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Applied Dental Hygiene 2 > Oral ulcers > Flashcards

Oral ulcers Flashcards

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1
Q

What is an ulcer?

A

A loss of epithelium which can affect cutaneous or mucosal tissue

These are usually painful and may require topical drug therapy

The occurrence of these can either be in a single episode of recurrent

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2
Q

What are the causes of oral ulceration?

A

Trauma

Immunological

Infection

Systemic

Poor diet

Familial trait

Stress

Virus

Unknown (idiopathic)

Allergies

Malignancies

Drug therapy

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3
Q

Give some examples of infective ulcers

A

Herpes

Tuberculosis

Syphilis

Measles

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4
Q

Give some examples of non-infective ulcers

A

Traumatic ulcers

Recurrent apthous stomatitis

Leukaemia

Behcet’s disease

HIV

Lupus erythematosus

Pemphigus vulgaris

Erythema multiforme

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5
Q

What are the 2 types of herpes?

A

primary herpetic stomatitis
- occurs as primary infection in a single occurrence

herpes labialis
- can remain latent after primary infection
- recurrent
- reactivated in 20-30% patients

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6
Q

Where does primary herpetic stomatitis originate from?

A

herpes simplex virus with transmission from close-contact

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7
Q

What are the clinical features of primary herpetic stomatitis?

A

Can affect any part of oral cavity – hard palate and dorsum of tongue

Vesicles are 2-3mm, these rupture and form shallow ulcers

Are yellowish grey with red margins

Has swollen gingival margins

Has enlarged lymph nodes

These persist for 7-10 days or longer if immunocompromised

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8
Q

How does herpes labialis present?

A

cold sores

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9
Q

What are the triggers for cold sores?

A
  • Common cold
  • Febrile infections
  • Sunshine
  • Menstruation
  • Stress
  • Trauma
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10
Q

What are the symptoms and clinical presentation of herpes labialis?

A

Burning sensation

Tingling

Erythema at site

Formation of vesicles

Enlarge and coalesce then weep exudate

Crust over

Scab and finally heal

Cycle may take up to 10 days

Treat with acyclovir asap, may prevent vesicle formation and shorten vesicle duration

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11
Q

What are the 3 ways herpes can transmit?

A
  • Mouth to mouth
    Droplets spread containing virus in saliva and in vesicles
  • Mouth to finger
    Results in herpetic whitlow
  • Eye to eye
    Via aerosols
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12
Q

What is oral tuberculosis a complication of?

A

rare condition

open pulmonary tuberculosis

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13
Q

Where are the typical lesions in oral tuberculosis located?

A

An ulcer mid dorsal of the tongue

Lip and other areas are less affected

Painless in early stages in lymph nodes (NAD)

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14
Q

How can oral tuberculosis be treated?

A

Drug therapy for pulmonary infection, oral ulcers will then heal

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15
Q

What is the incubation period of syphilis?

A

9-90 days

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16
Q

What are the 2 types of syphilis?

A

congenital

acquired

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17
Q

What are the 3 stages in acquired syphilis?

A
  • Primary (3-4 weeks)
  • Secondary (1-4 months)
  • Tertiary (3 or more years after infection)
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18
Q

What is the infective agent in syphilis?

A

Treponema pallidum

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19
Q

What happens at primary acquired syphilis?

A

at 3-4 weeks

Usually occurs on tongue but is rarely on lip or intraorally

Most commonly affects genitalia

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20
Q

How do ulcers appear in primary acquired syphilis?

A

Appears as small papule or large painless ulcer

Is highly infectious

Heals 1-2 months

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21
Q

How do oral lesions present in secondary acquired syphilis?

A
  • Mucous patches
  • Split papules
  • Snail track ulcers

highly infectious

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22
Q

How do palms and soles appear in secondary acquired syphilis?

A

rash with copper appearance

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23
Q

How do oral lesions present in tertiary acquired syphilis?

A

glossitis or gumma (mid-line palate)

non-infectious

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24
Q

How do we treat syphilis?

