Ulcerations

Question 1

Nectrotizing Sialometaplasia

Answer 1

Painless Swelling

Dusky, Ulcerated Erythema in Hard Palate

Associated anaesthesia of area

Differential Diagnosis:

SCC - although SCC uncommon on Hard Palate

Question 1

Reversed

Oral Ulceration on non-keratinized surfaces

Single or multiple small lesions

Fever

Malaise

Cervical lymphadenopathy

Infections

DIffernential Diagnosis:

MiRAS, Behcet’s Disease

Answer 1

Cyclic Neutropenia

Question 2

Herpetiform RAS

Answer 2

Ulcers similar to MiRAS but increased number

Up to 50 seperate lesions

Differential Diagnosis:

Primary Herpetic Gingivostomatitis

ANUG

Behcet’s DIsease

Question 2

Erosive Lichen Planus

Answer 2

White patches or striae

May affect any oral site

Erosive form of disease may form Ulceration

Differential Diagnosis:

Lichenoid Reaction

SSC

Question 2

Lichenoid Reaction

Answer 2

Widespread Irregular White Patches

Occasional ulceration with sloughing

Question 2

Osteoradionecrosis

Answer 2

Ulceration and Necrosis of Soft tissues

Areas of exposed bone

Growing areas of bone necrosis

Portions of bone may eventually be lost

Histroy of Radiation followed by minor trauma e.g XLA

Degree of severity in proportion with ammount of radiation

Differential diagnosis

SSC

Question 2

Reversed

Widespread Irregular White Patches

Occasional ulceration with sloughing

Answer 2

Lichenoid Reaction

Question 3

Behcet’s Disease

Answer 3

Multisystem Condition

Usually begins in 3rd decade of life

Oral and Genital Manifestations

Ulceration

Uveitis

CVD

Differential Diagnosis:

Any form of RAS

Question 3

Bisphosphonate-related osteonecrosis of the jaw

Answer 3

Exposed bone for 8+ weeks without evidence of malignancy or prior radiotherapy.

Usually occurs poth tooth extraction

Can lead to tooth loss, infection, exudate and sinus tract formation.

Question 3

Reversed

Exposed bone for 8+ weeks without evidence of malignancy or prior radiotherapy.

Usually occurs post tooth extraction

Can lead to tooth loss, infection, exudate and sinus tract formation.

Answer 3

Bisphosphonate-related osteonecrosis of the jaw

Question 3

Reversed

Rapid formation of painful ulceration

Located at gingival margin & Interdental papillae

Marked Halitosis

Most commonly affects Mandibular Anterior region

Answer 3

ANUG

Question 4

Cyclic Neutropenia

Answer 4

Oral Ulceration on non-keratinized surfaces

Single or multiple small lesions

Fever

Malaise

Cervical lymphadenopathy

Infections

DIffernential Diagnosis:

MiRAS, Behcet’s Disease

Question 6

Squamous Cell Carcinoma

Answer 6

Can vary from small erythmatous patch to large ulceration

70% of cases present in floor of mouth, tongue and retromolar region

Rolled, indurated margins when present on lip

60-70% Are painless at early stage

Differential Diagnosis:

RAS, Traumatic Ulceration

Question 8

Reversed

Multisystem Condition

Usually begins in 3rd decade of life

Oral and Genital Manifestations

Ulceration

Uveitis

CVD

Differential Diagnosis:

Any form of RAS

Answer 8

Behcet’s Disease

Question 9

Minor RAS

Answer 9

Small or small number of shallow ulcers approx 5mm in diammeter or less.

Affects non-keratinized sites e.g labial mucosa, buccal mucosa, floor of mouth

Heal 10-14 days without scarring

Differnential Diagnosis: Traumatic Ulceration, Cyclic Neutropenia, Behcet’s Disease

Question 12

Epstein-Barr virus - associated ulceration

Answer 12

Isolated mucosal lesion

Central necrosis

Question 13

Radiotherapy Induced Mucositis

Answer 13

General erythema of Mucosa

Areas of shallow ulceration and fibrinous exudate

Pain , **Xerostomia, **Loss of taste

Begins 1-2 weeks post radiation therapy

Differential Diagnosis

Graft Vs Host

Erosive Lichen Planus

SSC

Question 14

Reversed

Macular or Papular rash

‘Snail Track’ Ulcers in 1/3 of cases

Febrile illness

Malaise

Headache

Lymphadenopathy

Sore Throat

Appear 6+weeks after infection, resolve within 2-6 weeks

Answer 14

Syphilis - Stage 2

Question 16

Reversed

Gumma in the Palate

Leukoplakia affecting dorsal surface of tongue

Answer 16

Syphilis - Stage 3

Question 19

Reversed

Single Localised deep ulcer

Irregular outline

In Cases of chemical irritation:

Widespread area superficial area of erosion

Slough of fibrinous exudate

Differntial Diagnosis: RAS, Cyclic Neutropenia

Answer 19

Traumatic Ulceration

Question 21

Reversed

Painless Swelling

Dusky, Ulcerated Erythema in Hard Palate

Associated anaesthesia of area

Differential Diagnosis:

SCC - although SCC uncommon on Hard Palate

Answer 21

Nectrotizing Sialometaplasia

Question 23

Syphilis - Stage 1

Answer 23

Firm Nodule

Breaks down after few days to leave painless ulcer with indurated margins

Enlarged Cervical Lymph Nodes

Resolves wthin 3-12 weeks without scarring

Question 24

Reversed

Ulcers 1-3cm in diammeter

singular or 2-3 at a time

Last 4-6 weeks

Can affect any Oral Site - including keratinized

Can sometimes scar.

