mouth ulcers

Question 1

what are the 3 main types of mouth ulcers

Answer 1

• minor (Aphthous ulcers)
• major (Aphthous ulcers)
• herpetiform

Question 2

aphthous ulcers - minor
details

Answer 2

• how common are theyvery, 75-85%
• what do they look likeround or avoid, grey-white in colour, lesions inside the mouth
• where do they usually affectnon keratinised mucosa (delicate areas) e.g. cheeks, tongue, inside lips
• how big are theysmall (diameter 2-4mm), shallow with a clearly defined rim
• how painful are theyvery: can impact eating and drinking
• how many can you get in one goup to 6 in one go
• how long do they usually take to healwithin 7-10 days with little-no scarring

Question 3

aphthous ulcers - major

Answer 3

• how common are theyless, 10-15%
• more common in what patientsimmunosuppressed e.g. with hiv
• where do they usually affectany oral site e.g. palate, tongue
• how big are theydiameter 1-3cm
• how painful are theysignificant pain and dysphagia
• how many can you get in one goup to 6
• how long do they usually take to heal10 days - 6 weeks or longer
• do we refer?yes

Question 4

herpetiform ulcers

Answer 4

• how commonuncommon!
• how many in one gopresent in multiple pin sized ulcers which come together to form a larger area of ulceration
• how painfulvery
• where do they usually affectany oral site e.g. palate and dorsum of tongue
• how long to healover 10 days
• more common in what groupsfemales and later age onset
• do they frequently reoccuryes and this makes it seem constant
• do we referyes

Question 5

differential diagnosis

Answer 5

chicken pox, similar ulcers, oral malignancy, Hand foot and mouth, adverse drug reactions (of NSAIDs, beta blockers or nicorandil), primary oral herpes simplex virus

Question 6

general patient advice for mouth ulcers:

Answer 6

• wash hands before and after treatment
• frequent application
• avoid certain foods e.g. acidic, salty, spicy (worsens pain)
• use soft toothbrushes, and certain tooth pastes
• use a straw to drink to avoid ulcers
• use a salt/saline mouthwash as often as needed but don’t swallow, with half a teaspoon of salt.

Question 6

whats the referral criteria for mouth ulcers

Answer 6

• 14 days - 3 weeks + (must refer)
• left a scar or elsewhere on the body
• irregular shaped ulcers / different to ones had before
• multiple in mouth / one big
• ulcer caused by major trauma
• located towards back of mouth
• major or herpetiform
• if the patient reports painful or swollen joins, as this could be lupus (autoimmune inflammation) or behcets disease (blood vessel inflammation)

Question 7

main treatments for mouth ulcers

Answer 7

• gels, pastes, mouthwashes, liquids, pastilles
• protective bases
• antibacterials e.g. benzalkonium
• local analgesic e.g. choline salicylate, or bonjela gel to the ulcer

Question 8

Outline the main causes and triggers for these conditions

Answer 8

• cannot be passed from person 2 person: mainly unknown/often recurrent
• some examples = genetics, stress, trauma, nutritional deficiencies, stopping smoking, etc… not all known
• can occur with all ages, but freq and severity reduce with increasing age

Question 9

how to apply bonjela and what is it used for

Answer 9

Massage approximately one centimetre of gel onto the sore area. This can be repeated after 3 hours.
for inflammation and the relief of pain associated with mouth ulcers,

Question 10

Mouth Ulcer antibacterials pastilles
(Benzalkonium Chloride etc) used why and how

Answer 10

can be used to help relieve the pain of mouth ulcers and soothe sore gums.
take one pastille every 2 hours, if you need to. Do not take more than 8 pastilles in 24 hours.