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Oral Ulceration - Coggle Diagram
Oral Ulceration
Iatrogenic - Drug Induced
Methotrexate
Taken daily as chemotherapy regime
Mucositis
taken weekly for autoimmune conditions e.g. Rheumatoid Arthritis
Oral ulceration (10-17%)
Risk of Oral Ulceration
errors in dosing regime
no/insufficient folate supplementation
myelosuppression
reduced excretion due to already reduced renal failure
reduced excretion due to drug interactions (NSAID)
increased anti-folate effect due to drug interactions
Nicorandil
potassium channel activator for second line prophylaxis of stable angina
Presentation
Present 4-36 months after start of tx
large deep persistent ulcers
unresponsive to tx except nicorandil cessatino
NSAIDS
Bisphosphonates
Extensive, superficial ulceration
Due to inadequate indigestion of oral tablets
Management
Liase with GMP
Referral for diagnosis
Topical analgesia
Traumatic
Types
physical
chemical
thermal
Management
eliminate suspected source of trauma and review 10-14 days
if no improvement referral
Infective
Bacterial
Viral
Idiopathic - Recurrent Apthopthous Ulceration
Recurrent ulceration confined to the mouth in the absence of systemic disease
Epidemiology
F>M
Non-smoker
High socio-economic class
white
Aeitology
- unclear but linked to
stress
menstrual cycyle
hypersensitivity to foods
smoking cessation
drug history
family history
Types
Minor
small ulcers (8-10mm) appear over non-keratinsed mucosa
Major
perseient deep ulcers
Herpetic
multiple small ulcers which coarse to form one large ulcer
Management
Identify any underlying cause
referral for management of underlying cause
explanation of diagnosis
Reilf of Symptoms
Benzydamine Hydrochloride 0.15% MW (Difflam)
Lidocaine Ointment (5%)
Lidocaine Spray (10%)
Control of Ulceration
SLS free toothpaste
Hydrocortisone oromucosal tablets 2.5mg
Betamethasone soluble tables 500mg as MW
Clenin Modulite 50mg (Belcometasone)
Dispersible doxycycline as MW
CHX as MW
Autoimmune
due to auto-antibodies targeting components of the epithelium or basement membrane
mucous membrane pemphigoid
pemphigus vulgaris
Neoplastic
Squamous cell carcinoma