions can cause ulcers?

A

Erosive Lichen Planus
Pemphigus
Pemphegoid
Erythema multiforme

24
Q

If a patient has a single non healing ulcer in their mouth for a long time what could this be?

Even with treatment

A

Neoplastic cancerous ulcer

Single persistent ulcer

25
Q

Define atrophy when referring to the epithelium

A

Loss of thickness

26
Q

When diagnosing RAS what investigations need to be done?

A

Blood tests
- Flood blood picture
- Haematinics - B12 / Folate / Ferritin
- Liver function test

Biopsy
- In the hospital, if malignancy suspected

27
Q

Define plaque when referring to the mucosa and epithelium

A

Raised uniform thickening of a portion of skin / mucosa with a well defined edge

28
Q

If a patient has crops of ulcers that heal completely and then they come back what conditions could this be?

A

Recurrent Aphthous Stomatitis
Erythema multiforme

Recurrent ulcerations

29
Q

List the characteristics of Major RAS:

Size
Shape
Colour
Duration
Site
Ulcers number/crop
Peak age of onset

A

Size - > 10 mm diameter
Shape - Irregular/oval
Colour - Grey base +/- indurated (firm) edge
Duration - 2-12 weeks
Site - Any surface (especially back of mouth)
Ulcers/crop - Up to 10
Peak age of onset - 1st decade

Scar on healing

30
Q

What is an ulcer in regards to the mucosa?

A

Area of total loss of epethelium
(Skin and Epethelium)

31
Q

If a patient has a single non healing ulcer in their mouth for a long time what could this be?

Even with treatment

A

Neoplastic cancerous ulcer

Single persistent ulcer

32
Q

What relevant questions needed to be asked in the medical/social history of a patient with ulcers?

A

Age
Other malignant disease (past or present)
Smoking - pack years (risk x10)
Alcohol - units per week (risk x4)
Areca nut/Betel nut chewing

Smoking and alcohol (risk x40)

BDS 4: Oral Medicine (15 decks)

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