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FINALS - Oral Medicine > Oral Ulcers > Flashcards

Oral Ulcers Flashcards

1
Q

What is an ulcer?

A

A localised breach in the mucosa, resulting in inflammation and exposing underlying connective tissue.

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2
Q

What can cause oral ulceration?

A

Trauma
Stress
Nutrient deficiencies
Viral/bacterial infection
Immunological issue
Allergy/hypersensitivity

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3
Q

What can indicate what the cause of an ulcer may be?

A

Site
Onset
Duration
Number
Texture
Appearance

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4
Q

How can you identify a traumatic ulcer?

A

White keratinised border
Clear causal agent
Surrounding mucosa soft

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5
Q

How do you identify aphthous ulcers?

A

Yellow in centre
Red at the border

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6
Q

What types of aphthous ulcers?

A

Major - larger than 1cm
Minor - smaller than 1cm
Herpetiform - multiple small lesion

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7
Q

What blood tests are commonly used to investigate anaemia?

A

Full blood count
B12 screen
Folate Screen
Ferritin Screen
Coeliac screen

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8
Q

What is necrotising sialometaplasia?

A

Necrotising disease of minor salivary glands.

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9
Q

What further questions would you ask about a patients GI tract if they present with ulcers?

A

Abdominal pain
PR Bloodmucous
Altered bowel motion
Unintentional weight loss

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10
Q

Which features of a lesion may indicate oral cancer?

A

Hard to touch
Raised
Rolled borders
Exophytic

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11
Q

How can you differentiate between a neoplasm and an ulcer?

A

An ulcer will be free moving, where as if you tried to move a neoplastic lesion then the tissue under the lesion will also move.

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12
Q

What is included in haematinic bloods?

A

Ferritin, folate, B12.

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13
Q

What should you do if you suspect a malignancy?

A

Urgently refer to OMFS

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14
Q

Which immunological issues can cause oral mucosal ulceration?

A

Lichen planus
Lupus
Vesiculo-bullous
Erthema multiforme

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15
Q

Which GI diseases can manifest themselves as ulceration in the oral cavity?

A

Crohn’s disease
Ulcerative colitis

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16
Q

What are the causes of single episode oral ulceration?

A

Trauma
1st episode of recurrent ulcer
Primary viral infection
Oral squamous cell carcinoma

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17
Q

What are the causes of recurrent oral ulceration?

A

Apthous ulceration
Lichen planus
Vesiculobullous lesions
Viral lesion
Trauma
Systemic disease

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18
Q

Describe the oral ulcers that may present due to Crohn’s disease?

A

Mixture of ulcer types, including aphthous and ones specific to Crohn’s.

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19
Q

What are Crohn’s specific ulcers and how do you treat them?

A

Crohn’s specific ulcers present as linear lesions at the depth of the sulcus.

They are full of Crohn’s associated granumolas, and can persist for months.

Intralesional steroids may help.

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20
Q

What questions should you ask a patient about an oral ulcer?

A

How long have they had it?
Does it keep recurring?
Is it painful?

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21
Q

How long should an ulcer be persistent for before you become suspicious?

A

More than 2 weeks.

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22
Q

When examining an ulcer what aspects should be looked at?

A

Margins - raised/flat/rolled
Base - soft/firm/hard
Surrounding tissue - inflamed/normal
Size of lesion - >1mm/<1mm
Is it growing - yes/no/shrinking
Is there any systemic illness

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23
Q

How can you identify a traumatic ulcer?

A

Normal/abnormal epithelium
Healing (typically healed in 2 weeks)
Clear cause

24
Q

How would you identify a recurrent herpetic lesion?

A

Ulceration limited to one nerve group, typically on the hard palate. These will have prominent vesicles which burst.

25
Q

What does a painful herpetic lesion on the hard palate signify?

A

That the lesion is more likely to be herpes zoster rather than herpes simplex.

26
Q

How do you treat herpetic lesions?

A

Acyclovir (can also be used as a prophylactic if its a severe problem)

27
Q

What are the four main types of recurrent aphthous stomatitis?

A

Minor
Major
Herpetiform
Behcet’s syndrome

28
Q

What is the general rule for identifying aphthous ulcers?

A

Recurrent self-healing ulcers affecting exclusively the non-keratinised mucosa are inevitable aphthae.

29
Q

What is the key distinction between major and minor aphthous ulcers?

A

Major can last for months, and can affect any of the oral mucosa including keratinised areas.

They may leave scarring, are typically larger than 1cm, and poorly respond to steroids.

30
Q

How can you identify herpetiform aphthous ulcers?

A

Small ulcers on non-keratinised tissue, can sometimes coalesce into large areas of ulceration.

31
Q

What are Aphthous ulcers?

