APHTHOUS ULCERS
Have you ever faced sores inside your mouth?it makes
talking and eating quite difficult right.
These ulcers, for unknown reasons, are known to appear more
in females aged between 10-30years. It is believed that nearly 20% of the
general population is affected by this dz at least one time in life. And as I
had already mentioned, there’s a remarkable familial tendency for the occurrence of
this dz.
AKA recurrent aphthous stomatitis/ canker sores are a common
dz in which there are painful, recurring single or multiple ulcers on the
oral mucosa.
This dz is generally confused with herpes simplex virus
infection on the grounds of clinical appearance, duration of lesions,
recurrence and precipitating factors but let me tell u that there’s no
etiologic relationship and these guys are different from each other.
ETIOLOGY: the exact
cause of these ulcers are unknown
But there are predisposing factors leading to it. I’ve made
a mnemonic for it AGAINST, where
Stands for age, allergy
G is genetic which means that the individuals have a
positive family hx for the dz
H hormonal changes
I Immunology where the Ig G AND Ig M bind to spinous cells
of the epithelial layer
N nutritional deficiency of iron, vit b12 or folic acid
S for stress and
systemic disorders or syndromes which include HIV, Behcet syndrome, reiters syndrome
sweets syndrome, MAGIC syndrome which stands for major aphthous and generalized
inflamed cartilage ), PFAPA syndrome which means a periodic fever, aphthous,
pharyngitis and cervical adenitis.
T stands for trauma which includes self inflicted biting of the oral
mucosa, tooth brushing, needle injection, or any dental procedures.
Apart from these, an alpha-hemolytic strep, s. sanguis is highly implicated as the causative agent of this dz.
Let's RECALL IT ONCE AGAIN AGAINST which means…………
WHAT ARE THE TYPES OF APHTHOUS ULCERS??
There are three broad types which are
Minor aphthous ulcers
Major
And herpetiform a ulcers
Minor, aka Mikulicz ulcers are the ones whose size is less
than a cm. generally involve the non keratinized mucosa which involves the
mucosa of ur cheeks, inside of ur lips and underneath ur tongue. it heals
within a week without any scarring.
Major aka Sutton's ulcers are larger, about greater
than a cm and they can even involve the keratinized mucosa eg the palate. It
heals slowly taking about a month and might leave behind a scar.
Major or minor aphthous ulcers might range from 1-to 6 in
number.
The last type is herpetiform which as the name suggests
appears as tiny fluid-filled vesicles that turn into a pinhead-sized ulcer
resembling a herpes virus infection. They are less than a cm and are dispersed
widely over the mucosa.
The aphthous ulcer begins as a single or multiple
superficial erosions covered by a grey membrane
It generally has a necrotic centre with clearly defined raised
margins surrounded by an erythematous halo. The lesion is typically very
painful so it commonly interferes with eating and speech.
The onset of the disease may occur with a variety of manifestations,
which are not invariably present in all cases. These include the occurrence of
one or more small nodules; burning sensation, erythema or redness, generalized oedema or swelling of the oral cavity, especially the tongue; paresthesia or
abnormal tingling sensation. malaise;
low-grade fever; localized lymphadenopathy; and vesicle-like lesions containing
mucus,
The frequency of outbreaks of the aphthae varies remarkably
between patients. Some persons will have
only one or two attacks in a year, while others will have one
or two attacks in a month, and almost every month for prolonged periods, sometimes
even years.
TREATMENT:
Minor ulcers heal themselves within a week so no specific tt
is required. However, since the lesions are painful, topical analgesia or
anaesthesia with lidocaine can be given.
For Major ulcers, steroids such as prednisolone 30-40 mg
should be given
Other tt options include tetracycline oral rinse thrice a
day for 5 days which might be for the bacterial infection leading to
aphthae
Long term use of steroids might lead to various complications so we can switch to immunomodulators such as colchicine.
You don’t have to worry much since this is a very common
condition occurring in the oral cavity. For managing this condition, Just take care
of the symptoms such that you don’t feel much pain.
That’s all for today. Hope it was helpful. Do give the video
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TILL then, med it made it for u…….