ulceration and OLP

Question 1

describe the pattern of ulceration seen during a herpes infection

Answer 1

intra oral lesions most commonly seen on hard palate
ulceration usually limited to one nerve group or branch and will re appear in same area each time

Question 2

describe the differences in discomfort between ulceration from herpes zoster and herpes simplex

Answer 2

zoster - ulceration is preceeded by significant discomfort
simplex - discomfort comes from burst vesicles and exposed connective tissue rather than virus itself

Question 3

what is shingles

Answer 3

also termed herpes zoster
infection from varicella zoster virus (which also causes chickenpox) which causes painful rash and blisters on skin

Question 4

what systemic treatment might recurrent herpetic lesions require

Answer 4

systemic Aciclovir

Question 5

what form of RAS is most likely to leave scars

Answer 5

major

Question 6

how can we distinguish between RAS herpetiform and primary herpetic gingivostomatitis

Answer 6

primary herpetic gingivostomatitis will affect keratinised mucosa unlike herpetiform. PHG also rarely recurrent

Question 7

name 4 predisposing factors for RAS

Answer 7

stress
genetic predisposition
systemic disease
mechanical injuries
viral and bacterial deficiencies

Question 8

briefly describe the events leading up to the formation of an aphthous ulcer

Answer 8

1. damage to basal cells in basement membrane means they are no longer able to form replacement epithelial cells
2. as existing cells make their way towards the surface and are lost, ulceration will appear as there are no new epithelial cells to replace them

Question 9

when is RAS treatment most effective

Answer 9

ulcer prodrome period, before damage to basal cells occurs and epithelial cell production is halted

Question 10

how long does it take for an ulcer to appear after the immunological process has begun

Answer 10

3-4 days

Question 11

what test is done to investigate coeliac disease

Answer 11

TTG test
tissue transglutaminase

Question 12

what investigations may be done when investigating RAS

Answer 12

blood tests - to investigate haematinic deficiencies - ferritin, folate and vitamin B12
TTG test - coeliac screen
Allergy tests

Question 13

what time period are aphthous ulcers most common in children

Answer 13

during period of rapid growth
usually 8-11 and 13-16
Most cases are due to lower iron levels as nutrients being used so fast

Question 14

what are the 3 clinical presentations of lichen planus

Answer 14

reticular
atrophic
ulcerative

Question 15

describe the appearance of reticular lichen planus

Answer 15

lacy pattern of white running across mucosa
mucosa can be normal or have slight erythmatous change

Question 16

describe the appearance of atrophic lichen planus

Answer 16

mucosa has strong erythematous change

Question 17

ulcerative lichen planus

Answer 17

atrophy extended to point of no epithelium present
symptoms sometimes mitigated by fibrous covering of lesions

Question 18

cutaneous lichen planus

Answer 18

most common appearance is raised purple lesions around the wrist

Question 19

oral lichen planus symptoms

Answer 19

often none
sensitivity to hot/ spicy food
50% of patients have other area of body involved too

Question 20

most common oral sites of lichen planus

Answer 20

buccal mucosa followed by gingivae and tongue