A
  • Immunologically generated Recurring oral ulcers
  • An ulcer is a break in the epithelium
  • Follow a set pattern depending on ulcer type
32
Q

What is the aetiology of aphthous ulcers?

A
  • Genetically driven with environmental modification
  • Multifactorial environmental triggers and variable expression
33
Q

What are the main forms of Recurrent Aphthous Stomatitis (RAS)?

A
  • Minor
  • Major
  • Herpetiform
  • Oro- Genital ulcer syndromes e.g. Behcet’s syndrome
34
Q

What type of Aphthous ulcer does this picture show?

A
  • Minor
  • Yellow fibrinous ulceration surrounded by red erythematous
35
Q

What are the findings common to Minor Apthous ulcers?

A
  • Yellow oval ulcerative area on mucosa
  • Peri lesional Erythematous surrounding area
  • Less than 10mm diameter
  • Last up to 2 weeks
  • Only affect non-keratinised mucosa
  • Heal without scarring
  • Usually have good response to topical steroids
36
Q

What type of Aphthous ulcer is this?

A
  • Major
  • Area of epithelial loss with fibrinous edge covering
  • Peri lesional erythematous halo
37
Q

What are the findings for Major Aphthous ulcers?

A
  • Can last for months
  • Can affect any part of oral mucosa i.e. keratinised or non keratinised
  • May scar when healing
  • Poorly responsive to topical steroids (intralesional steroids more useful)
  • Usually larger than 10mm
38
Q

What are the common findings of Herpetiform Aphthae?

A
  • Rarest form of Aphthous ulcers
  • Multiple small ulcers on non-keratinised mucosa
  • Heal within 2 weeks
  • Can coalesce into larger areas of ulceration
  • Nothing to do with Herpes virus
39
Q

What is the difference between HSV and Herpetiform Aphthae?

A
  • HSV involves keratinised epithelium , herpetiform aphthae does not
  • HSV usually not recurrent
40
Q

What does this show?

A
  • Herpetiform Recurrent Aphthous stomatitis
41
Q

What does this show?

A
  • Herpetiform Recurrent Aphthous stomatitis
42
Q

What does this show?

A
  • Herpetiform Recurrent Aphthous stomatitis
43
Q

What are the classical findings of Behcets disease?

A
  • 3 episodes of mouth ulcers in a year
  • At least two of the following, genital sores, eye inflammation, skin ulcers, pathergy
44
Q

What are some other oro-gneital ulcerative conditions exist?

A
  • Lichen planus
  • Veiculobullous disease
45
Q

What does this picture show?

A
  • Behcet disease
  • Minor or major recurrent aphthous stomatitis
46
Q

What is Behcets disease primarily termed?

A
  • Vasculitis (inflammation of blood vessels)
47
Q

What areas of the body can Behcets disease affect?

A
  • Oral and genital ulcertation
  • Eye disease (anterior or posterior uveitis and can lead to loss of vision in 20%)
  • Bowel ulceration (iliocaecal area - pain and cramping)
  • Heart and lungs
  • Brain
  • Joints
48
Q

What is the management of Behcets disease?

A
  • Treat local oral disease or RAS
  • Systemic immunomodulation
    - Colchicine as off label first txt
    • Azathioprine/Mycophenolate
    • Biologics like infliximab
  • Managed with help of rheumatology and national specialist txt centres
49
Q

What are some predisposing factors of RAS?

A
  • Genetic predispotion
  • Systemic disease
  • Stress
  • Viral and bacterial infections
  • Microelement deficiences like iron or B12
  • Hormonal fluctuations i.e. premenstrual
50
Q

What is the immunologicalpathology of RAS?

A
  • Occurs at basal cell membrane
  • Damages the basal cells meaning stem cells no longer able to produce epithelial replacement cells
  • Ulceration appears as no epithelial cells to replace them as exposure of connective tissue at epithelial membrane
51
Q

When is the txt most effective for RAS?

A
  • Damage happens before ulcer appears
  • Txt most effective in ulcer prodrome period (feel prodromal tingling)
  • If pt has ulcer morbidity then may use phrophylaxis
52
Q

What blood test can be used to investigating Aphthous ulcers?

A
  • Haematinic deficiencies to assess Iron (ferritin) , B12 and Folic acid
  • Coeliac disease using TTG (tissue transglutaminase) - if TTG positive then test Anti-gliadin and Anti-endomysial antibodies
53
Q

What toothpastes are SLS free?

A
  • Sensodyne Pronamel
  • Kingfisher
54
Q

What is SLS?

A
  • Sodium lauryl sulfate
55
Q

When should you refer to Oral Med?

A
  • When simple investigations for haematinic deficiency’s and topical txt does not work
  • Children under 12

FINALS - Oral Medicine (13 decks)

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