Oral Ulcers and Erosion Definitions
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Questions and Answers

What is a likely underlying cause of persistent multiple ulcers in the mouth?

  • Exposure to sharp objects
  • Mechanical factors like dentures
  • An underlying systemic disease (correct)
  • Inadequate oral hygiene

    • Which of the following is least likely to cause recurrent mouth ulcers?

  • Iatrogenic factors
  • Anaemia
  • Non-accidental injury (correct)
  • Thermal injury from hot food

    • Which dermatological condition is associated with recurring mouth ulcers?

  • Rosacea
  • Lichen planus (correct)
  • Eczema
  • Psoriasis

    • Which gastrointestinal condition is known to cause recurrent oral ulcers?

    <p>Inflammatory bowel disease</p> Signup and view all the answers

    What type of drug is associated with recurrent mouth ulcers as a side effect?

    <p>Methotrexate</p> Signup and view all the answers

    What characterizes an ulcer as defined in the content?

    <p>Area of total loss of epithelium</p> Signup and view all the answers

    Which of the following is classified as a persistent ulcer?

    <p>Chronic Infections like TB</p> Signup and view all the answers

    What is a potential cause of multiple recurrent ulcers?

    <p>Drugs</p> Signup and view all the answers

    What type of ulcer can mimic neoplastic ulcers?

    <p>Deep fungal ulcers</p> Signup and view all the answers

    Which aspect is NOT a principle of diagnosis for oral ulceration?

    <p>Surgical intervention</p> Signup and view all the answers

    How can social history contribute to the diagnosis of oral ulcers?

    <p>Dietary habits and smoking status</p> Signup and view all the answers

    What is an example of a drug that is linked to the development of deep ulcers?

    <p>Nicorandil</p> Signup and view all the answers

    Which condition is not classified under single ulcers?

    <p>Chronic Infections</p> Signup and view all the answers

    What is the most common cause of a persistent single ulcer?

    <p>Trauma</p> Signup and view all the answers

    Which factor significantly increases the risk of oral malignancy?

    <p>Age</p> Signup and view all the answers

    Which of these conditions is least likely to cause a recurrent single ulcer?

    <p>Oral malignancy</p> Signup and view all the answers

    What metric is NOT relevant to understanding a patient's ulcer history?

    <p>Favorite color</p> Signup and view all the answers

    Which of the following best describes a common presentation of fungal infections that cause oral ulcers?

    <p>Multiple self-limiting ulcers with systemic features</p> Signup and view all the answers

    What kind of lifestyle factors can influence ulcer development related to menstruation?

    <p>Smoking and alcohol consumption</p> Signup and view all the answers

    Which of these is a characteristic feature of malignant ulcers?

    <p>Very deep ulcers with an injurated edge</p> Signup and view all the answers

    What can indicate a history of trauma in a patient's ulcer profile?

    <p>Irregular ulcer shape that grew over time</p> Signup and view all the answers

    Which oral condition is most likely to present with systemic features such as fever and malaise?

    <p>Multiple self-limiting ulcers</p> Signup and view all the answers

    Which behavior greatly increases the risk factor for developing oral malignancies?

    <p>Smoking and excessive alcohol use</p> Signup and view all the answers

    What is the estimated prevalence of lichen planus?

    <p>0.5-2%</p> Signup and view all the answers

    Which condition is most commonly associated with oral ulceration?

    <p>Lichen planus</p> Signup and view all the answers

    Which demographic is more likely to develop lichen planus?

    <p>Females aged 30-60 years</p> Signup and view all the answers

    What is a characteristic feature of lichen planus?

    <p>White patches</p> Signup and view all the answers

    Cyclical neutropenia leads to which oral condition?

    <p>Persistent oral ulcers</p> Signup and view all the answers

    Which gastrointestinal disease is known for causing oral ulceration?

    <p>Crohn's disease</p> Signup and view all the answers

    Which condition does NOT typically present with oral ulcers?

    <p>Tension headache</p> Signup and view all the answers

    What is a sign of Vitamin C deficiency in the oral cavity?

    <p>Red and swollen gingivae</p> Signup and view all the answers

    What medication or material can be associated with oral lichenoid lesions?

    <p>Amalgams</p> Signup and view all the answers

    Which of these conditions is classified as a haematological disease associated with oral lesions?

    <p>Chronic myeloid leukaemia</p> Signup and view all the answers

    Which vitamin deficiency is associated with spontaneous bleeding of the gingivae?

