Oral ulceration (Assessment of) – Overview – Aetiology – Best Practice

Oral ulceration (Assessment of) - Overview - Aetiology - Best Practice

Aphtha is painful ulcerous lesions surrounded by pale yellow-red halo which occur in the mouth commonly in cheek and lip mucosa, sometimes on the tongue, on the soft palate, in the pharynx, gingiva etc. One day after the blisters appeared, a nonpruritic, bilateral rash developed on his palms and soles. Though similar, fever blisters and canker sores have important differences.What Are Fever Blisters? Which one of the following is the best diagnosis? Since the treatment and cause of these two sores are completely different, it is extremely important to know which is which. Fever blisters are usually painful; pain may precede the appearance of the lesion by a few days. Fever, sunburn, trauma, hormonal changes or emotional upset can trigger their appearance.

He also had coalescing erosions on his lower lip and numerous tender linear fissures in a cross-hatched pattern on the dorsum of his tongue. The most likely diagnosis is an adverse drug reaction to carbamazepine. Occasionally we can see this condition of geographic tongue in areas that are not the tongue at all. The diagnosis is primarily clinical by the characteristic distribution of cutaneous lesions over hands, feet and buttocks along with oral lesions. Rarely, herpes simplex virus type 2 (HSV-2) may cause primary infection of the oral cavity, typically in association with orogenital sex, but recurrent oral HSV-2 disease is rare. Iron deficiency can contribute to impaired immune function and epithelial abnormality. Trauma: biting cheek, lip and tongue, damage from tough foods and tough tooth brushing, wounds of improper prostheses provide a basis for aphtha.

Iron deficiency in males is uncommon and, if present, suggests occult bleeding (e.g., bleeding ulcer, gastrointestinal [GI] malignancy). How Are Fever Blisters Treated? Constitutional signs and symptoms of pallor, fatigue, malaise, shortness of breath, tachycardia, headache, and irritability may be present. Contact your doctor or dentist for the latest information. Eighty percent of the U.S. These mouth sores are most often seen in tobacco users. A viral culture taken from the dorsal fissures grew HSV type 1.

Folate deficiency is usually caused by dietary lack, while vitamin B12 deficiency is usually caused by parietal cell antibodies that block B12 absorption (pernicious anaemia). We can see them in the roof of the mouth or we can see them in the lower jaw. While folate supplementation may improve the macrocytosis associated with either deficiency, it will not address neurological pathology associated with pernicious anaemia. The herpes simplex virus-1 (HSV-1) causes oral herpes; both HSV-1 and herpes simplex virus-2 (HSV-2) cause genital herpes. Patients with vitamin C deficiency may present with gingival oedema, bleeding, ulcerations, secondary bacterial infections in the mouth, and loosening of the teeth. Repetitive lesions are leaned towards developing in the same site. Oral ulcerations can be a manifestation of several dermatological diseases.

A topical corticosteroid preparation such as triamcinolone dental paste (Kenalog in Orabase 0.1%) is helpful. These ulcers tend to be chronic, and recognition should lead to appropriate referral and treatment. The more commonly encountered conditions include oral lichen planus, pemphigus vulgaris, and mucous membrane pemphigoid. Leukoplakia—A thick, whitish-color patch that forms on the inside of the cheeks, gums, or tongue. Immunofluorescence is important in diagnosing autoimmune bullous skin disorders. At that time, her tongue was free of pain and the fissure had almost healed. Occurrence of oral lesions without concurrent skin lesions is fairly common, affecting about 15% to 35% of cases.

Herpes is a viral infection that can occur in the mouth. While people of any age may be affected, middle age is the most common. Herpes simplex viruses (HSVs) cause raised and oozing sores or blisters. Multiple bilateral and symmetrical lesions may manifest as a singular or variable mix of reticular (line, papule, plaques), erosive, or ulcerative lesions. Typical lacey white striations (Wickham’s striae) are usually present. Purely reticular presentations are often asymptomatic and discovered incidentally during routine examination. Leukoplakia can progress to cancer.

Oral ulceration (Assessment of) - Overview - Aetiology - Best Practice
Pemphigus: a group of autoimmune blistering diseases. Pemphigus vulgaris (PV) and paraneoplastic pemphigus can involve the skin and mucosal surfaces of the mouth, eyes, nasopharynx, and oesophagus. Other than the lips, the most common areas for oral cancer to develop are on the tongue and the floor of the mouth. It has no gender predilection, and the typical age of onset is 40 to 60 years. When the tongue is involved, the lateral surface is usually affected4. About 90% of cases manifest with chronic oral ulcerations, with areas often subjected to trauma (e.g., buccal mucosa, tongue, palate) being the most commonly affected. Now let’s take a look, a little bit, at the recurrent lesions.

