University:
American Career College
Course:
NURS-113 | Beginning Medical/Surgical Nursing
Academic year:

2018
Views:

390

Pages:

42
Author:

KillSteel

SORE MOUTH ORAL ULCERATION Lumps & swellings in the mouth Causes of sore mouth & oral ulceration Trauma  Mechanical: dentures  Chemical: caustic Infective  Viral: herpes, chicken pox, hand, foot & mouth disease (HFMD) & AIDS  Bacterial: syphilis,TB & scarlet fever  Fungal: Candida Haematological  Iron & folate deficiency anaemia  Pernicious anaemia  Agranulocytosis Neoplastic  Carcinoma  Leukemia Autoimmune  Pemphigus  Pemphigoid Idiopathic  Aphthous ulcer  Lichen planus  Behcet´s syndrome Others  Vitamin C deficiency  Black hairy tongue  Stevens-Johnsons syndrome Traumatic ulcers Chronic trauma usually from ill-fitting dentures or sharp tooth, may cause non-healing ulcers on the tongue, gums, lips or cheeks. Treatment: refitting the dentures. Aphthous ulcers These are the most common mouth ulcers . The ulcers are small & painfull. They usually affect the edge of the tongue but can occur anywhere within the oral cavity. The exact cause remains unknown, although stress, allergy, trauma, genetic predisposition, AIDS, hematological deficiencies & hormonal changes have all been suggested. Usually these ulcers present no more than a minor irritation for a few days before they resolve naturally. Occasionally these ulcers are severe & recurrent; treatment then include simple analgesics & steroid pastilles & the exclusion of any causative factors. Rarely, single, giant aphthous ulcer occur & here the diagnosis is often less certain; biopsy may be necessary. Infective ulcers Herpes simplex mouth ulcers are painful. Their appearance is similar to herpetiform aphthous ulceration but mild pyrexia & malaise also occur. Acyclovir is effective if given in the early stage. The mucous patches & snail track ulcers of syphilis are classic but rarely seen nowadays . The oral manifestations of AIDS (AIDS defining illnesses) include oral candidiasis, Kaposi´s sarcoma & hairy leukoplakia of the tongue. Remember that people with AIDS commonly present with unusual or recurrent oral infections. In patients presenting with these conditions, one must have high index of suspicion. Cancer SCC of the tongue & mouth nearly always starts as an ulcerating mass. Any ulcer that fails to heal within 2 weeks should be biopsied to exclude malignancy. There is a misconception that painful ulcers are more likely to be benign; this is incorrect. Malignant tongue ulcers are also painful. Blood & dietary disorders The haemopoietic agents iron, folate & vitamin B12 are required for the maturation of healthy oral mucosa, & so deficiency of these factors is associated with oral ulcerations. Agranulocytosis & leukemia can cause oral ulceration. White patches in the mouth Candida Oral candidal infection tends to occur at the extremes of age & in immunocompromised people (e.g. people with DM or AIDS). Candida can occur on the palate as a result of steroid deposition with asthma inhalers. White specks coalesce to form patches or a membrane that, when lifted, reveals a red raw, bleeding mucosal surface. The diagnosis is usually clinical & the condition responds to topical antifungal preparations Leukoplakia A white patch in the mouth is called leukoplakia, Although this is only a descriptive term & not a diagnosis. The word leukoplakia is often used to mean hyperkeratosis of the oral mucosa. Hyperkeratosis is usually associated with local irritation,e.g. from poorly fitting dentures, smoking, drinking alcohol & eating strong spices. It important to recognize & biopsy leukoplakia, since 3% of such lesions undergo malignant changes within 5 years. Erythroplakia (speckled leukoplakia): Red patches in the mouth has the highest risk of malignant potential. Hairy leukoplakia (because of its histological appearances), occurs as white patches on the lateral border of the tongue in people with AIDS. Lichen planus This is an inflammatory disease of unknown aetiology that can affect the skin & oral cavity. The classic form gives a white lace-like appearance (reticular type). This condition is extremely painful. It usually responds to local steroid preparations; if not, laser ablation is often effective. Black hairy tongue The cause of this condition is unknown, but it does seem to be associated with smoking. There is an overgrowth of filiform papillae. Treatment consists of brushing of the tongue to scrape these away. Lumps & swellings in the mouth Congenital  Haemangioma  Cystic hygroma Aquired  Ranula  Mucous retention cyst  Torus palatinus Neoplstic  Benign Salivary tumours,e.g. pleomorphic adenoma. Malignant  SCC  Salivary tumours,e.g. adenoid cystic carcinoma  Sarcoma  Lymphoma Dental  Abscess  Cyst Congenital masses Congenital masses are rare. The most frequent are haemangioma & cystic hygroma. Any type of congenital oral mass may present at or soon after birth either with airway or feeding problems. Torus palatinus This is an osteoma of the hard palate. These need to be removed only if they cause symptoms or interfere with denture. Mucus retention cyst The mucosa of the oral cavity is rich in mucous glands. If these become blocked, a retention cyst develops. These smooth, pale, round swellings may occur anywhere in the mouth or lips. Excision is required only if they are symptomatic. Ranula A ranula (which literally means ´small frog`) Is a retention cyst that forms in the floor of the mouth under the tongue. It develops from the submandibular or sublingual gland ducts. Marsupialization (stitching open) of the cyst is the most effective treatment. Oral cavity tumours Both benign & malignant tumours may affect the oral cavity & present as a lump in the mouth. The intra-oral minor salivary glands may give rise to a variety of the tumours, such as benign pleomorphic adenoma & malignant adenoid cystic carcinoma. The most common oral cavity tumours is SCC. Squamous cell carcinoma SCC tend to occur in mid- to late life. Alcohol & tobacco are strong aetiological factors. The carcinomas may arise from areas of leukoplakia or erythroplakia. The most common sites are the lateral border of the tongue & the floor of the mouth. A deep per oral biopsy is essential. Clinical features of oral cancer  Persistent oral swelling for >4 weeks  Mouth ulceration for >4 weeks  Sore tongue  Dysphagia  Jaw or facial swelling  Painless neck lump (metastatic node)  Unexplained tooth mobility  Trismus Treatment options include: o External-beam & interstitial radiotherapy, & o Surgical en bloc resection of the tumour ( 2 cm safe margin in all planes). o Chemotherapy used in conjunction with radiotherapy has shown some promising results. KEY POINTS Oral Ulceration:  Exclude local irritant factors such as trauma, smoking ,spirit and spices.  Exclude blood disorders and deficiency states.  White or red patches within the mouth may undergo malignant transformation. These should be biopsied in most cases.  Remember that people with AIDS commonly present with unusual or recurrent oral infections.  Oral ulcers that fail to heal within 2 weeks must be biopsied to exclude malignancy.