    <p>Vitamin C</p> Signup and view all the answers

    What is a common clinical feature of acute lupus affecting the oral cavity?

    <p>Erythemato-purpuric macules</p> Signup and view all the answers

    Which of the following best describes herpetiform ulcers?

    <p>Multiple small ulcers occurring together</p> Signup and view all the answers

    What is a notable clinical feature of recurrent aphthous stomatitis (RAS)?

    <p>Includes minor, major, and herpetiform types</p> Signup and view all the answers

    Which condition commonly causes oral and genital ulcers and is often confused with others?

    <p>Behçet's disease</p> Signup and view all the answers

    What is the relation between single persistent ulcers and oral cancer?

    <p>They are unlikely to be malignant.</p> Signup and view all the answers

    What role does the general dental practitioner (GDP) have in identifying ulcers?

    <p>To decide whether to treat, not treat, or refer</p> Signup and view all the answers

    What distinguishes discoid lupus lesions from lichen planus lesions in the oral cavity?

    <p>They often occur on uncommon sites like the palate.</p> Signup and view all the answers

    Study Notes

    Definitions

    • Erosion - Skin or mucous membrane loss not reaching the basement membrane
    • Excoriation - Scratch mark with intact base of the mucous membrane/epidermis
    • Ulcer - Complete loss of epithelium, reaching underlying connective tissue

    Classification of Oral Ulcers

    • Single ulcers:
      • Recurrent - trauma, aphthous stomatitis, herpes
      • Persistent - neoplasms, trauma, TUGSE, infections, drugs
    • Multiple ulcers:
      • Recurrent - aphthous stomatitis, erythema multiforme, recurrent herpes
      • Persistent - dermatological conditions (lichen planus and vesiculobullous conditions), drugs
    • Ulcers mimicing neoplastic ones: Deep fungal ulcers, syphilitic ulcers, drug-related ulcers (e.g. nicorandil)

    Key Points for Diagnosis

    • History
      • Presentation: appearance and patient's interpretation
      • History of presentation: recurrence, cause
      • Medical History: new medications
      • Social history: diet, smoking
      • Review of systems: underlying disease e.g. Lupus

    Features of Ulcer History

    • Age of onset
    • Duration - time to heal
    • Frequency of attacks - duration of healing and ulcer-free periods
    • Site - common and unaffected areas
    • Size - growth
    • Shape
      • Oval or irregular
      • Coalescence: do multiple smaller ulcers combine to form one larger ulcer?
    • Prodrome - does the patient feel the ulcer developing?
    • Relation to menstruation or smoking
    • Change in degree of ulceration over time
    • Synchronous/Asynchronous: do ulcers heal one at a time, or overlap?

    Risk Factors for Oral Malignancy

    • Age (older = higher risk)
    • Other malignant diseases
    • Smoking (risk x10)
    • Alcohol (risk x4; threshold 14 units/week)
    • Smoking + Alcohol (risk x40)
    • Areca nut/Betel nut chewing
    • UV radiation (lip cancer)
    • Potentially malignant oral epithelial lesions

    Examination

    • Establish a routine, systematic approach
    • Extra Oral
      • Lymphadenopathy
      • Skin and ocular changes
      • General appearance (well or unwell)
    • Intra Oral
      • Soft tissues: all mucosal surfaces, typically before teeth
      • Two mirrors to reflect buccal mucosae and lips
      • Pay special attention to the retro-molar fossa and posterior lingual aspects of the tongue

    Persistent Single Ulcer

    Trauma

    Most common cause of a single ulcer

    • Mechanical: sharp tooth, appliances, non-accidental injury, self-inflicted, iatrogenic
    • Thermal: hot/cold
    • Chemical: e.g., aspirin sucking
    • Radiation
    • Electric current

    Infection

    • Mostly multiple and self-limiting, with systemic features (fever, malaise)
    • Bacterial
      • Tuberculosis (Mycobacterium Tuberculosis)
      • Syphilis (Treponema pallidum)
    • Fungal (deep mycosis) usually requires further investigation and history of travel

    Drug Reaction

    • Often multiple ulcers/erosions (but can be single, more likely to be associated with chemical burn)
    • Patients may recall a timeline
    • Most common example: Aspirin
    • Other medicines causing ulcers:
      • Methotrexate: multiple ulcers
      • Nicorandil: single, large, deep ulcers

