ORAL ULCERATION

Question 1

What is oral ulceration?

Answer 1

Localised defect where there is destruction of epithelium exposing underlying connective tissue

Question 2

What to ask about to know the cause of ulceration?

Answer 2

• Site
• Onset
• Duration
• Texture
• Appearance
• Size
• Pain
• Predisposing factors
• Relieving factors

Question 3

What might be the causes of oral ulceration?

Answer 3

1. Traumatic
2. allergic
3. metabolic/nutritional
4. infective
5. immunological
6. Drug induced
7. Neoplastic
8. Inflammatory
9. Idiopathic

Question 4

Describe how would a traumatic ulcer present?

Answer 4

• White borders
• Soft ulcer

Question 5

Examples of metabolic and nutritional ulcers

Answer 5

Apthous-like ulceration
* Red border
* Yellow or white ulcer

• in children and teenagers due to growth
• in Adults with GI/GU pathology
• Poor diet
• Aneamia

Question 6

Examples of gut disease that might cause ulceration?

Answer 6

~ Malabsorption
- Crohn’s
- Coeliac disease
- Ulcerative colitits
- pernicious
~ Blood loss
- IBD
- Peptic /duodenal ulcers
- colonic polyps
- colon cancer

Question 7

What are the ingredients in foods that might cause ulceration and give 2 examples of each

Answer 7

• Sorbate - cheese , baked goods , canned fruits and veg
• Cinnamaldehyde - sweets and chwing gum
• Benzoates - Fizzy drinks and acidic foods

These are often associated with OFG / Lichenoid reactions

Question 8

What question about the gut would you want to ask a pt presenting with ulcers?

Answer 8

• Abdominal pain
• PR blood/mucus
• Altered bowl movement
• Unintentional weight loss

Question 9

What question about Connective disease would you want to ask a pt presenting with ulcers?

Answer 9

• Joint pain and studdness
• Photosensitive rashes
• Xerostomia
• Fatigue

Question 10

Iatrogenic causes of ulceration

Answer 10

• Chemotherapy
• Radiotherapy
• Graft versus host disease
• Drug induces ulceration

Question 11

Drugs that might cause ulceration

Answer 11

• Pottasium channel blockers
• Bisphosphonates
• NSAIDs
• DMARDs

Question 12

How would a neoplastic ulcer present?

Answer 12

• Exophytic
• Rolled borders
• Raised
• Hard to touch
• Non- moveable
• Not always painful
• Sensory disturbance

Question 13

What is the management for oral ulceration

Answer 13

• Reverse the reversible
• Refer for FBC/B12/Folate / Ferritin/ Coeliac Screen
  1. Simple mouthwash
  2. antiseptic mouthwash
  3. LA ( benzydamine or lidocaine)
  4. Steroid mouthwash
  5. Onward referral to Oral medicine