The typical oral lesion appears as a painful erosion/ulcer with an irregular border of necrotic epithelium and is partially covered by a fragile membrane. Herpes simplex virus (HSV) commonly causes infections of the skin and mucous membranes. The Nikolsky sign tends to be positive (i.e., slight rubbing of the skin exfoliates the outermost layer). Concurrent skin or eye lesions, as well as lesions in the nasopharynx and oesophagus, may be present. Two autoantibodies are associated with PV, and their relative amounts determine the clinical phenotype of the disease. Reduce stress. Paraneoplastic pemphigus is the least common, but most serious, form of pemphigus.

Most cases occur in patients who have already developed cancer. Clinical features include acute or chronic mouth sores (flaccid bullae, irregular erosions, ulcerations) commonly located on the gingiva, buccal mucosa, tongue, and palate; ocular symptoms (conjunctivitis, symblephara); and concurrent skin lesions. Mucous membrane pemphigoid (MMP): one of a group of uncommon, immune-mediated sub-epithelial blistering diseases. Autoantibodies to BP180 and BP230 are associated with MMP. It has an annual incidence of 50 to 83 per million population. There is a distinct female-to-male predilection, and the age of onset is 51 to 62 years. MMP primarily involves the oral cavity and conjunctiva.

Initial redness, swelling, heat, and pain, or itching in the area where the infection will erupt. The most frequent presentation of MMP in the mouth is desquamative gingivitis (the gingiva has a friable, fiery red, atrophic appearance). The Nikolsky sign tends to be positive. Linear IgA bullous dermatosis: an uncommon, immune-mediated sub-epithelial blistering disease that usually occurs in children aged 60 years. Pruritic papules, vesicles, and bullae are typically distributed symmetrically over the trunk and extremities. The lesions characteristically resemble a string of pearls (an urticarial plaque surrounded by vesicles). Mucosal involvement is typically found in the oral cavity and conjunctiva.

Epidermolysis bullosa acquisita: an immune-mediated sub-epithelial blistering disease with a similar clinical appearance to MMP. Patients have tense blisters and fragile skin, and may have scarring. Progressive and recurrent disease in mucosal tissues can result in irreversible complications including blindness, ankyloglossia (tongue-tie), and oesophageal strictures. Chronic ulcerative stomatitis: a rare, mucocutaneous disorder with predominant oral involvement of the tongue, buccal mucosa, and gingiva. It is histologically similar to lichen planus and may have a similar clinical presentation. There is a distinct female-to-male predilection, and it is most common in the fifth and sixth decades of life. These places are the most common, but sores can appear anywhere on the body, including the genital area.

Patients have a characteristic positive response to hydroxychloroquine therapy. Contact stomatitis: caused by a variety of topical agents including oral hygiene products, foods, and additives. Commonly implicated drugs include barbiturates, lidocaine, gold salts, chlorhexidine, penicillamine, salicylates, and sulfonamides. It typically presents with a single isolated ulcer located on the side of the tongue surrounded by an erythematous halo and is resistant to usual treatments. The prevalence is unknown. Removal of the offending agent resolves the ulcerative lesions. Oral lichenoid reaction: the number of agents with the potential to cause these ulcerations is extensive and includes dental restorative materials, flavouring agents, and several drugs (the most frequently implicated are non-steroidal anti-inflammatory drugs [NSAIDs] and angiotensin-converting enzyme [ACE] inhibitors).

Drug-related lesions are often mucocutaneous in distribution and resemble lichen planus. Oral lichenoid reaction lesions associated with restorative materials tend to present as an isolated area of involvement near the offending material (e.g., the buccal and/or gingival mucosa in proximity to an amalgam restoration). It may take several months to resolve once the offending agent is removed, which complicates the diagnosis. Anti-resorptive agent-induced osteonecrosis of the jaw (ARONJ): a destructive oral condition manifesting with oral mucosal ulceration and osseous exposure in a patient with past or ongoing exposure to bone-preserving drugs (e.g., bisphosphonate class of drugs and denosumab). Antecedent intra-oral trauma (e.g., dentoalveolar surgery) is noted in most cases. Anti-resorptive drug uncoupling of the osteoclast-osteoblast balance likely contributes to the aetiopathogenesis of ARONJ. Those at highest risk include oncology patients exposed to prolonged dosing of the most powerful nitrogen-containing bisphosphonate regimens.

Patients exposed to low-dose anti-resorptive drug (e.g., osteoporosis prevention) are at much lower risk for ARONJ. Pain is a common presenting complaint. Therapeutic options are limited and focused on eliminating pain, controlling infection, and minimising further disease progression. Chemicals/medications: these may include oral rinses, topical medications, or disinfectants. Patients undergoing cancer chemotherapy that adversely affects normal proliferation and repair of mucosal tissues may experience ulcerations. Commonly involved medications are: alkylating agents, antimetabolites that affect DNA synthesis, anthracyclines, platinum-based agents, vinca alkaloids, and taxanes.

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