    Malignant Ulceration

    • Range of neoplasms present with oral ulcers, very deep with injured edge
    • Most are oral squamous cell carcinomas
    • Rare causes:
      • Haematological malignancies (mainly lymphoma)
      • Salivary gland neoplasms
      • Sarcoma (rare)
      • Metastatic disease (lymph nodes or bone, rarely gingiva)

    Recurrent Single Ulcer

    Similar to persistent single ulcers, but excluding oral malignancy

    • Mechanical
      • Sharp tooth or restoration
      • Appliances
      • Non-accidental injury
      • Self-inflicted (e.g., toothbrush)
      • Iatrogenic (unlikely to be recurrent)
    • Thermal: hot/cold (if recurring with specific foods)
    • Chemical: Aspirin (unlikely to be multiple sites)
    • Radiation (if multiple sites of radiation therapy)
    • Electric
    • Infective

    Persistent Multiple Ulcers

    • Typically secondary to underlying systemic disease
    • Secondary to Dermatological:
      • Lichen Planus
      • Immunobullous conditions (Pemphigus & Pemphigoid)
    • Secondary to Gastrointestinal:
      • Inflammatory Bowel Disease: Crohn's & Ulcerative Colitis
    • Secondary to Haematological disorders:
      • Anemia
      • (Haematological) Malignancy
    • Secondary to Connective tissue disease:
      • Lupus (especially during flare)
    • Secondary to Drugs:
      • Methotrexate

    Oral Ulceration Secondary to Dermatological Conditions

    • Lichen planus (most common)
    • Mucous Membrane Pemphigoid / Bullous Pemphigoid
    • Linear IgA Disease / Dermatitis Herpetiformis
    • Pemphigus
    • Erythema Multiforme
    • Epidermolysis Bullosa

    Lichen Planus

    Key features:

    • Chronic mucocutaneous disease of unknown etiology
    • Autoimmune, cell-mediated immunological reaction
    • Prevalence: 0.5-2%
    • Female: Male ratio 2:1
    • Onset: 30-60 years old
    • Range of clinical appearances with characteristic histology
      • White patches
      • Ulcers (usually in buccal sulcus)

    Oral Lichenoid Lesions

    • Subtle clinical and histopathological differences from lichen planus
    • Associated with numerous medications and dental materials (amalgams)

    Secondary to Gastrointestinal Enteropathy

    • Inflammatory Bowel Disease
      • Crohn's disease
      • Ulcerative Colitis
    • Warning signs/symptoms:
      • Change in bowel habit
      • Dyspepsia (indigestion)
      • Rectal bleeds/occult blood

    Oral Ulceration Secondary to Haematological Disease

    • Haematinic deficiency (iron, vitamin B12, etc.)
    • Cyclical Neutropenia
    • Leukaemia

    Oral Ulceration Secondary to Connective Tissue Disease

    • Acute lupus
      • Erythemato-purpuric macules
      • Palatal erythema
      • Petechiae
      • Ulceration
    • Chronic (discoid lesions)
      • Atrophic or ulcerated round lesions with peripheral keratotic striae
      • Linear ulcers with keratotic striae
      • Palatal discoid lesions

    Recurrent Multiple Ulcers

    • Recurrent Oral Ulcers (ROU)
      • Recurrent Aphthous Stomatitis (RAS)
        • Minor
        • Major
        • Herpetiform
      • Ulcers related to smoking cessation
      • Behcet's disease
      • PFAPA syndrome (Periodic Fever, Aphthous Stomatitis, Pharyngitis, Adenitis)
      • Recurrent Erythema Multiforme
      • Idiopathic

    Major Roles for the General Dental Practitioner (GDP)

    • Identify ulcers requiring treatment and referral
    • Screen for Malignant and Potentially Malignant Disease
      • Oral Squamous Cell Carcinoma - Early detection improves survival rates and reduces need for radical surgery
    • Establish provisional diagnosis
    • Decide to treat, not treat, or refer (all potential malignancies referred via 2-week wait pathway)
    • Prescribe correct drugs/therapies

    Note:

    Oral cancers fall under the category of single persistent ulcers. If the ulcer comes and goes, it is unlikely to be an oral cancer.

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    Related Documents

    Oral Ulceration Lecture 3 PDF

    Description

    Test your knowledge on the definitions and classifications of oral ulcers. This quiz covers various types of ulcers, their characteristics, and key points for diagnosis, including patient history and potential causes. Improve your understanding of oral health issues and diagnostic criteria.

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