Oral Ulcerations

• causes?

  • trauma
  • drug induces
  • idiopathic
  • systemic disease eg Crohn's, Coeliac's
  • dermatological disease eg LP
  • infective
  • neoplastic
• investigation?

  • detailed mh, sh, dh
  • ioe, eoe
  • special tests: biopsy, imaging technique, haematological, specimen for microbiological culture
• traumatic ulcers:

  • most common
  • mechanical/thermal/chemical
  • ill fitting denture? ortho? self induced?
• traumatic ulcer

  
• traumatic ulcer from lip biting

  
• drug induced ulcers

  
• what drugs can cause ulcers?

  • nicorandil
  • vasodilators
  • angina tx
  • NSAID's
  • beta blockers
• drugs that cause ulcers:

  
• nicorandil

  
• methotrexate

  
• idiopathic recurrent apthous stomatitis?


  • history of recurrent ulcers in healthy person
• idiopathic recurrent apthous stomatitis?


  • history of recurrent oral ulcers in healthy person
  • female predominance
  • onset on childhood
• minor RAS

  • most common - 80%
  • non-keratinised mucosa
  • 2-10 ulcers
  • >1cm diameter
  • heals withing 7-14 days
  • no scarring
  • painful
• minor RAS

  
• major RAS

  • uncommon <10%
  • 1-3 ulcers
  • +1cm diameter
  • slow healing - 1-2 months
  • scarring
  • non keratinised or keratinised mucosa
• major RAS

  
• major RAS

  
• herpetiform RAS

  • 10%
  • non keratinised and keratinised mucosa
  • multiple ulcers
  • 1-2mm diameter
  • heal variably
  • scar
• herpetiform RAS

  
• investigation?


  • diet diary
  • full blood cell count
  • haematinics - ferritin, vit b12, red cell folate
  • triggers, stress, food, trauma?
• management?

  • Correct underlying systemic problems if present
  • Topical antimicrobials : Chlorhexidine 0.2% mw1% gel, tetracycline mw
  • Topical anti inflammatory : Difflam mw/spray
  • Topical steroids: Prednisolone mw, Betnesol mw, Fluticasone propionate
  • Systemic treatment
• what systemic disease relate to recurrent oral ulcerations?


  • Behcets
  • Coeliac
  • Crohns
• Behcet's?


  • multisystemic inflammatory autoimmune disorder
  • clinically: recurrent oral/genital ulceration and uveitis
  • other conditions linked: cariovasulaar, skeletal etc
• Betcets disease tx of oral lesions?


  • colchicine
  • topical steriods
  • topcil antimicrobials
• Crohns disease?


  • inflammatory bowel disease
  • unknown aetiology
  • autoimmune origin
  • oral ulcerations, cobblestoning, lip swelling, tissue tagging, angular cheilitis
  • hyperplastic gingivitis
  • granulomas on biopsy
• cobblestoning

  
• Coeliac?


  • autoimmune, unknown aetiology
  • triggered by gluten
  • can present at anytime in life
  • oral ulcerations
  • tx gluten free diet
• vesiculo-bullous disorders

  
• pemphigus vulgaris?


  • rare childhood
  • palate and lips
  • blisters rupture and ulcerate, heal slowly without scarring
  • severe desquamative gingivitis
• pemphigus vulgaris

  
• Mucous membrane Pemphigoid

  
• Mucous membrane Pemphigoid?

  • nikolsky sign postive
  • blisters rupture quickly, sore, bleed
  • scars
  • desquamtive gingivitis
  • rare on lips
• ocular MMP

  
• oral MMP

  
• infective ulceration

  
• primary herpetic gingivostomatitis

  
• herpes zoster

  
• Syphilis

  
• TB with nonspecific ulceration

  
• charcteristics of syphilis?


  • snail track ulcers
  • mucosal patches
  • condyloma late