Oral ulceration

Oral Ulceration

By:
Dr. Ahmed Salih KhudhurBDS, MSc, PhD Newcastle University/ UK
دكتور احمد صالح خضر

UNIVERSITY OF MOSUL

COLLEGE OF DENTISTRY
2020-2021
Department of Oral and Maxillofacial Surgery
Department of:
HERE


Introduction
•

How to Examine an Ulcer

•

How to Examine an Ulcer

•

How to Examine an Ulcer

While examining a patient with an oral ulcer, ask about the following:


History of the ulcer:
1. According to the patient’s chief complain, is the ulcer painful?
2. According to the patient’s chief complain, does the patient know the duration? or was it noticed by another clinician who referred the patient to you?
3. Can the patient recall any possible cause?
4. Recurrent or not?

Past dental history?

Medical history?

Family history?

Social history?

How to Examine an Ulcer

While examining a patient with an oral ulcer, inspect the following:
Location (position)
Number
Size and shape
Color
Edge and floor
Surrounding area
Tender to palpation?
Base: Relation to the underlying structures? (Loose, Firm or Fixed/ Indurated)
Regional lymph nodes


If necessary and to exclude a disease/ condition (differential diagnosis) or to confirm the diagnosis, you may send the patient for investigations such as:
# Biopsy # Microbiological & Immunological tests # Haematological tests
# Imaging (MRI, CT scan, CBCT, PET scan…) # Further investigations…..
PET scan: positron emission tomography

Classification of Oral Ulceration

Ulcers divided clinically

Persistent Recurrent

Which is a useful first step in differential diagnosis

Most oral ulcers heal after a few days to 2 weeks (maximum duration) depending on their size and location, more rapidly on the floor of mouth or buccal mucosa (non-keratinized mucosa) than on the palate or gingivae (Keratinized mucosa).

Recurrent oral ulcers recur singly or in groups at the same or different sites.

It is important to distinguish recurrent oral ulceration which has a few causes, from recurrent aphthous ulceration (RAU/RAS) which is a specific ulcer (condition).

Classification of Oral Ulceration

Ulcers can be According to Number

Primary Secondary Single Multiple

• Other classification according to etiology:
• Traumatic
• 2. Infective
Acute infection such as: Acute necrotizing ulcerative gingivitis & Noma
Chronic infection such as: Tuberculosis, Syphilis, Histoplasmosis
Viral infections such as: Herpes viruses

• 3. Miscellaneous causes ( RAS/RAU, Behçet’s disease, IBD, Cyc. N, EM, SJS/TEN, Oral mucositis, Pemphigus & MMP, Oral cancer, ulcers associated with oral & systemic diseases

Classification of Oral Ulceration

• Important causes of oral mucosal ulcers

• Vesicular-bullous diseases

• Ulceration without preceding vesiculation
• Infectious
• Primary herpetic stomatitis
• Herpes labialis
• Herpes zoster and chickenpox
• Hand-foot-and-mouth disease
• Herpangina
• Measles
• Glandular fever
• Tuberculosis
• Syphilis
• Non-infectious
• Pemphigus vulgaris
• Mucous membrane pemphigoid
• Linear IgA disease
• Dermatitis herpetiformis
• Bullous erythema multiforme
• Traumatic
• Aphthous stomatitis
• Behçet’s disease
• HIV-associated mucosal ulcers
• Lichen planus
• Lupus erythematosus
• Eosinophilic ulceration
• Wegener’s granulomatosis
• Some mucosal drug reactions
• Carcinoma


THE END

UNIVERSITY OF MOSUL

COLLEGE OF DENTISTRY
2020-2021