Oral Medicine and Radiology MCQ answer 13

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Answer is B

• Recurrent aphthous ulcerations (RAU’s) are idiopathic ulcerations. Diagnosis of RAU’s is of exclusion; the clinical impression may be confirmed with histologic examination and by response to treatment.

• The three disease entities of RAU’s are minor, major and herpetiform.

• Minor (recurrent) aphthous ulcerations are smaller than 1.0 cm, well-circumscribed, round, may have a yellow-gray pseudomembrane, and surrounded by a erythematous halo. Differential diagnosis includes recurrent HSV infection. Treatment is focused to provide symptomatic relief. Analgesic mouth rinses: 2% -4% viscous Lidocaine solution (10 ml swished and expectorated) is the most commonly used. Kenalog in Orabase may also be used.

• Major (recurrent) aphthous ulcerations are larger than 1.0 cm. They are well-circumscribed, round, and shallow or deep with indurated margins. A gray pseudo membrane covering the lesion may sometimes be present. They can occur anywhere on the oral mucosa. They are usually single ulcerations. In immunosuppressed individuals, groups of up to 10 lesions can be observed. These ulcers persist for more than 3 weeks and tend to heal with scar formation. In patients with HIV, major (recurrent) aphthous ulcerations have been associated with severe immune suppression, with CD4 counts below 100 cells/mm3, and are markers for HIV disease progression. Treatment for major (recurrent) aphthous ulcerations includes administrations of systemic corticosteroids. Topical formulations include: clobetasol or fluocinolide gel applied directly to the lesion, dexamethasone elixir mouth rinses (0.5 mg/5ml), and systemic administration of 60-80 mg of prednisone per day for 10 days have been used successfully. In steroid resistant patients, alternative therapy of 100-200 mg thalidomide may be used. It has severe side effects, but, has been used with some success to treat both oral and esophageal ulcerations. Refractory cases can be treated with colchicines or levamisole. Antibiotics and antifungal agents may also be used concurrently to prevent bacterial or fungal superinfections.

• Herpetiform ulcers are the least common type of aphthous ulcers; they are smaller than 1 mm, with perilesional erythema. They are found in batches of up to 100 on the nonkeratinized mucosa such as the ventral surface of the tongue and soft palate. Treatments are similar to those for minor RAU’s: symptomatic relief, suppression of the local pathologic immune reaction, and treatment of concomitant superinfection.