A

penicillin

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25
What happens in the prodromal stage of measles?
koplik’s spots can appear these are white spots in buccal sulcus and palate are associated with lymphadenopathy (disease affecting lymph nodes)
26
What are 3 types of traumatic ulcers?
mechanical, thermal, chemical
27
How do mechanically-induced traumatic ulcers appear?
Raised boarders Keratotic boarders Necrotic centre Depressed centre Oval in shape Erythematous zone at periphery which lightens with keratinisation Centre usually yellow/grey
28
How can mechanically-induced traumatic ulcers arise?
Food (sharp, hard) Denture/orthodontic appliances (pressure or friction) Toothbrushing trauma (clumsy, wrong type of toothbrush) Dental treatment (LIA, instrument trauma) Bites (eating, fits) Habits (neuroses)
29
Why do thermal traumatic ulcers occur?
- Irradiation - Hot food or drink (usually on palate)
30
How do thermal traumatic ulcers appear?
Erythematous and raised
31
Why do chemical traumatic ulcers occur?
- Analgesia (eg aspirin burn) - Recreational drugs (eg cocaine)
32
How does cocaine affect the mucosal lining?
Cocaine is quickly absorbed by the mucosal lining of oral cavity. After few applications, signs of tissue degeneration is evident.
33
How do chemical traumatic ulcers appear?
Less well-defined with mucosal sloughing
34
What reasons do ulcers arise in systemic aetiology?
- Immunosuppressed/drug therapy - Stress - Hereditary - Nutritional - Neoplasms - Unknown
35
What is recurrent aphthous stomatitis (RAS)?
recurrent episodes of intraoral ulcers which can have single or crops of multiple ulcers
36
Who does RAS most commonly affect?
children and young adults Smokers are less affected
37
How do RAS ulcers generally appear?
- Ovoid or round - Yellowish centre - Inflammatory halo
38
What is the aetiology of RAS?
- 90% unknown, idiopathic - Menstruation - Can be food allergy eg nuts, choc - 20% of RAS patients have nutritional deficiency (folic acid, iron, vitamin B12)
39
What are 3 types of RAS?
1. Minor 2. Major 3. Herpetiform
40
What are the features of type I RAS?
Usually 1-5 present Less than 10mm On labial and buccal mucosa Heal with no scarring
41
What are the features of type II RAS?
This is an exaggerated version of the minor aphthae Is larger, more destructive and lasts longer >10mm Soft palate, tonsillar fauces, labial/buccal mucosa and tongue Red raised border with deep erosion of tissue Heal with scarring
42
What are the features of herpetiform aphthae?
Recurrent focal ulceration, resembles herpes Numerous pin-head size grey/white erosions that enlarge and coalesce – become ill-defined 1-2mm, in clusters of 10-100 Adjacent mucosa is erythematous Any part of oral cavity can be affected May or may not scar
43
How to treat type I RAS?
chlorhexidine 0.2% m/w and good OH Usually self-healing
44
How to treat type II RAS?
chlorhexidine 0.2% m/w and good OH May require antibiotics to prevent secondary infection May require corticosteroids
45
How to treat type III RAS?
If large surface area then same treatment as type 2
46
Where are oral cancers mostly found?
lower lip (most frequent) lateral borders of tongue and floor of mouth (70% oral cancers in above sites)
47
How do oral cancers present?
- Oral ulcers - Red patch - White patch - Red & white patch - Atrophic area
48
What are the major effects of leukaemia?
- Raised susceptibility to infection - Bleeding tendency
49
What are the oral and peri-oral effects of leukaemia?
- Gingival swelling - Mucosal ulceration (either due to cytoxic drugs or immunodeficiency) - Purpura - Cervical lymphadenopathy
50
What is the prevalence of Behçet's disease?
syndrome is rare in the UK, more common Turkey and Japan It affects males more than females between ages of 20-40 years old
51
What are the general effects of Behcet’s syndrome?
- Genital lesions - Ocular disease - Skin lesions - Arthritis
52
What are the oral and peri-oral effects of Behcet’s syndrome?
Oral ulceration that is recurrent Treatment is difficult
53
What are patients with HIV susceptible to?
RAS candidal infections and hairy leukoplakia necrotising ulcerative gingivitis (NUG)
54
What is lupus erythematous?
disease of the connective tissue
55
What are the 2 types of lupus erythematous?
Systemic – oral lesions 20% of the time - Can have rashes, joint pain - Treat with systemic steroids Discoid – oral lesions 25% of the time - Essentially a skin disease - Treat with topical corticosteroids
56
What is pemphigus vulgaris?
uncommon autoimmune disease first lesions appear in mouth
57
How do lesions appear in pemphigus vulgaris?
vesicles on skin and mucous membrane can be fatal if left untreated
58
What is the prevalence of pemphigus vulgaris?
Affects more females than males aged 40-60 years old
59
What is erythema multiforme?
mucocutaneous disease with unknown aetiology oral lesions are the most prominent
60
How do general lesions of erythema multiforme present?
- Body rashes - Ocular damage, rarely blindness, renal failure
61
How long does erythema multiforme last?
3-4 weeks with recurrence of several months over period of 1-2 years Usually runs a limited course
62
How do we treat erythema multiforme?
Systemic corticosteroids and antibiotics
63
Which drugs cause oral ulceration?
- Immunosuppressants (ciclosporin) For liver and heart transplant - Antimetabolites Cancer drugs, tumours, leukaemia, meningeal cancer Eg methotrexate - Alkaloids Nitrogen containing substances produced by plants, these are important drugs eg morphine
64
How should we manage oral ulcers?
- Attempt to identify cause - Inform the dentist! - Record details: size, location, colour, shape, margins and base - Monitor progress - Deliver OHI most will heal within 2 weeks, if still present then report to supervising clinician

Applied Dental Hygiene 2 (10 decks)

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