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60 Cards in this Set
- Front
- Back
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What is a Canker Sore?
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Recurrent Aphthous Stomatitis or Ulcers (i.e. RAS, RAU) in the superficial layer of the oral mucosa
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Where can Canker sores develop in the mouth?
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1) Soft palate
2) Under tongue 3) Floor of mouth 4) On inside lining of lips (labia) 5) Cheeks (buccal) |
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What is the general description of a Canker Sore?
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A superficial ulceration of the oral mucosa with yellow-white/grayish white pseudo membrane and red-inflammed border
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"Canker Sores are not painful and sensitive when palpated" True or False?
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False; they are very painful and sensitive when palpated
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"Canker Sores are considered non-infectious" True or False?
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TRUE
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"The cause of Canker Sores is unknown" True or False?
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TRUE
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What are some of the theories for the causes of Canker Sores?
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Genetics, Stress, Nutritional deficiencies, Diet, Hormonal Changes, Allergies
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"Canker Sores are often confused with ________ and ________"
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Cold Sores and Chancre Sores
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What are some of the complications of Canker Sores?
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Pain, Eating Issues and Weight Loss
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Which conditions can give similar lesions to Canker Sores?
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Behcets Syndrome, Crohn's Disease, Celiac Disease, HIV
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Which of the different types of Canker Sores is the most common form?
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Minor Canker Sores
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What is the prevalence of Minor Canker Sores?
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70-95%
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What is the prevalence of Major Canker Sores?
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10-15%
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What is the prevalence of Herpetiform Canker Sores?
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5-10%
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What is the physical description of Minor Canker Sores?
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Small (<1cm), Shallow, circular/oval ulcers
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What is the physical description of Major Canker Sores?
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Larger (>1cm), Deeper ulcers
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What is the physical description of Herpetiform Canker Sores?
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Like like Herpes Labialis (But NO herpes virus can be cultured)
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How many sores usually develop per episode with Minor Canker Sores?
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Usually 1-3 lesions per episode
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How many sores usually develop per episode with Major Canker Sores?
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Usually 1-2 lesions per episode
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How many sores usually develop per episode with Herpetiform Canker Sores?
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10 or more multiple pinpoint ulcers and vesicles which coalesce into larger lesions
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How quickly do Minor Canker Sores heal?
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Heals within 2 weeks with little to no scarring
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How quickly do Major Canker Sores heal?
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Heals within weeks or months, with painful swallowing difficulties and may have scarring
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How frequently do episodes of Minor Canker Sores occur?
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2-8 episodes per year
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How frequently do episodes of Major Canker Sores occur?
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More frequent than minor canker sores (>2-8 episodes per year)
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Which of the different types of Canker Sores is mostly likely to occur in immunodeficient patients?
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Major Canker Sores
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Which of the different types of Canker Sores can also occur on keratinized mucosa?
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Herpetiform Canker Sores
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When do Chancre sores develop?
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During the primary stages of Syphilis infection and usually on genitals
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What is the physical description of Cancre Sores?
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Red, Painless sores that resolves after a few weeks then about 1-2 months later forms a white mucous patch
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What is the main difference between Canker and Chancre Sores?
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Chance sores are highly infectious while canker sores are not infectious
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When would you refer Canker Sores to a Physician?
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1) Severe pain (while eating)
2) Ulcer >1cm in diameter and deep 3) Ulcer lasts >14 days 4) Myriad of pinpoint ulcers & vesicles 5) >5 ulcers present 6) Ulcers coalesce into larger irregular lesions 7) Scarring 8) Recurs 6-12 times times a year |
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How can you make a differential diagnosis between Canker Sores and other medical conditions?
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1) Fever/Sore throat/Swollen Lymph nodes
2) Ulcers on other parts of the body (skin/genitals/eye) 3) Diarrhea with blood/mucus 4) Large white patches on tongue/cheeks 5) Ulcer is not easily distinguishable 6) Weight loss 7) Systemic Disease 8) Change in bowel habits 9) Ulcers greater than 2 weeks (esp in tobacco users) |
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What are the risk factors of Canker Sores?
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1) Stress
2) Injury in oral cavity (bite/scratch/chemical trauma) 3) Genetics 4) Nutritional Deficiency 5) Food Allergies 6) Medication use 7) Sodium Lauryl Sulfate in toothpaste 8) Recently quit smoking 9) Immunosuppression |
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Which medications elevate the risk for Canker Sores?
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NSAIDs, Beta Blockers, Alendronate, Immunosupressants (e.g. Methotrexate)
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What types of nutritional deficiencies increase the risk for Canker Sores?
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Iron/Folate/Zinc/Vitamins B1, B2, B6, B12
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What are the goals of therapy for Canker Sores?
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1) To reduce pain
2) To reduce duration of ulcer 3) To prevent complications of canker sores 4) To prevent recurrences |
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"There is very little evidence that ANY drug therapies are effective at any of the goals of therapy" True or False?
