Oral Ulcer Overview and RAS

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Questions and Answers

What is the primary characteristic of oral ulcers as mentioned?

They are typically bilateral.

They are always accompanied by a fever.

They only occur in individuals under 50.

They can sometimes have no clear diagnosis. (correct)

Which of the following conditions is associated with Methotrexate?

Recurrent aphthous stomatitis

Herpes zoster

Rheumatoid arthritis

Suspected oral ulceration (correct)

What are common risk factors for the reactivation of herpes zoster?

Immunosuppression and aging (correct)

Young age and physical activity

Stress and dehydration

Frequent dental visits and high sugar intake

Which medication class is often linked to oral mucositis?

Chemotherapy agents Signup and view all the answers

Which symptom is unlikely to manifest with herpes zoster according to the discussed characteristics?

Bilateral dermatomal involvement Signup and view all the answers

What percentage of patients correctly defined the term 'ulcer' in the study?

56% Signup and view all the answers

Which of the following is a common characteristic of acute traumatic ulceration?

Typically solitary Signup and view all the answers

What is a common misinterpretation of the term 'impacted tooth' as found in the study?

Infection of gum or tooth Signup and view all the answers

Which type of oral ulcer is typically associated with immune-mediated factors?

Recurrent aphthous stomatitis Signup and view all the answers

What is the recommended time frame for acute traumatic ulcers to heal provided the source of trauma is removed?

2 weeks Signup and view all the answers

Which group of patients might be more prone to medication-related oral issues?

Immunocompromised patients and those on chemotherapy Signup and view all the answers

What does the term 'mucosa' refer to, according to the study findings?

Mucous membrane lining various cavities Signup and view all the answers

In the context of oral ulcers, what is a common error made by patients regarding 'sedation'?

Misunderstanding its necessity during procedures Signup and view all the answers

What is a defining characteristic of recurrent aphthous stomatitis?

Painful ulcers with well-defined margins Signup and view all the answers

Which of the following medications is most commonly associated with causing dry mouth due to salivary gland hypofunction?

Venlafaxine Signup and view all the answers

In the context of oral ulcers, what is typically observed in recurrent aphthous stomatitis?

Ulcers that have erythematous haloes Signup and view all the answers

What feature differentiates Riga Fede disease from other types of oral ulcers?

Is specifically found in children Signup and view all the answers

What is the typical size and characteristic of ulcers seen in recurrent aphthous stomatitis?

2-3 mm in diameter and round Signup and view all the answers

How is the incidence of recurrent aphthous stomatitis influenced by demographics?

More common in individuals of higher socioeconomic status Signup and view all the answers

What is a distinguishing clinical feature of oral ulcers associated with Behçet disease?

Presence of systemic symptoms Signup and view all the answers

Which underlying condition does NOT typically lead to a change in the appearance of recurrent aphthous stomatitis?

Bacterial infections Signup and view all the answers

Study Notes

Oral Ulceration Overview

Oral ulcers can be solitary or multiple.
Oral ulcers can be painful or painless.
Oral ulcers can be firm to palpate.

Dry mouth can be caused by medications.
Medications commonly associated with dry mouth include: oxybutynin, tolterodine, duloxetine, quetiapine, bupropion, olanzapine, solifenacin, clozapine, fluoxetine, and venlafaxine.

Riga-Fede

Similar to Traumatic Ulcerative Granuloma with Stromal Eosinophilia (TUGSE) but occurs in children.

Recurrent Aphthous Stomatitis (RAS)

RAS lesions are round or ovoid.
RAS lesions have circumscribed margins.
RAS lesions have erythematous haloes.
RAS lesions present a yellow or grey base.
RAS lesions are found on non-keratinized and mobile mucosa.

RAS Epidemiology

RAS is common, frequently starting in childhood.
RAS often has a family history.
RAS tends to improve with age.
RAS presents a slightly higher prevalence in females.
RAS is prevalent worldwide, occurring most often in developed countries with higher socioeconomic status.

Differentiating RAS in Underlying Conditions

RAS usually appears clinically identical, regardless of an underlying condition.
Behçet disease and PFAPA (Periodic Fever, Aphthous Stomatitis, Pharyngitis, and Adenitis) can mimic RAS.

