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5th Oral Disease -Histology Lectures > Oral Ulceration > Flashcards

Oral Ulceration Flashcards

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1
Q

What is an ulcer?

A

Full thickness loss of epithelium
From basal cell layer to keratin
Exposing underlying connective tissue

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2
Q

What are the components of ulcer?

A

Ulcer covered by slough
Underlying granulation tissue
Mixed inflammatory infiltrate

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3
Q

Difference between ulcer and erosion?

A

Erosion = partial loss (e.g pempihus vulgaris)

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4
Q

What is slough made up from?

A

Fibrino-purulent

Fibrin and neutrophils

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5
Q

What is granulation tissue made from?

A

Fibroblasts and endothelial cells

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6
Q

What is in mixed inflammatory infiltrate?

A

Acute inflammation cells = neutrophils

Chronic inflammatory cells = lymphocytes/ plasma cells

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7
Q

Difference between primary and secondary ulcer?

A

Primary - begins as ulcer

Secondary - being blister/ vesicles

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8
Q

What are some possible differentials of ulcers?

A 
Neoplastic
Traumatic
Developmental
Infective
Idiopathic
Iatrogenic
Manifestation dermalogical disease
Manisfestation systemic disease
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9
Q

Give example of developmental ulcer?

A

Epidermolysis bullose

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10
Q

Give example infective ulcer?

A

Syphillis

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11
Q

Give example of idiopathic ulcers?

A

RAS

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12
Q

Give example of dermatological ulcer?

A

Lichen planus

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13
Q

What is crucial in ulcer hx?

A

If single or recurrent episodes

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14
Q

Give example of single episode ulcers - both single and multiple?

A

Single ulcer - SCC

Multiple ulcer - herpes zoster

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15
Q

Give example of multiple episode ulcer - both single and multiple?

A

Single - mucocutaneous disorders

Multiple - RAS

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16
Q

What are causes of single episode ulcers?

A

Traumatic - physical, chemical, thermal
Malignancy
Infective
Drugs

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17
Q

How to tx traumatic ulcer?

A

Reassurance
Remove cause e.g sharp cusp
Consider difflam/ corsodyl
Should improve

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18
Q

What would make you suspicious of malignancy?

A

Any ulcer that doesn’t heal within 3 weeks and has unexplained cause
Regard as malignant until proven otherwise - biopsy

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19
Q

What guidelines should be used to cancer referral?

A

NICE clinical guidelines - suspected cancer: recognition and referral

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20
Q

Give example of causes of multiple ulcers?

A 
Herpes simplex
Herpes zoster
Erythema multiforma
H,F&M
Herpangina
Iatrogenic e.g drug
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21
Q

What drugs can cause iatrogenic ulcers?

A 
Allopurinol
Cytotoxics
Gold
Indomethacin
Methotrexate
Nicorandril
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22
Q

How to diagnosis iatrogenic ulcers caused by drugs?

A

Link cause and effect
Establish cause and should see improvement in ulcer
Can lease w/ GP

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23
Q

What else can cause mucositis and iatrogenic ulcers?

A

Irradiation

Managed in hospital - hard to manage

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24
Q

What should be considered in ulcer hx?