Differntial Diagnosis: Cyclic Neutropenia, Behcet’s Disease, Traumatic Ulcer

Answer 24

Major RAS

Question 24

Reversed

Isolated mucosal lesion

Central necrosis

Answer 24

Epstein-Barr virus - associated ulceration

Question 25

# Reversed **Ulcer on dorsal surface of tongue** **may affect other sites ** **Irregular ulcers** **Raised Borders** **Blood-tingued Sputum, night sweats, fever, weight-loss** **Differential Diagnosis:** **Deep Fungal Infection** **SCC**

Answer 25

**Tuberculosis**

Question 26

**Major RAS**

Answer 26

**Ulcers 1-3cm in diammeter** **singular or 2-3 at a time** **Last 4-6 weeks** **Can affect any Oral Site - including keratinized** **Can sometimes scar.** **Differntial Diagnosis: Cyclic Neutropenia, Behcet's Disease, Traumatic Ulcer**

Question 27

**Graft Versus Host Disease**

Answer 27

**_Acute Form:_** **occurs** **Skin rashes and Blisters occur in 50% of cases** **_Chronic Form:_** **\>100 days following BMT** **WHit ereticulatedlesions** **Burning Mucosa** **Xerostomia** **Differential Diagnosis:** **Erosive Lichen Planus**

Question 28

**ANUG**

Answer 28

**Rapid formation of painful ulceration** **Located at gingival margin & Interdental papillae** **Marked Halitosis** **Most commonly affects Mandibular Anterior region**

Question 30

**Tuberculosis**

Answer 30

**Ulcer on dorsal surface of tongue** **may affect other sites ** **Irregular ulcers** **Raised Borders** **Blood-tingued Sputum, night sweats, fever, weight-loss** **Differential Diagnosis:** **Deep Fungal Infection** **SCC**

Question 31

**Syphilis - Stage 3**

Answer 31

**Gumma in the Palate** **Leukoplakia affecting dorsal surface of tongue**

Question 32

# Reversed **Small or small number of shallow ulcers approx 5mm in diammeter or less.** **Affects non-keratinized sites e.g labial mucosa, buccal mucosa, floor of mouth** **Heal 10-14 days without scarring** **Differnential Diagnosis: Traumatic Ulceration, Cyclic Neutropenia, Behcet's Disease**

Answer 32

**Minor RAS**

Question 33

# Reversed **General erythema of Mucosa** **Areas of shallow ulceration and fibrinous exudate** **Pain , ****Xerostomia, ****Loss of taste** **Begins 1-2 weeks post radiation therapy** **Differential Diagnosis** **Graft Vs Host** **Erosive Lichen Planus** **SSC**

Answer 33

**Radiotherapy Induced Mucositis**

Question 34

**Syphilis - Stage 2**

Answer 34

**Macular or Papular rash** **'Snail Track' Ulcers in 1/3 of cases** **Febrile illness** **Malaise** **Headache** **Lymphadenopathy** **Sore Throat** **Appear 6+weeks after infection, resolve within 2-6 weeks**

Question 35

# Reversed **Ulceration and Necrosis of Soft tissues** **areas of exposed bone** **Growing areas of bone necrosis** **Portions of bone may eventually be lost** **Histroy of Radiation followed by minor trauma e.g XLA** **Degree of severity in proportion with ammount of radiation** **Differential diagnosis** **SSC**

Answer 35

**Osteoradionecrosis**

Question 36

# Reversed Ulcers similar to MiRAS but increased number Up to 50 seperate lesions Differential Diagnosis: Primary Herpetic Gingivostomatitis ANUG Behcet's DIsease

Answer 36

**Herpetiform RAS**

Question 37

# Reversed **White patches or striae** **May affect any oral site** **Erosive form of disease may form Ulceration** **Differential Diagnosis:** **Lichenoid Reaction** **SSC**

Answer 37

**Erosive Lichen Planus**

Question 38

# Reversed **Can vary from small erythmatous patch to large ulceration** **70% of cases present in floor of mouth, tongue and retromolar region** **Rolled, indurated margins when present on lip** **60-70% Are painless at early stage** **Differential Diagnosis:** **RAS, Traumatic Ulceration**

Answer 38

**Squamous Cell Carcinoma**

Question 39

**Traumatic Ulceration**

Answer 39

**Single Localised deep ulcer** **Irregular outline** **_In Cases of chemical irritation:_** **Widespread area superficial area of erosion** **Slough of fibrinous exudate** **Differntial Diagnosis: RAS, Cyclic Neutropenia**

Question 40

# Reversed **_Acute Form:_** **occurs** **Skin rashes and Blisters occur in 50% of cases** **_Chronic Form:_** **\>100 days following BMT** **WHit ereticulatedlesions** **Burning Mucosa** **Xerostomia** **Differential Diagnosis:** **Erosive Lichen Planus**

Answer 40

**Graft Versus Host Disease**

Question 41

# Reversed **Firm Nodule** **Breaks down after few days to leave painless ulcer with indurated margins** **Enlarged Cervical Lymph Nodes** **Resolves wthin 3-12 weeks without scarring**

Answer 41

**Syphilis - Stage 1**