oral ulceration

Question 1

What are the 5 causes of ulcers?

Answer 1

Trauma
Immunological
Carcinoma
Infection
Medical conditions

Question 2

Name 2 types of immunological ulcers

Answer 2

Aphthous ulcers
Ulcerative lichen planus

Question 3

Name 2 medical conditions which can cause ulcers

Answer 3

Crohn’s disease
Ulcerative colitis

Question 4

Name 4 possible causes for a single episode of oral ulceration

Answer 4

Trauma
First episode of recurrent oral ulceration
Primary viral infection
Oral squamous cell carcinoma

Question 5

Name 6 causes of recurrent oral ulceration

Answer 5

Aphthous ulceration
Lichen planus
Vesiculobullous lesions (blisters which will burst to form ulcers)
Recurrent viral lesion
Trauma
Systemic disease eg - Crohn’s

Question 6

How do ulcers usually present in Crohn’s disease?

Answer 6

A mixture of Crohn’s specific ulcers and aphthous ulcers due to the haematinic deficiency from Crohn’s disease

Question 7

Describe Crohn’s specific ulcers

Answer 7

Linear at the depth of the sulcus
Contain Crohn’s associated granulomas
Persist for months - intralesional steroids help

Question 8

What questions should be asked about ulcers when taking a history?

Answer 8

Site
Size and shape
Is it a blister or ulcer (blister which bursts to leave an ulcer)
How long for - more than 2 weeks?
Is it recurrent - same site, different site
Is it painful
How long is the ulcer free period

Question 9

What should be asked when examining an ulcer?

Answer 9

Are the margins flat, raised or rolled
Is the base soft, firm or hard
Is the base covered by granulation tissue
Does it have a fibrous exudate
Is the surrounding tissue normal or inflamed
Does the patient have signs of systemic illness

Question 10

How long should traumatic ulcers take to heal?

Answer 10

If cause removed should heal in roughly 2 weeks

Question 11

When should unexplained ulcers be biopsied?

Answer 11

If lasting more than 2 weeks to ensure no malignancy

Question 12

What are recurrent herpetic lesions and where are they most often found?

Answer 12

Ulceration limited to one nerve group/branch
Lesions recur in the same place
Patient often aware of early symptoms and vesiculation which bursts
Often occur on hard palate

Question 13

What is recurrent aphthous stomatitis?

Answer 13

A group of conditions where there is immunological damage to the oral mucosa

Question 14

What type of mucosa is affected by RAS?

Answer 14

Non-keratinised mucosa only

Question 15

What is the most likely cause for an ulcer on keratinised mucosa?

Answer 15

Viral