Oral Ulcers

Question 1

Whats ulcer

Answer 1

An ulcer is a break in the continuity of the epithelium, exposing the connective tissue to the oral environment.
Ulcers may have sharp well-defined borders or ragged margins, but all are covered by a grey-yellow fibrin slough.

Question 2

Classify Truamatic ulcers

Answer 2

Physical Trauma: Caused by mechanical injury such as biting, sharp teeth, dental braces, or poorly fitting dentures.
Chemical Trauma: Resulting from exposure to chemicals, such as aspirin burn or ingestion of corrosive substances.
Thermal Trauma: Caused by hot food or liquids.

Question 3

Classify Infectious Ulcers

Answer 3

Viral Infections: Herpes simplex virus (primary herpetic gingivostomatitis and recurrent herpes simplex labialis), varicella-zoster virus (chickenpox and shingles), and coxsackievirus (hand, foot, and mouth disease).
Bacterial Infections: Syphilis, tuberculosis, and bacterial infections secondary to immunosuppression.
Fungal Infections: Candidiasis (especially in immunocompromised patients) and histoplasmosis

Question 4

Name Immune Mediated ulcers

Answer 4

Recurrent Aphthous Stomatitis (RAS): Minor, major, and herpetiform ulcers with unknown etiology but thought to involve an immune component.
Autoimmune Diseases: Systemic lupus erythematosus, Behçet’s disease, pemphigus vulgaris, and bullous pemphigoid.
Allergic Reactions: Contact hypersensitivity to dental materials, foods, or medications.

Question 5

Classify Neoplastic ulcers?

Answer 5

Benign Neoplasms: Papillomas and fibromas can ulcerate.
Malignant Neoplasms: Oral squamous cell carcinoma, lymphomas, and metastatic cancers to the oral cavity.

Question 5

What are the ulcers related to systemic diseases?

Answer 5

Gastrointestinal Diseases: Crohn’s disease, ulcerative colitis, and celiac disease.
Hematologic Disorders: Anemia (iron, folate, vitamin B12 deficiency), neutropenia, and leukemias.
Nutritional Deficiencies: Deficiencies in vitamins and minerals (e.g., iron, vitamin B12, folate, zinc).

Question 5

Drugs induced ulcers are due to?

Answer 5

Direct Toxicity: Chemotherapy and radiation therapy to the head and neck area.
Medication Side Effects: Nonsteroidal anti-inflammatory drugs (NSAIDs), bisphosphonates, and certain antibiotics.

Question 6

Classify Ulcers ?

Answer 6

Truamatic, Chemical, Thermal, Immune related, Due to Systemic disease,Nutritional Deficiency,Idiopathic, Eosinophilic`

Question 7

Eosinophilic ulcers are also called?? and define Eosinophillic ulcer?

Answer 7

Truamatic Granuloma,
Eosinophilic ulcers, are a relatively rare characterized by the presence of eosinophils, a type of white blood cell, in ulcerative lesions of the oral mucosa…

Question 8

What are the causes of eosinophilic ulcers?

Answer 8

The exact cause of eosinophilic oral ulcers is not well understood,
Trauma to the oral mucosa
Allergic reactions
Certain foods or medications
Underlying systemic conditions

Question 9

Symptoms Of Eosinophillic oral ulcers?

Answer 9

Single or multiple ulcers
Often painful
Can be located on any part of the oral mucosa, including the lips, tongue, and buccal mucosa
The ulcers may have a raised, rolled edge and a yellow or grey floor
They may persist for weeks to months if untreated

Question 10

How to diagnose Eosinophilic Oral Ulcer?

Answer 10

Diagnosis typically involves a thorough clinical examination and a detailed medical history. A biopsy of the lesion is often required to confirm the diagnosis and rule out other conditions, such as infectious ulcers, malignancy, or other types of inflammatory lesions. Histologically, eosinophilic ulcers are characterized by a dense infiltrate of eosinophils, along with other inflammatory cells.

Question 11

Whats the treatment of eosinophilic oral ulcers?

Answer 11

Treatment of eosinophilic oral ulcers often involves:
Addressing any identified triggers or underlying conditions
Topical corticosteroids to reduce inflammation
Intra lesional corticosteroids for more severe cases
Systemic corticosteroids may be considered in cases where topical or intra lesional treatment is ineffective
Good oral hygiene and avoiding trauma to the oral mucosa

Question 12

3 types of R.A.S?

Answer 12

Minor Aphthous Ulcer
Major Aphthous Ulcer
Herpetiform Ulcer

Question 13

Canker sores is commonly used for —— ulcers?

Answer 13

Canker Sores

Question 14

Whats the age of onset for different types of R.A.S?

