Makindo Medical Notes.com

Persisting oral ulcers lasting more than several weeks need referring to exclude malignancy

About

• Relatively common 10-20% of population
• Often recurrent and usually benign
• Probably commoner in females

Aetiology

• Probably commoner in females
• Immune dysregulation
• All age groups from infants to adults
• No conclusive evidence of infective/viral cause

Associations

• Trauma from Poorly fitting Dentures
• Iron deficiency
• Vitamin deficiencies
• Malnutrition
• Stressful events
• Perimenstrual
• Crohn's disease
• Lichen planus
• Erythema multiforme
• Coeliac disease
• Systemic Lupus erythematosus
• HIV infection
• Behcet's disease - Middle Eastern/Asian/Japan
• Drugs - Nicorandil

Clinical

• Painful shallow ulcers on the tongue or oral mucosa
• Self-limiting and heal within 1-2 weeks
• Ask about genital ulcers

Simple Classification

• Minor ulcers: Commonest. Small yellow and oval and less than 10 mm across. Mild pain involved. Heal without evidence of scarring
• Major ulcers less common. It is larger than 10 mm in diameter and can take months to heal and cause severe pain limiting dietary intake. These can scar.
• Herpetiform ulcers are uncommon. They are very small ulcers that may be multiple and coalesce. Not caused by herpes virus. Healing over weeks/months.

Investigations

• Investigations warranted where systemic disease suspected
• Consider FBC, ESR, Folate, Ferritin, B12, Glucose
• HIV test where indicated
• Anti-endomysial for Coeliac disease

Management

• Avoid irritant foods likely to exacerbate pain e.g. hot or spicy foods, toast and hard or abrasive foods. Soft foods. Soft toothbrushes.
• Chlorhexidine mouthwash used twice a day (brand name Corsodyl or Chlorohex) may reduce the pain and help to heal. Can cause staining of teeth especially after coffee/tea.
• Hydrocortisone lozenges may help symptoms and healing. The patient can use the tongue to keep the lozenge in contact with an ulcer as it dissolves. Can 'stop' the ulcer if used early enough.
• Analgesic agents can help to reduce pain. Consider Difflam or choline salicylate gel (brand name Bonjela). Note it contains Aspirin and should not be given to under 16s
• Severe cases require Colchicine, Oral Prednisone or even Azathioprine. Thalidomide has been used.