38 Oral Pathology Oral Ulcers
Temporomandibular joint
Intra-oral examination
A detailed examination of the TMJ is probably only needed when a specific problem is suspected from the history.3 The TMJ can also be affected by diseases.4 The most frequent are rheumatoid arthritis3, juvenile idiopathic arthritis and traumatic injuries.4
Intraoral examination should assess first, at the present moment, the presence or absence of ulcers. If present, examination of an ulcer should include assessment of nine important features: - Number - Size - Shape - Base - Edge (margins) and surrounding tissues - Pain - Location - Duration - Etiologies Visual inspection is essential but palpation is also an important part of the examination of an ulcer. Gloves must be worn for palpation and the texture of the ulcer base, margin and surrounding tissues should be ascertained by gentle pressure.1, 3
Salivary glands As with the TMJ, examination of the salivary glands is only required when the history suggests this is relevant. For example, bacterial sialadenitis, involves the parotid glands, is accompanied by swelling, pain, fever and erythema of the overlying skin.3 Fig 4
Characteristics of an ulcer Number Fig. 4: Minor aphthous ulcer Fig 5
Fig. 5: Minor recurrent aphthous Fig 6
Fig. 6: Major aphthous ulcer Dental News, Volume XXI, Number II, 2014
There are two clinical situations; either there are one or multiple ulcers: so first, ulcers should be counted. If one ulcer is present, the following diagnosis should be considered: - Aphthous ulcer (Fig. 4) - Traumatic ulcer (Fig. 5) - Rare tuberculosis and malignant ulcers If more than one ulcer is present, the following diagnosis should be considered: - Recurrent aphthous ulcers (Fig. 6) - Traumatic ulcers (Fig. 7) - Primary herpetic gingivostomatitis - Varicella - Herpangina - Hand, foot and mouth disease (Fig. 8) - Tuberculosis ulcer For instance, recurrent minor aphthous ulcers tend to occur in crops of two to three but variable patterns are seen, ranging from occasional single ulcer to over 20 at any one time.2, 3, 9 The number of recurrent major aphthous ulcers varies between 2 to 510. Herpetiform ulcers are characterized by multiple small ulcers (10 to 100).2, 5 In primary herpetic gingivostomatitis, is characterized by multiple ulcers.11