Answer 14

Minor and major = 10-19
Herpetiform= 20-29

Question 15

How many ulcers are typically present in Minor RAS?

Answer 15

A: 1-5 ulcers

Question 16

Q: How many ulcers are typically present in Herpetiform RAS?

Answer 16

A: 10-100 ulcers

Question 17

What are the principal sites for Minor RAS?

Answer 17

A: Lips, cheeks, tongue

Question 18

What are the principal sites for MAJOR RAS?

Answer 18

Palate and Pharynx

Question 19

What are the principal sites for Herpetiform RAS?

Answer 19

A: Floor of mouth, palate, pharynx, gingiva

Question 20

Typical sizes of ulcers in Minor,Major And Herpetiform RAS?

Answer 20

Minor: <10mm
Major : >10mm
Herpetiform: 1-2mm

Question 21

Duration Of minor major and herpetiform RAS ulcers?

Answer 21

Minor 7-14 days, Major >30 days , Herpetiform 10-30 days

Question 22

Clinical Scenario Question

A 17-year-old otherwise healthy female presents to your clinic complaining of painful mouth ulcers that have recurred several times over the past year. She reports that the ulcers appear on the inside of her lips and cheeks and tend to heal on their own within two weeks without leaving scars. On examination, you observe one small, shallow, round ulcer approximately 5 mm in diameter on the non-keratinized buccal mucosa. The lesion has a yellowish floor with an erythematous margin. She recalls having similar episodes every 2–3 months.

Which of the following is the most likely diagnosis?

A) Herpetiform ulceration
B) Major aphthous ulcer
C) Minor aphthous ulcer
D) Traumatic ulcer
E) Oral candidiasis

Answer 22

C

Question 23

These are the Clinical features of? More than 10mm in diameter Ulcers persist for several months Also involve keratinised part of oral mucosa Heal with scarring Reoccur within a month Present as crater like ulcers with rolled margins

Answer 23

Major RAS

Question 24

Treatment for RAS?

Answer 24

1. Topical Treatments Corticosteroids: Topical corticosteroids (e.g., triamcinolone acetonide in dental paste, fluocinonide, clobetasol propionate) are commonly used to reduce inflammation and pain. Antiseptics: Mouthwashes containing chlorhexidine can reduce the bacterial load and promote healing, but may temporarily stain teeth. Local Anesthetics: Products containing lidocaine or benzocaine can provide temporary pain relief. Protective Coverings: Protective pastes or cyanoacrylate adhesives can shield the ulcer from irritation. Anti-inflammatory Agents: Amlexanox paste may help to reduce ulcer size, pain, and healing time. 2. Systemic Treatments For severe or refractory cases, systemic treatments may be considered: Systemic Corticosteroids: Prednisone may be used in short courses for severe outbreaks. Immunosuppressants: Drugs like azathioprine, cyclosporine, or methotrexate may be used in severe, treatment-resistant cases under specialist care. 3. Nutritional Supplements Supplementation may be beneficial if the ulcers are linked to nutritional deficiencies: Vitamin B12: Effective in reducing the frequency, duration, and pain of aphthous ulcers in deficient patients. Iron and Folic Acid: Supplementation may help if tests indicate deficiencies. 4. Alternative and Complementary Therapies SLS-Free Toothpaste: Toothpaste without sodium lauryl sulfate (SLS) may reduce the frequency of ulcers for some individuals. Honey: Application of honey to ulcers may reduce pain and size of the lesions. Zinc Lozenges: May help in reducing the duration and pain of aphthous ulcers. Laser Therapy: Low-level laser therapy can promote healing and reduce pain.  5. Behavioral and Lifestyle Changes Stress Management: Techniques or meditation can help if stress is a trigger. Dietary Modifications: Avoiding spicy, acidic, or abrasive foods. Identifying and eliminating specific food triggers (e.g., nuts, chocolate, certain fruits) through an elimination diet can also be helpful

Question 25

Clinical diagnoses of behchet disease?

Answer 25

There's no single test for Behçet's Disease. Diagnosis typically involves clinical criteria, including the presence of recurrent oral ulcers plus two of the following: genital ulcers, eye inflammation, skin lesions, or a positive pathergy test

Question 26

Treatment For Behcets disease?

Answer 26

Includes topical treatments for oral and genital ulcers, systemic medications like corticosteroids, immunosuppressants (e.g., azathioprine, cyclosporine), and biological agents targeting specific immune pathways (e.g., TNF inhibitors)

Question 27

Topical treatment for behcet disease?

