Recurrent Aphthous Ulceration Flashcards
what are the 3 main clinical forms of Recurrent aphthous ulceration
minor - most common
major
herpetiform
name and discuss 3 potential predisposing factors to RAU
Genetic - family history in around 40 % of cases, variety of HLA associations reported but no specific pattern identified
Trauma - may precipitate and influence site but no key role in aetiology
Allergy - histological features of RAU indicate either a type III or type IV hypersensitivity reaction, also increased IgE levels in some patients
Hormones - some women report apthae recurrence in week leading up to their period
GI disease - usually due to malabsorption and haematinic deficiency rather than disease itself. association with coeliac disease in 5 % of cases
what group of patients is it very uncommon to see RAU
smokers
RAU almost entirely affects non smokers
discuss the typical clinical appearance of aphthous ulcers (not including size distribution etc)
yellow/ gray base with erythmatous halo
‘ fibrinous exudate covering connective tissue with a peri lesional erythmatous halo’
discuss the clinical features of MINOR RAU
(number, size, site, duration and scarring)
number 1-6
size - <10mm, usually 3-6mm
site - non keratinised mucosa
duration 7-10 days
scarring - none
discuss the clinical features of MAJOR RAU
(number, size, site, duration and scarring)
number 1-3
size - >10mm
site - any site in mouth , commonly soft palate
duration >30 days
scarring - common
discuss the clinical features of HERPETIFORM RAU
(number, size, site, duration and scarring)
number 10-100s
size <2mm but may coalesce
site - non keratinised mucosa
duration - 7-14 days
scarring - none
the immunopathology of RAU is complex, describe the histological events leading up to the clinical presentation of an ulcer
damage to basal cells in basement membrane renders them unable to produce replacement epithelial cells
as existing cells make their way up through the layers and are lost, ulceration will appear as there is no new cells to replace them
therefore damage has occurred BEFORE the ulceration appears
when is treatment of aphthous ulcers most effective
in the prodromal period before the ulcer has appeared
what should be asked when taking a history of a patient complaining of ulceration
- how long has ulcer (s) been present
- are they recurring? if so how long is ulcer free period
- where do they occur? always on non keratinised mucosa?
- any family history of ulceration?
- any systemic symptoms ? thinking infection
- is it a blister/ vesicle before it turns into an ulcer
- any signs and symptoms of behcets disease
what should be looked at during an examination of a patient with ulceration
- location - keratinised/ non keratinised mucosa, use landmark and measurements
- definition and distibution - multiplicity, are the margins defined/ rolled/ raised
- size - use intra oral ruler or probe
- shape - pedunculated, sessile, oval, round
- colour - homogenous, non-homogenous
- consistency - indurated, soft, fluid filled
- Texture - rough, smooth
- History - how long, had before, same site, family history
if RAU is suspected what further investigations should be done
- blood tests - FBC and haematinics screen (folate, ferritin and B12)
- TTG test (coeliac test)
Possibly allergy testing - or may advise patient to avoid certain foods for 3 months e.g benzoate and cinammon containing
when should cases of RAU be referred
- children < 12
- all treatment detailed in SDCEP exhausted and no good result
when are periods of aphthous ulcers commonly seen in childhood
during periods of rapid growth e.g 8-11 and 13-16
what ‘sign’ can be looked out for in children to aid deciding if they are in period of growth
‘new shoe sign’
feet grow first
