ORAL MED apthous stomatitis management Flashcards
(23 cards)
what questions must be asked when a pt presents with aphthous ulceration?
is there any other site involvement?
is there any GIT symptoms or associated systemic upset?
when a pt presents with aphthous ulceration, who may you need to liaise with and why?
GMP
blood tests for deficiencies
what is the diagnostic criteria for Behcets disease?
at least 3 episodes of aphthous ulceration in past 12 months
plus at least 2:
- eye involvement
- recurrent genital ulceration
- skin lesions
- positive pathergy test
what is Behcets disease?
multisystem vasculitis
what is erythema nodosum?
painful patched on the skin that are red or darker than surrounding skin - mainly seen on lower limbs
what is pathergy?
exaggerated skin condition
what are the 2 clinical features of Behcets?
pathergy
erythema nodosum
treatment for asymptomatic aphthous stomatitis?
no tx required
do we treat symptomatic aphthous stomatitis?
match treatment to symptom severity
generally, list the types of management for symptomatic aphthous stomatitis?
SLS free toothpaste
topical analgesic
topical steroid
diet modification
symptom severity measure (oral disease severity score)
does SLS toothpaste cause aphthous ulcers?
no but it is thought to make them worse
what dietary substances may trigger aphthous stomatitis?
benzoate and cinnamon
under the NHS, what topical therapy is available for aphthous stomatitis?
analgesic mouthwashes
- benzydamine
- lidocaine
antimicrobial mouthwashes
- chlorhexidine gluconate
- doxycycline
topical steroids
- betamethasone
- beclometasone
- hydrocortisone
for managing aphthous stomatitis, what forms is benzydamine available in?
0.15% mouthwash
0.15% oromucosal spray
why is benzydamine used to manage aphthous stomatitis?
it has anti-inflammatory properties
for the management of aphthous stomatitis, what forms is lidocaine available in?
5% ointment
10% spray
for managing aphthous stomatitis, how would 10% lidocaine spray be used?
sprayed onto a cotton wool bud
what advice is given to pts if they are using lidocaine to manage their aphthous stomatitis?
dont eat/ drink 30 mins after due to the area being numb and you could burn yourself
why can doxycycline be used to manage aphthous stomatitis?
it has anti-inflammatory properties (normally 3 day course)
how are pts advised to use topical steroids (specifically betamethasone) for aphthous stomatitis?
use as you begin to feel the ulceration developing until it heals
must be spat out - risk of adrenal suppression
how does management of aphthous stomatitis in secondary care differ to primary care?
sometimes, the potency of the topical steroid is increased
a combination (triple mouthwash) - 500microg betamethasone, 100mg doxycycline, nystatin (1ml in 10ml water)
systemic medication - short course of prednisolone, colchicine, DMARDs
give examples of DMARDS?
azathioprine
mycophenolate mofetil
in secondary care, for managing aphthous stomatitis, why is nystatin prescribed alongside betamethasone and doxycycline?
risk of them causing candidiasis