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TRUE
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What is the first line recommendation for Canker Sores?
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Non-pharmacological recommendations
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What are the non-pharmacological therapies for Canker Sores?
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1) Chew slowly and carefully when eating
2) Avoid sharp edged foods (chips, crunchy, fried) 3) Avoid foods that cause pain (acidic, salty, alcohol, chocolates) 4) Replace old toothbrush with splayed bristles 5) Make adjustments to oral implements (braces/mouth guards) 6) Avoid or reduce risk factors 7) Salt water rinses (2.5ml-5ml of table salt in warm water) |
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What pharmacological recommendations for Canker Sores?
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1) Antimicrobial mouthwashes (Chlorhexidine, Hexetidine, Listerine)
2) Local Anesthetics 3) Oral Analgesics 4) Milk of Magnesia 5) OTC Magic Mouthwash 6) Protectants (Orabase, Zilactin) 7) Bleach Type mouth wash rinses (Amosan, Diluted Hydrogen Peroxide) 8) Vitamin B12 9) Topical Corticosteroids 10) Benzydramine 11) Tetracycline Rinse |
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What is the evidence for Antimicrobial mouth-rinses for Canker Sores?
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i) May help to reduce duration and severity of pain of ulcers
ii) Increase the number of ulcer free days between recurrences iii) DOES NOT REDUCE INCIDENCE OF NEW ULCERS |
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"Antimicrobial mouth rinses reduce the incidence of new ulcers" True or False?
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FALSE
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What is the evidence of efficacy of Chlorhexidine 0.-1.0% in the treatment of Canker Sores?
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i) Reduces number of ulcer days index; 7-10 fewer ulcer days over 5-6 weeks
ii) Increased number of ulcer free days iii) May reduce the duration of ulcers by <1 day (NSS) iv) DID NOT REDUCE INCIDENCE OF NEW ULCERS v) Unclear reduction of pain |
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What are the side effects of Chlorhexidine 0.1-1.0%?
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Bitter taste, Brown staining of teeth/tongue, Nausea
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What is the evidence of efficacy for Hexetidine in the treatment of Canker Sores?
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Not much more effective than placebo at reducing ulcer incidence and duration and severity of pain
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What is the evidence of efficacy for Listerine (Thymol, Eucalyptol, Menthol, MethylSalicylate) in the treatment of Canker Sores?
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No difference on ulcer incidence, duration or pain when compared to placebo
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What is the evidence of efficacy for Local Anesthetics in the treatment of Canker Sores?
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Short duration of effects and toxicity can occur with chronic or excessive use
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What are the alternative uses of Local Anesthetics?
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Abrasion of canker sore membranes with cotton tips soaked with anesthetic (RAS minor only);
Avoid contact with other healthy mucosa to avoid Methylglobinemia |
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What is the evidence of efficacy for Protectants in the treatment of Canker Sores?
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Orabase (Carboxymethylcellulose) and Zilactin (Hydroxycellulose) may help to soothe, coat and protect ulcer
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What is the evidence of efficacy for Bleach Type mouth rinses in the treatment for Canker Sores?
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Amosan (Sodium Perborate), Diluted Hydrogen Peroxide can be used but may not be more effective than salt water rinses
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What is the danger of using Amosan for Canker Sores?
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Has sodium perborate which may contain Boron which is toxic
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What is the danger of using Diluted Hydrogen Peroxide for Canker Sores?
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Hydrogen peroxide may theoretically inhibit healing
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What is the evidence of efficacy for the use of Vitamin B12 for Canker Sores?
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1000mcg SL daily with patients who don't have B12 deficiency;
i) Reduced ulcer duration ii) Reduced pain scale iii) Reduced average no. of episodes per month) iv) Reduced no. of patients with no episodes in 6th month |
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How long before a benefit was seen with Vitamin B12 for Canker Sores?
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After 4 months of treatment
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Which Topical Corticosteroids can be used for Canker Sores?
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Hydrocortisone, Triamcinolone, Betamethasone
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What is the evidence of efficacy for Topical Corticosteroids in the treatment for Canker Sores?
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i) Trend to reduce ulcer days index
ii) Trend to reduce severity of pain iii) Inconsistent reduction of duration of ulcers iv) inconsistent results in the incidence of new ulcers |
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What are the risks of Topical Corticosteroids for Canker Sores?
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Risk of fungal and bacterial infections
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What is the evidence of efficacy for Benzydamine in the treatment for Canker Sores?
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Only provided transient pain relief
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What are the risks of using Benzydamine in the treatment of Canker Sores?
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Considerable stinging & burning due to the ethanol components
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What is the evidence of efficacy for Tetracycline Rinse in the treatment of Canker Sores?
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i) Reduced duration of ulcer and days of pain by 4 days
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What are the risks of using Tetracycline Rinse in the treatment of Canker Sores?
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1) Risk of fungal infections (>5 days of use) 2) Risk of developing bacterial resistance (>5 days of use) 3) Don’t use in children
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