Systemic Involvement in RAS

RAS may be associated with systemic conditions.
Systemic conditions can be autoimmune, hematological, gastrointestinal, infectious, or neoplastic.
Systemic conditions associated with RAS include:
- Behçet syndrome
- Subepithelial immune blistering diseases
- Pemphigoid and variants
- Dermatitis herpetiformis
- Linear IgA disease
- Epidermolysis bullosa
- Erythema multiforme
- Lichen planus
- Pemphigus vulgaris
- Hematological disorders
- Anemia
- Gammopathies
- Hematinic Deficiencies
- Micronutrient Deficiencies
- Leukemia and myelodysplastic syndrome
- Neutropenia
- Cyclic neutropenia
- Other white cell dyscrasias
- Gastrointestinal disease
- Celiac disease
- Crohn’s disease
- Ulcerative colitis
- Giant cell arteritis
- Hypereosinophilic syndrome
- Lupus erythematosus
- Periarteritis nodosa
- Reiter’s syndrome
- Sweet’s syndrome
- PFAPA
- Sarcoidosis
- MAGIC
- Wegener’s granulomatosis
- Infectious mononucleosis
- Syphilis
- Tuberculosis
- Neoplasms of the salivary glands
- Metastatic neoplasms
- Kaposi sarcoma
- Oral Ulcers

Patient Understanding of Terminology

Many patients may not understand the terminology used in oral surgery and medicine.
Studies show that a significant number of patients misunderstand common terms.
Common terms that are often misunderstood include:
- Ulcer
- Impacted tooth
- Radiograph
- Sedation
- Biopsy
- Mucosa
- Benign

Oral Ulcer Types

Oral ulcers can be classified as either traumatic or immune-mediated.
Traumatic ulcers may also lead to squamous cell carcinoma.

An Approach to Oral Ulceration Flowchart

A flowchart is used to guide diagnosis and treatment of oral ulcers.
Factors to consider in the flowchart include:
- Immunocompromised Patient?
  - Transplants
  - Chemotherapy
  - T2DM - well controlled?
- Has the patient been unwell?
  - Malaise
  - Fever

Oral Ulcer Duration Considerations

Oral ulcers usually resolve within 2 weeks.
Oral ulcers that persist beyond two weeks may have an underlying cause.
An ulcer lasting more than two weeks is considered chronic.

Acute Traumatic Ulceration

Acute traumatic ulcers are usually solitary.
Causes may be difficult to determine in children.
Ulcers should resolve within two weeks if the trauma source is removed.

Chronic Traumatic Ulceration (TUG/TUGSE)

Chronic traumatic ulceration is known as Traumatic Ulcerative Granuloma with Stromal Eosinophilia (TUGSE).

TUGSE and Squamous Cell Carcinoma (SCC)

TUGSE can be misdiagnosed as an SCC.
Herpes zoster can present with oral ulcers.
Herpes zoster symptoms can mimic toothache before the rash appears.
Oral ulcers should not be attributed to toothache before a complete assessment.

Oral ulcers can be caused by medications.
Common drug classes that can lead to oral ulcers include:
- Antihypertensives
- Antidiabetics
- NSAIDs
- Methotrexate
- Allopurinol
- Amphotericin B

Oral ulcers can be a possible side effect of methotrexate therapy.

Mucositis (Chemoradiation)

Oral mucositis, a side effect of chemotherapy and radiation, damages the lining of the mouth.

Oral Ulceration - Direct Damage

Oral ulcers can result from direct damage to the oral mucosa.

Symblepharon

Symblepharon is a condition where the eyelid adheres to conjunctiva.

Red Flags in Oral Ulceration

Indurated oral ulcers are a concerning finding.
Persistent oral ulcers should be investigated.

Oral Ulceration Take Away Points

Diagnosing oral ulceration can be challenging.
The two-week rule is helpful for evaluating oral ulcers.
Even subtle oral ulcer pathology should be evaluated.

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Description

This quiz covers essential information about oral ulceration, including types, causes, and specific conditions such as recurrent aphthous stomatitis (RAS). Explore the characteristics, epidemiology, and medication-related issues regarding salivary gland hypofunction. Test your knowledge to enhance your understanding of these important oral health topics.