If you are concerned that you suffer from any of these conditions please see your DOCTOR or DENTIST who will assess you.
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Oral Ulceration

CAUSES

Traumatic : mechanical, chemical, thermal, radiation

Infective : bacterial, viral, fungal

Idiopathic : recurrent oral ulceration (minor, major, and herpetiform)

Associated with systemic disease : haematological and gastrointestinal diseases

Associated with dermatological diseases : lichen planus, vesiculobullous diseases

Traumatic ulceration of the tongue

Major aphthous ulceration of the soft palate

Major aphthous ulceration of the lip

Herpetiform ulceration of the hard palate

Erythema multiforme (blood encrusted and ulcerated lips)

Recurrent ulceration is by far the most common type of ulceration encountered in general practice. The vast majority of ulcers are benign but those that persist for more than 2 weeks in the absence of trauma should raise suspicion of malignancy and warrant biopsy. Crops of minor aphthous ulcers are also common (affecting up to one third of the population) but they are small and shallow and occur 2-5 at a time, mainly on the lips, tongue or cheeks.

TREATMENT

Reassurance

•   Remove any cause e.g. sharp tooth
•   Good oral hygiene
•   Symptomatic relief e.g. chlorhexidine mouthwash, Difflam mouthwash and lignocaine gel

 

Other treatments include topical and systemic steroids and very rarely thalidomide (prescribed on a named-patient-only basis) but these should be administered under specialist supervision only.

Ulcers that should be referred to a specialist include:

• All cases of erythema multiforme, herpetiform and major aphthous ulceration
• Those with severe minor aphthae: continuous ulcers or ulcer-free periods of only a few weeks, or > 10 crops of ulcers, ulcers which are associated with prolonged healing (>14 days)
• Those with any suggestion of underlying anaemia, bowel disease or skin, joint or eye abnormalities consistent with Bechet's syndrome.
• Ulceration which does not neatly fit into a diagnostic category.

Mucous membrane pemphigoid

AETIOLOGY

Unclear, usually affects middle aged females.

PRESENTATION

Oral lesions on the palate and gingivae consisting of blood filled blisters that last for several days which are followed by persistent irregular erosions or ulcers once the blisters have burst.

Desquamative gingivitis is common.

MANAGEMENT

Diagnosis is confirmed by biopsy/immunofluorescence.

• Most patients respond well be topical corticosteroid therapy.
• More severe cases require systemic treatment.
• Ophthalmic involvement may be necessary if there is ocular involvement. .

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