Mouth Ulcer Causes and Diagnosis

Mouth Ulcers

• Mouth ulcers are a common condition that can recur in some people, and the cause is unknown.
• There are three main types of aphthous ulcers: minor aphthous ulcers (MAU), major aphthous ulcers, and herpetiform ulcers.
• MAU is the most common type, accounting for about 80% of mouth ulcers, and is characterized by 1-5 lesions that are less than 1 cm in size, usually found on the tongue margin and inside the lips and cheeks.
• MAU is a self-limiting condition that can be managed with over-the-counter (OTC) products.
• Major aphthous ulcers are larger and more painful than MAU, and may require referral to a specialist.
• Herpetiform ulcers are the least common type, characterized by 10-100 small, painful ulcers that can occur in any intraoral area.

Patient Assessment

• When assessing a patient with mouth ulcers, age is an important factor, as MAU is rare in children under 10 years old and may require referral.
• The appearance, duration, and size of the ulcer, as well as the number of lesions, are important factors in diagnosis.
• Pain is a key presenting symptom, and patients with painless ulcers in the oral cavity should be referred to a specialist.
• Associated symptoms, such as diarrhea, weight loss, and involvement of other mucus membranes, should be assessed.
• A patient's medication history is also important, as some medications can cause mouth ulcers as a side effect.

Treatment and Management

• Paste preparations can be applied to the ulcer with a finger, and mouthwashes can be used to prevent secondary bacterial infection.
• Triamcinolone acetonide in orabase can be applied to the ulcer with a finger, and antiseptic mouthwashes can be used to prevent infection.
• Topical anesthetics, such as benzocaine or lidocaine gel, can be used on a when-needed basis.
• If there is no improvement after 1 week, the patient should see a doctor.

Dandruff and Seborrheic Dermatitis

• Dandruff is a chronic, relapsing condition characterized by increased cell turnover rate, which may be associated with the yeast Malassezia ovale.
• Dandruff is rare in young children, but the incidence increases rapidly with age, peaking in the second decade of life and declining thereafter.
• Patient assessment involves distinguishing dandruff from psoriasis and seborrheic dermatitis based on appearance and location.
• Treatment involves using ketoconazole shampoo, selenium sulfide shampoo, and other topical treatments.
• Patients should understand that treatment will not cure dandruff permanently and that it will be necessary to use treatment on a less frequent basis to prevent recurrence.

Seborrheic Dermatitis

• Seborrheic dermatitis is characterized by accelerated epidermal proliferation and sebaceous gland activity on the scalp, face, and trunk.
• It is common in infants, relatively rare in children, and peaks in incidence between 18-40 years.
• Patient assessment involves differentiating seborrheic dermatitis from dandruff and psoriasis, and noting other symptoms such as eyelid and ear problems.
• Treatment options are the same as for dandruff, including ketoconazole shampoo.

Cradle Cap

• Cradle cap is a form of seborrheic dermatitis of the scalp that usually appears within the first 3 months of life and resolves spontaneously within a year.
• Treatment involves simple measures such as daily use of baby shampoo and gentle brushing, and medicated shampoos containing coal tar or keratolytic-tar combinations can be tried if symptoms persist.