question 28 Flashcards
(8 cards)
recurrent apthous stomatitis
history
o Ulceration history – where, when, how many, size and shape, blister or ulcer, how long for, recurrent, pain, how many, triggers (trauma, allergy, spontaneous), anything make it worse/better, ulcer free period, any genital or eye ulcers?
o MH – allergies, medications, medical conditions, any deficiencies
recurrent apthous stomatitis
Extra and Intra-oral examination – diagnosis from worst ulcer
o Location, colour, size, shape
o Margins – flat, raised or rolled
o Base – soft, firm or hard. Covered in granulation tissue or fibrinous exudate?
o Surrounding tissue – inflamed, normal, white/keratotic?
o High risk areas – lateral border of tongue, FoM, soft palate, oropharynx
recurrent apthous stomatitis
causes
o Trauma
o Immunological – aphthous ulceration, lichen planus, lupus, vesiculobullous, erythema multiforme
o Infection – bacterial, viral (herpes, hand foot and mouth disease), fungal
o Adverse drug reactions/allergies
o Nutritional or haematinic deficiencies
o Gastrointestinal disease – UC or Crohn’s
o Oral squamous cell carcinoma
ras
signs synptoms
pain, inflammation, ulceration, dehydration (if severe)
ras
types
o Minor - <10mm in diameter, up to 2 weeks, non-keratinised mucosa
o Major - >10mm, may last months, both types of mucosa
o Herpetiform – multiple small ulcers on non-keratinised mucosa, up to 2 weeks
o Behcets – pt presents with 3 episodes of mouth ulcers a year alongside genital sores, eye inflammation, skin ulcers, pathergy
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predisposing factors
genetic predisposition, stress, trauma, systemic disease, haematinic deficiencies
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special invest
o FBC – iron, B12, folic acid
o TTG (tissue transglutaminase) – coeliac
o Allergy tests/patch testing – benzoate, sorbate, cinnamon, chocolate
o Photographs
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management
o If patient is severely dehydrated seek emergency medical care
o Determine how long ulceration has been present:
Less than 3 weeks:
* Try to remove potential cause:
o Remove sources of trauma – sharp cusps, restorations or ortho appliances
o Ill-fitting dentures - adjust dentures, reline or remake, advise pt to keep dentures out where possible
o Avoid dietary triggers – SLS, food diary
* Advise the patient to use 0.2% CHX mouthwash or HSMW to keep clean, recommend optimal analgesia, soft diet, avoid spicy or citric foods, drink cool drinks through a straw and avoid hot drinks, use soft TB with SLS free TP, ice cubes over sores, OTC numbing gels
* Advise that ulcers are common and likely to resolve within 1-2 weeks.
* Benzydamine hydrochloride, 0.15% spray or MW may be prescribed for symptomatic relief
* For disabling lesions topical steroids may be prescribed (unlicensed for ulcers), however only if in prodromal period (before ulcer has formed) – Beclometasone MDI or Betamethasone soluble tablets MW
* Referral if recurrent or cannot be managed by yourself – evidence of systemic disease, blood deficiencies, coeliac positive, allergies, medications (NSAIDs, beta blockers, Nicorandil), oral cancer?
3 weeks or more – refer patient to oral surgery/oral med to investigate potential dysplasia or malignancy
* If suspected oral cancer refer as an urgent 2 week referral for biopsy