A

Size, shape, number, location and duration

Periodicity, pain, precipitating and reliving factors

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25
What should be considered in ulcer examination?
Size, shape, site, number, base | Edge, discharge, consistency, nodes and other features
26
What is a factitious ulcer?
Self-induced | Often seen in children
27
What bored of ulcer would be suggestive of malignancy?
Raised, rolled borders | Ulcers floor of mouth - high RF
28
What is RAS?
Recurrent apthous stomatitis
29
What are the 3 different types of RAS?
Minor RAS Major RAS Herpetiform RAS
30
What are possible differentials of RAS - recurrent and multiple ulcers?
Behcet's disease Recurrent erythema multiforme Mucocutaneous disorder
31
What are the features of RAS?
Common -20% population affected | Painful - affected eating, drinking, speech
32
What is the most common RAS ulcer?
Minor - 80% of RAS ulcer
33
What age does minor RAS affected?
Peak age 10-30
34
What size would you expect a minor RAS ulcer to be and how many?
1-5 ulcers approx 3-8mm diameter To be minor must be less 10mm
35
How long to minor RAS ulcers last?
7-10 days | Variable ulcer free period
36
Where do minor RAS affected?
Often non-keratinised mucosa Usually front of mouth Heal w/o scar
37
Characteristic of minor RAS?
Less 10mm diameter Tender to touch Red halo w/ yellow ulcer slough
38
What % of RAS ulcers are major?
10%
39
What size are major RAS ulcers - how many?
1.5-2cm Must be larger 10mm Can be single or multiple
40
How long to major RAS ulcers last?
3 weeks - 3 months
41
Where to major RAS ulcers affect?
Non-keratinised mucosa but can affect masticatory | Often affect back of mouth
42
What is a characteristic of major RAS not seen in minor?
Can heal w/ scaring | White scaring
43
What % of RAS are herpetiform ulcers?
5%
44
What is herprtiform ulcers?
Dozens of small ulcers that may coalesce to form large irregular ulcer Symptomatic
45
Where likely to find herpetiform ulcers?
Mainly floor of mouth, margin and ventral surface tongue
46
How long to herpetiform ulcers last?
7-10days
47
Are herpetiform ulcers associated w/ herpes?
No
48
Tx of herpetiform ulcers?
If symptomatic doxycycline mouthwash
49
What are contributory factors of ulcers?
Stress Trauma Hormone Smoking
50
Relationship w/ smoking and RAS ulcer?
Smokers have less problem w/ RAS
51
What are predisposing factors of ulceration?
``` Haematological deficiency Neutropenia Immune deficiency GI tract disease e.g UC Vitamin deficiency Food intolerance ```
52
What investigations could be undertaken if ulceration?
Blood -FBC, ferritin, B12 and folate | Coeliac screen
53
What are the 3 components of tx of ulcers?
Preventative Symptomatic tx Suppressive tx
54
What is preventative tx?
Tx underlying systemic disease/ haematological deficiency Remove trauma OHI Diet advice
55
What is symptomatic tx?
Chlorhexidine mouthwash Difflam mouthwash Covering agents
56
What is difflam mouthwash?
Benzidamine = analgesic agent
57
What are the types suppressive treatments?
Local or systemic
58
Examples of local suppressive txs?
``` Steroids -topica Hydrocortisone pellets Beclometasone spray Beamethasone mouthwash Flixonase nasals ```
59
Examples of systemic suppressive txs?
Prednisolone - steroid Thalidomide Azathioprine
60
Use of systemic suppressants and therefore the disadvantages?
Dampens immune response, more prone to other opportunistic infection (candida), change blood sugar, effect metabolism – weight gain
61
Risk of using thalidomide?
Risk peripheral neuropathy
62
Who is Behcet's disease founds in?
Mainly young adults Male: female = 2.3:1 Increased incidence Japan and Turkey
63
What are the systemic diseases associated w/ Behcet's?
``` Blidness Neurological damage Oro-genital ulcer Vasculitis Death ```
64
Criteria of Behcet's disease?
Recurrent oral apthous ulceration ``` + 2 of the following: Recurrent genial ulcer Uveitis/ retinal vasculitis Skin lesions Positive pathergy test ```
65
What are other common features associated w/ Behcet's?
Arthritis GI lesions CNS involvement Vascular lesion
66
What are the 3 other causes of ulceration?
Muco-cutaneous disorders Haematological disorders GI disorders
67
Examples of muco-cutanous disorders?
Lichen planus Pemhigus Pemphigoid Erythema multiforme

5th Oral Disease -Histology Lectures (11 decks)

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