Answer 27

Corticosteroid Mouth Rinses or Gels: Topical corticosteroids such as triamcinolone acetonide mouth rinse or gel can help reduce inflammation and pain associated with oral ulcers. They are often applied directly to the ulcers several times a day. Topical Anesthetics: Over-the-counter or prescription topical anesthetics (e.g., lidocaine mouthwash or gel) can provide temporary pain relief by numbing the oral ulcers. Barrier Protection: Using protective barriers such as oral pastes or gels can help shield the ulcers from irritation caused by food or oral hygiene products

Question 28

Systemic management of behcet disease? Initial, Maintenance and Longterm Management?

Answer 28

Initial Dosage: Prednisone or prednisolone is commonly used as the initial systemic corticosteroid. The initial dosage may range from 0.5 to 1 mg/kg/day, usually not exceeding 60-80 mg/day. This dosage is often used to rapidly control acute manifestations or severe flares of Behçet's disease. Maintenance Dosage: Once the acute symptoms are controlled, the dosage is gradually tapered to the lowest effective dose to maintain disease remission. A common approach is to reduce the dose by 5-10% every 1-2 weeks or based on clinical response and disease activity. The maintenance dosage may range from 5 to 15 mg/day, although some patients may require higher or lower doses long-Term Management: Long-term use of systemic corticosteroids at high doses should be avoided due to the risk of side effects, including osteoporosis, diabetes, hypertension, and immunosuppression

Question 29

It represents a hypersensitivity reaction to infectious agents or medications.

Answer 29

Erythema Multiforme

Question 30

Clinical Findings Of Eryhtema Multforme?

Answer 30

EM generally affects those between ages 20 and 40 years with 20% occurring in children. More common in women compared with men (1.5:1) Patients with recurrent EM have an average of 6 episodes a year , remission occurred in 20% of cases. Episodes usually lasts several weeks. There may be a prodrome of fever, malaise, headache, sore throat, rhinorrhea and cough. The skin may feel itchy and burnt.

Question 31

**Clinical Scenario Question** A 22-year-old male presents to the dermatology clinic with complaints of skin lesions that appeared rapidly over the past three days. He reports that the rash began as red spots on his hands and has progressively spread towards his arms, face, and trunk in a symmetric pattern. On examination, multiple papular lesions are seen, some of which have developed into lesions with a central dusky area, surrounded by concentric rings of varying color. A few lesions have central blistering. The patient denies any recent travel but reports a recent history of herpes simplex virus (HSV) infection about a week ago. **Which of the following is the most likely diagnosis?** A) Stevens-Johnson Syndrome B) Urticaria C) Erythema Multiforme D) Pityriasis Rosea E) Contact Dermatiti

Answer 31

c

Question 32

Oral Findings Of Erythema Multiforme?

Answer 32

The oral lesions initially manifest with edema, erythema, and erythematous macules of the lips and buccal mucosa, followed by the development of multiple vesicles and bullae that quickly rupture. Ranges from mild erythema to large painful ulcerations

Question 33

Intact vesicles are rarely observed because?

Answer 33

they rapidly break down to form ill-defined ulcers.

Question 34

Clinical Findings of other mucosa in Erythema multiforme?

Answer 34

Genital and ocular sites are affected in 25% and 17% of cases respectively. Involvement of the eye may cause lacrimation and photophobia. Genital lesions are painful and may cause urinary retention.

Question 35

Whats classification Of erythema multiforme?

Answer 35

Erythema multiforme minor (EMm) Erythema multiforme major (EMM) Stevens- Johnson Syndrome (SJS) Toxic Epidermal Necrolysis (TEN)

Question 36

Acute EM management?

Answer 36

Avoid all inciting factors, such as medication use Mild disease:-systemic or topical analgesics HSV-induced EM:- Antiviral suppressive therapy Mycoplasma pneumoniae–associated EM might include antibiotics. Empirical use of a macrolide or tetracycline 250mg four times a day for atleast 1week Severe cases:- systemic corticosteroids (prednisone, 40–60 mg/d with dosage tapered over 2–4 weeks) and topical steroids

Question 37

Management Of Recurrent EM?

Answer 37

HSV-associated recurrent EM or idiopathic recurrent EM A 6-month trial of continuous antiviral therapy Acyclovir 400 mg twice daily Valacyclovir 500 mg twice daily Famciclovir 250 mg twice daily If unresponsive, double the dose or switch to different antiviral therapy.

Question 38

Rapidly develops into painful and erythematous gingiva with scattered punched-out ulcerations, usually on the interdental papillae

Answer 38

nug

Question 39

Management of NUG/NUP

Answer 39

Supportive care and pain control Debridement to remove debris and plaque Chlorhexidine digluconate mouthrinse Metronidazole Scaling and root planning Cases of noma need aggressive treatment with nutritional supplementation, antibiotics, and tissue débridement