Oral Ulceration Flashcards
causes of mucosal ulceration (5)
- trauma
- immunological - aphthous ulcers, lichen planus, lupus, vesiculobullous, erythema multiforme
- carcinoma
- infections - bacterial, fungal, viral
- gastrointestinal - crohn’s, ulcerative colitis
4 stages of single episode oral ulceration
- trauma
- 1st episode of recurrent oral ulceration
- primary viral infection i.e. herpes / coxsackie virus
- oral squamous cell carcinoma
key to diagnosis of ulcer
HISTORY
where
size & shape
blister or ulcer
how long for - >2 weeks is alarm bells
recurrent? if so same or different site
pain
crohn’s disease oral ulcers
- can be mixture of ulcer types. aphthous type ulcers. haematinic deficiency associated.
- crohn’s specific are linear at depth of sulcus. full of crohn’s associated granulomas. persist for months; intralesional steroids help
when examining ulceration
- margins - are they raised / rolled / flat
- base - is it soft / firm / hard
- surrounding tissue - is it inflamed / normal
- systemic illness?
traumatic ulceration
common
usually single episode but can be recurrent if cause not removed
normal or abnormal epithelium
if you remove cause it should heal within 2 weeks
recurrent herpetic lesions
ulceration limited to one nerve group / branch
often hard palate - lesion recurs in same place and pt often aware of prodrome & vesiculation which bursts
pain suggests herpes zoster rather than simplex
treat with systemic aciclovir (prophylactic if a severe problem)
recurrent aphthous stomatitis (RAS)
minor
major
herpetiform
bechet’s syndrome
diagnosis is via history & exam (yellow/grey base with erythematous margin)
general rule of ulcers
recurrent self healing ulcers affecting exclusively the non keratinised mucosa are inevitably aphthae
recurrent ulcers in keratinised mucosa tend to be viral
primary / secondary causes of traumatic ulcer
primary = sharp edge on tooth / appliance
secondary = parafunction rubbing mucosa against teeth
what are aphthous ulcers
- immunologically generated recurring oral ulcers
- follow a set pattern depending on ulcer type
- genetically driven with environmental modification
- multifactorial environmental modification
- ulcer experience may change as ‘risk factors’ change over life
minor aphthous ulcers
less than 10mm diameter
last up to 2wks
only affects non keratinised mucosa
heal without scarring
usually a good response to topical steroids
commonest type of recurrent oral ulceration
the ulcer free period is a good guide to morbidity - longer ulcer free + less morbidity
major aphthous ulcers
can last for months
can affect any part of oral mucosa (keratinised or non keratinised)
may scar when healing
poorly responsive to topical steroids (intralesional steroids usually more effective)
usually >10mm (may get smaller ulcers also but diagnose from worst ulcer)
herpetiform aphthae
rarest form of aphthous ulcers
multiple small ulcers on non keratinised mucosa
heals within 2 weeks
can coalesce into larger areas of ulceration
nothing to do with herpes viruses - in early stages looks like primary herpetic gingivostomatitis, in HSV get keratinised epithelium involved but not in herpetiform aphthae
oral & genital ulceration
classically bechet’s disease
diagnosis =
3 episodes of mouth ulcers in a year
at least 2 of the following; genital sores, eye inflammation, skin ulcers, pathergy
