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Title: Oral Ulceration
Description: BDS3/4 level excellent Oral Medicine Notes from a Distinction-level student at King's College London Dental Institute. Notes are colourful, well-structured with images, tables and diagrams throughout. Detail is summarised into bullet points and short sentences with key terms etc.
Description: BDS3/4 level excellent Oral Medicine Notes from a Distinction-level student at King's College London Dental Institute. Notes are colourful, well-structured with images, tables and diagrams throughout. Detail is summarised into bullet points and short sentences with key terms etc.
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Oral Ulceration
Mucosal Terminology
• Erosion: Area of partial loss of skin or mucous membrane – breach of
epithelium
...
• Atrophy: Loss of thickness – thinning, no crater formation
...
• Excoriation: Scratch marks which has scored the epidermis – not an ulcer, don’t
get a crater
...
• Vesicle: Small blister (e
...
Herpes Simplex)
...
• Identify those ulcers which require treating and those that require referring
...
o Early detection: improves survival rates and reduces the need for radical surgery
...
• Examination
...
• Special investigations
...
Establish Diagnosis of Ulcer
• HPC: History of Present Complaint
...
• SH: Social History
...
• Systems Review: GIS, GUS, LMS, Skin
...
• Special Investigations
...
• Frequency of attacks
...
• Site-common and those never affected
...
• Shape
...
• Prodrome – early symptom
...
g
...
• Change in degree of ulceration over time
...
Relevant History – Pertinent to a Potential Carcinoma
• Age
...
• Smoking – pack years = number of packs per week x number of years smoked (risk x10)
...
• Smoking and alcohol – risk x40
...
Examination – Intra-Oral Mucosa
• Before examining teeth
...
• Include all mucosal surfaces
...
• Pay special attention to the retromolar fossa and posterior lingual aspects of the tongue
...
o Related to systemic disease
...
• Aphthous stomatitis is a specific diagnosis not just any ‘recurrent oral ulcers’
...
Classification
• Solitary
...
• Single bout of widespread
...
Classification of Oral Ulcers
• Recurrent ulceration
...
• Single episode of ulceration
...
Classification of Oral Ulceration
RECURRENT ORAL ULCERS (ROU)
• Recurrent Aphthous Stomatitis
...
RECURRENT/PERSISTENT ULCERATION
• 2° to Haematological disorders
...
• 2° to Dermatological conditions
...
• Traumatic – very common example, ulcer caused by sharp
cusp
• Drug reaction
...
Recurrent Ulceration
• Recurrent Aphthous Ulcers
...
• Smoking related to Aphthous Ulcers
...
• Recurrent Erythema Multiforme
...
• Gastrointestinal – bleeding disorders, diet, iron-deficiency?
• Dermatological
• Connective Tissue Disease
Oral Ulceration 2° to Haematological Disorders
• Warning signs/symptoms
...
o Heavy menstrual periods
...
o Rectal bleeding/occult blood
...
– determine underlying
anemia), B12, Folate, Ferritin
...
• Leukaemia
• Other deficiencies
...
o Change in Bowel Habit (COBH) – Diarrohea
...
o Rectal bleeds/occult blood
...
• Inflammatory Bowel Disease
...
o Ulcerative Colitis
...
2
...
Oral Ulceration Secondary to Dermatological Condition
• Lichen Planus – white striations, can get an ulcerative form of LP
...
•
•
•
•
Linear Ig A disease/Dermatitis
Herpetiformis
...
Erythema multiforme
...
Persistent Ulceration Related to Systemic Diseases:
1
...
• (Ferritin, Folate, B12)
...
• Blood transfusion reaction
...
2° to Connective Tissue Disease
• Warning signs/symptoms
o Joint pain
...
o Family history
...
• Reiters Syndrome
...
o Rheumatoid Arthritis
...
• Arthus Reaction
...
g
...
• Infective
o Viral (e
...
Herpes – may also be recurrent)
...
o Tuberculous
...
• Neoplastic (cancer)
Single Episode Ulceration
• Single or multiple ulcers?
• Single episode, persistent = WARNING
...
• Medical history
...
• Medical history – drugs
...
• Chemical
o Aspirin
Malignant Ulceration
• Squamous Cell Carcinoma
...
• Leukaemia
...
• Kaposi’s Sarcoma
...
• Recurrent Oral Ulcers (ROU)
o Recurrent Aphthous Stomatitis
...
• Recurrent Persistent Ulceration
o 2° to Haematological disorders
...
o 2° to Dermatological conditions
...
o Traumatic – very common example, ulcer caused by sharp cusp
o Drug reaction
...
• Provisional diagnosis
...
• Decision to treat, not to treat or to refer
...
• Assessment of response
...
Lichenoid
Reaction
Title: Oral Ulceration
Description: BDS3/4 level excellent Oral Medicine Notes from a Distinction-level student at King's College London Dental Institute. Notes are colourful, well-structured with images, tables and diagrams throughout. Detail is summarised into bullet points and short sentences with key terms etc.
Description: BDS3/4 level excellent Oral Medicine Notes from a Distinction-level student at King's College London Dental Institute. Notes are colourful, well-structured with images, tables and diagrams throughout. Detail is summarised into bullet points and short sentences with key terms etc.