Oral Ulceration

Question 1

What can cause ulceration on the mucosa?

Answer 1

• Trauma
• Immunological
• Carcinoma
• Infections
• Gastroinstestinal

Question 2

What immunological reactions can cause ulceration?

Answer 2

• Aphthous ulcers
• Lichen planus
• Lupus
• Vesiculo-bullous
• Erythema multiforme

Question 3

What gastrointestinal reactions can cause ulcerations?

Answer 3

• Chron’s disease
• Ulcerative colitis

Question 4

What are the Key features of Oral ulceration History?

Answer 4

• Where
• Size and shape
• Blister or ulcer
• How long for
• Recurrent (Same site, different site)
• Painful

Question 5

What are the key points you need to consider when examining an ulcer?

Answer 5

• Margins - Flat? Raised? Rolled?
• Base - Soft? Hard? Firm?
• Surrounding tissue - Inflamed? Normal?
• Systemic illness?

Question 6

What trauma can cause a single episode oral ulceration?

Answer 6

• Denture
• Appliance
• Sharp tooth or restoration edge

Question 7

What does this picture show?

Answer 7

• 1st episode of recurrent oral ulceration

Question 8

What does this picture show?

Answer 8

• Primary Viral infection producing ulceration
• Most common virus Coxsackie and Herpes virus

Question 9

What does this picture show?

Answer 9

• Oral squamos cell carcinoma

Question 10

What are some examples of Recurrent Oral Ulceration?

Answer 10

• Aphthous ulceration (can be minor/major/herpetiform)
• Lichen planus
• Vesiculobullous lesions
• Recurrent viral lesions - HSV/VZV
• Trauma
• Systemic disease i.e. Chrohns

Question 11

What type of Ulcers can Chrohns disease pts present with and why?

Answer 11

• Aphthous type ulcers due to haematinic deficiency and are oval in shape
• Chrohns specific ulcers

Question 12

What type of ulcers does this picture show?
- Describe them

Answer 12

• Chrohns specific ulcers
• Linear fissure pattern of ulcers at the depth of the sulcus
• Can persist for months and require intralesional steroids to help

Question 13

What are the findings with traumatic ulceration?

Answer 13

• Common
• Usually single episode but can be recurrent if cause is not removed
• Normal or abnormal epithelium
• Remove cause and should heal in about 2 weeks

Question 14

What would you do if the traumatic ulceration has not healed in 2 weeks after removing the cause?

Answer 14

• Biopsy to ensure not an early malignancy

Question 15

What has caused this traumatic ulceration?

Answer 15

• Chemical burn on the lip mucosa

Question 16

What has caused this type of traumatic ulceration?

Answer 16

• LA administration in child which has caused them to bite and chew on the mucosa

Question 17

What are recurrent herpetic lesions?

Answer 17

• Ulceration limited to one nerve group/branch
• Herpes simplex or herpes zoster

Question 18

When recurrent herpetic lesions occur on the hard palate what are the findings?

Answer 18

• Occur in same place
• Pt aware of prodrome and vesiculation which bursts
• Pain suggestes Herpes Zoster not simplex

Question 19

What is the txt of recurrent herpetic lesions?

Answer 19

• Aciclover 5%
• Apply up to 4 times a day on affected lesion as soon as symptoms start

Question 20

What is the generak rule for Ulcerations?

Answer 20

• Recurrent self-healing ulcers affecting exclusively the non-keratinised mucosa are most likely aphthae ulcers
• Recurrent ulcers affecting keratinised ulcers tend to be viral
• Traumatic ulcers tend to occur in areas of teeth or denture