Oral problems. Mouth Ulcer and Cold sore. Lec-2

Transcription

1 Oral problems Mouth Ulcer and Cold sore Lec-2 By: Dr.Khanda Taifwr 1

2 Mouth ulcers Mouth ulcers are extremely common, and are a recurrent problem in some people. Common sites are the tongue margin and inside the lips and cheeks. Most cases are minor aphthous ulcers, which are selflimiting. 2

3 The three main types of aphthous ulcers are. Minor Major Herpetiform 3

4 causes 40% of people have a family history of oral ulceration. Causes may includes 1. Infection 2. Trauma such as biting the inside of the cheek while chewing food, dentures may produce ulceration 3. Drug allergy 4. In women, it often precede the start of the menstrual period. 5. Stress and emotional factors 6. Deficiency of iron, folate, zinc or vitamin B12. 4

5 Clinical features of minor aphthous ulcers The ulcers are 1. roundish, grey-white in colour 2. They are small usually less than 1 cm in diameter 3. Pain is the key presenting symptom and can make eating and drinking difficult, although pain subsides after 3 or 4 days. 4. They occur singly or in small crops of up to five ulcers. 5. It normally takes 7 to 14 days for the ulcers to heal. 5

6 What you need to know: Age: Minor aphthous ulcers are more common in women and occur most often between the ages of 10 and 40 years. Nature of the ulcer Duration: Minor heal in less than 1week. Major take longer (10 30 days). Herpetiform ulcers; the patients think that the ulceration is continuous. 6

7 Minor aphthous ulcers 7

8 Major aphthous ulcer Herpetiform ulcers 8

9 What you need to know: Previous history: There is often a family history of mouth ulcers Episodes of ulceration generally recur after 1 4 months. Symptoms: 9

10 Medications that induce mouth ulcers 1. Aspirin and other non-steroidal anti-inflammatory drugs (NSAIDs) 2. Cytotoxic drugs 3. Nicorandil 4. Beta blockers 5. Sulphasalazine (sulfasalazine) 6. Radiotherapy 10

11 When to refer 1. Duration of longer than 3 weeks 2. Associated weight loss 3. Involvement of other mucous membranes 4. Rash 5. Suspected adverse drug reaction 6. Diarrhoea 7. Painless ulcer 11

12 Management 1. Local anaesthetics: e.g. lidocaine and benzocaine 2. Local analgesics: Benzydamine mouthwash or spray and choline salicylate dental gel. 3. Topical corticosteroids: Hydrocortisone sodium succinate pellets 4. Chlorhexidine mouthwash. 12

13 Cold sores Cold sores (herpes labialis) are caused by one of the most common viruses affecting humans worldwide. The virus responsible is the herpes simplex virus (HSV) HSV1 typically causes infection around or in the mouth, whereas HSV2 is responsible for genital herpes infection. 13

14 What you need to know Age Duration Symptoms and appearance -Tingling -Pain Location (current and previous) Precipitating factors -Sunlight -Infection -Stress Previous history Medication 14

15 Age: Cold sores are most commonly seen in adolescents and young adults. Following the primary attack, virus particles lie dormant in nerve roots until they are reactivated at a later stage Recurrent cold sores occur in up to 25% of all adults and the frequency declines with age. 15

16 Duration The duration of the symptoms is important as treatment with aciclovir (acyclovir) is of most value if started early in the course of the infection Usually the infection is resolved within 1 2 weeks. Any lesions that have persisted longer need medical referral. 16

17 Symptoms and appearance Discomfort, tingling or irritation may occur in the skin in early stage. Cold sores are extremely painful and this is one of the critical diagnostic factors. The cold sore starts with the development of minute blisters on top of inflamed, red, raised skin. The blisters may be filled with white matter. They quickly break down to produce a raw area with exudation and crusting by about the fourth day after their appearance. By around 1 week later, most lesions will have healed. 17

18 Symptoms and appearance 18

19 Precipitating factors 1. sunlight, 2. wind, 3. fever (during infections such as colds and flu) 4. menstruation, 5. local trauma to the skin. 6. Physical and emotional stress 19

20 Previous history Most sufferers experience 1-3 attacks each year. Cold sores occur throughout the year, incidence increased during the winter months slightly 20

21 Medication It is helpful to enquire what creams and lotions have been used so far. Patients using cytotoxic chemotherapy, are at risk of serious infection and should always be referred to their doctor. 21

22 When to refer 1. Babies and young children 2. Failure of an established sore to resolve 3. Severe or worsening sore 4. History of frequent cold sores 5. Sore lasting longer than 2 weeks 6. Painless sore 7. Patients with atopic eczema 8. Eye affected 9. Uncertain diagnosis 10. Immunocompromised patient 22

23 Management Aciclovir and penciclovir cream 5 times a day Bland cream; Keeping the cold sore moist will prevent drying and cracking. A simple cream, an antiseptic agent, can help to reduce discomfort. Complementary therapies; Balm mint extract and tea tree oil applied topically may have an effect on pain, dryness and itching 23

24 Practical points 1. HSV1 is contagious and transmitted by direct contact. 2. Patients should wash their hands after applying treatment to the cold sore. 3. Women should be careful in applying eye make-up when they have a cold sore to prevent infection affecting the eye. 4. Not share cutlery, towels, toothbrushes or face flannels until the cold sore has cleared up. 5. Use of sunscreens can be a useful preventive measure. 6. Patients with atopic eczema should avoid contact with anyone who has an active cold sore. 24