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Epithelial ulceration on tongue floor of the mouth

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Epithelial ulceration on tongue, floor of the mouth, soft palate, lining of lips and cheeks Lone or multiple lesions (crops) Minor: one oval flat ulcer with surrounding erythema Major: several oval, ragged, gray/yellow ulcers Herpetiform: multiple small ulcers in crops, most painful type Prodromal symptoms may occur 24 to 48 hours prior
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77 RAS Risk Factors Precipitating Factors Increased stress Local oral trauma Genetic factors Non-smokers Associated Conditions Allergy HIV/AIDS Systemic lupus erythematosus Inflammatory bowel disease Vitamin deficiencies Photo adopted from: http://www.leaisglutenfree.com/2010/11/cancer-packing-and-dreams/stress/
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78 Immediate Referral Symptoms of systemic infection such as fever, rash, or extensive swelling Frequently recurring lesions Lesions present ≥ 14 days Failure of appropriate self-treatment for 1 week
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79 Debriding / Cleansing Products Antiseptic with weak antibacterial properties Carbamide Peroxide 10 - 15% Gly-Oxide Oral Cleanser Liquid ® Hydrogen Peroxide 1.5 - 3% Orajel Antiseptic Mouth Sore Rinse ® Peroxyl Hygienic Dental Rinse Liquid / Gel ® Homemade sodium bicarbonate rinse: ½ to 1 teaspoon baking soda in 4 ounces of water Homemade sodium bicarbonate rinse: ½ to 1 teaspoon baking soda in 4 ounces of water
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80 Debriding / Cleansing Products Directions for use Apply drops to affected area OR use as a rinse Most effective when used after meals Allow to remain in place or swish for 1 minute Do not use more than 4 times daily for 1 week Hydrogen Peroxide 3% should be mixed 50:50 with water prior to swishing Lesions resolve ≤ 14 days, At day 7 discontinue debriding / cleansing agents and continue hygienic measures Lesions resolve ≤ 14 days, At day 7 discontinue debriding / cleansing agents and continue hygienic measures
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81 Oral Mucosal Protectants Coats and protects the affected area Reduces friction and irritation Provides temporary relief Paste, adhering film, or patch Canker Cover ® Orabase Soothe-N-Seal ® Directions Hold in place for 10 to 20 seconds to secure Apply as needed for pain relief, 3 to 4 times daily Photo adopted from: http://www.drugstore.com/
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82 RAS Supportive Treatment Topical anesthetics Avoid oral irritants until wounds heal Spicy, acidic, or sharp shaped foods Apply ice in 10 minute increments for immediate relief Antiseptic rinses may accelerate healing Saline rinses may soothe ulcers 1 - 3 teaspoons salt in 4 - 8 ounces warm water
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83 Herpes Simplex Labialis (HSL) Photo adopted from: http://medical-dictionary.thefreedictionary.com/_/viewer.aspx?path=mosby&name=500105-fx8.jpg
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84 Herpes Simplex Labialis “Cold sores”, “Fever Blisters” Caused by HSV-1 virus Exposure typically begins in childhood or adolescence 30 – 40% will develop recurrent infections Transmitted by direct contact through a break in the skin or mucous membranes Vesicle fluid contains live viruses
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85 HSL Clinical Presentation Outbreaks are painful and cosmetically unappealing Small red fluid-filled papules 1 - 3 mm wide Lesions often coalesce into clusters Crusting develops as vesicles mature and heal
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Epithelial ulceration on tongue floor of the mouth soft...

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