Dentaltown December 2015 - (Page 58)

pathology feature Oral Ulcerations A BRIEF REVIEW by Keith Murtagh, DDS M Many different disease processes may manifest as oral ulcerations. Accordingly, dental professionals are often the first (and sometimes only) professionals to identify these lesions. Recognition, diagnosis and management for these patients is crucial not only to their oral health, but to their overall health in general. Etiology and diagnosis must be determined to effectively render treatment. Causative agents may be reactive, autoimmune, neoplastic or infectious. Is the ulcer due to a patient biting his or her tongue, or is it because he or she has a serious undiagnosed autoimmune disease? This brief article will touch on common causes of oral ulcerations in an attempt to promote early diagnosis and intervention when needed. Traumatic ulcerations Traumatic ulcers are the most common cause for intraoral ulcerations and are seen in all age groups. Causes include biting of soft tissues (both accidental and parafunctional), fractured cusps or restorations, and hot or sharp food items. 58 DECEMBER 2015 // dentaltown.com Common locations for traumatic ulcers include lateral border of the tongue, buccal mucosa and labial mucosa. Diagnoses can usually be elicited by utilizing an accurate medical history and clinical examination (in the case of a sharp cusp or restoration). Management of these lesions is aimed at removing the etiology and re-evaluating for resolution. In the case of a suspected bite-induced traumatic ulcer where no other etiology can be found, reevaluation at two weeks is appropriate. Oral ulcerations that persist for more than two weeks without significant improvement or resolution require incisional scalpel biopsy to rule out malignancy (squamous cell carcinoma being the most common). Incisional biopsies of ulcerated mucosa should include adjacent normal-appearing tissue, as some disease processes (see below) occur at the epithelial-connective tissue interface. Topical corticosteroids may be used to hasten healing and decrease pain. Herpesviridae There are eight known viruses in the herpesviridae family that affect humans. These include simplex 1 (oral) and 2 (genital), Varicella zoster, Epstein-Barr, cytomegalovirus, 6 (roseolovirus) and 7, and HHV-8, which is associated with Kaposi's sarcoma. This article will focus on herpes simplex virus 1 (HHV-1) which is the most common of the viruses that cause oral and perioral ulcerations. Herpes infections consist of two main phases. It should be noted that not everyone who contracts the disease displays clinical symptoms. The primary phase is most commonly seen in young children. Inoculation is usually by contact with a family member or at school. This is followed by an incubation of up to 10 days followed by fever, malaise, pharyngitis, and cervical lymphadenopathy. Intraoral manifestations include gingivostomatitis and diffuse oral ulcerations that may occur on both attached and unattached mucosa. Desquamation of gingiva and inflammation of interdental Continued on p. 60 http://www.dentaltown.com

Table of Contents for the Digital Edition of Dentaltown December 2015

On Dentaltown.com
HOWARD SPEAKS: What Your Offi ce Manager Needs to Do Right Now
PROFESSIONAL COURTESY: What Grinds My Gears
Continuing Education Update
Industry News
Restoring Deep Cavity Preparations
How Do You Separate the Teeth for Band Fitting of Space Maintainer?
Oral Systemic Health and the Big Three
HR Compliance for Dentists: Three Costly Assumptions
Oral Ulcerations: A Brief Review
Debunking the Bleaching Myths
Practice Solutions: DentiMax
Are You Scared of Being Your Best? How to Face Your Fears and Grow Your Business
Planting Your Practice: How to Find the Ideal Spot
When the Patient Refuses Orthodontic Treatment
Pass It On: Generosity in the Business of Dentistry
Handling the Gagging Population
TOWNIE CHOICE AWARDS 2015 Townies Have Spoken!
Ad Index
You Should Know: Dental Fix Rx
Poll
CE: Radix Entomolaris: Treatment of a Mandibular First Molar with Distolingual Root
Dentally Incorrect

Dentaltown December 2015