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Tongue Ulcer

Tongue ulcers appear in a myriad of infectious, autoimmune, metabolic, malignant and iatrogenic conditions, and their duration, presence of pain, location, as well as progression is key in determining the underlying cause. History taking, a thorough physical examination, and a broad laboratory workup are vital steps during the diagnostic workup.


Presentation

Ulcerations in the oral cavity are relatively common in general practice, with estimates suggesting that up to 4% of the population in the United States suffer from some form of ulcerative lesion, and the tongue is one of the sites where they may develop [1] [2]. The reason for this rather high prevalence rate is the diverse etiology [1] [3] [4] [5] [6] [7]:

  • Trauma - Mechanical trauma (for example tongue biting) or chemical/thermal irritation [1] [4].
  • Infectious agents - Herpes simplex virus type 1 (HSV-1, responsible for both primary herpetic and recurrent herpes stomatitis) and Varicella zoster virus (VZV) are rather common causes of ulcerative lesions in the oral cavity, and the clinical presentation involves the initial appearance of vesicular lesions followed by their ulceration [1]. Actinomyces, Mycobacterium tuberculosis, Treponema pallidum (responsible for syphilis), and human immunodeficiency virus (HIV) are less frequent but still important pathogens responsible for ulcerative lesions [1] [4] [7].
  • Autoimmune conditions - Aphthous stomatitis is described as a separate entity of tongue and oral lesions due to their rather frequent occurrence, and studies estimate that up to 25% of the world's population may develop this type of lesion [1] [6]. They have a recurring pattern in many patients, and the term recurrent aphthous stomatitis (RAS) is used to denote the appearance of multiple, small, ovoid or round ulcers in the first few decades of life that spontaneously resolve within a few weeks [1] [6] [7]. They possess a gray to yellowish floor and are encircled by a red halo [6]. The pathogenesis remains unknown, but systemic lupus erythematosus (SLE), Crohn disease, and Behçet syndrome have been associated with their appearance [7]. In all of the mentioned conditions, oral ulcers are one of the key presenting signs [1] [3] [4]. In SLE, the "discoid lesions", hallmarks of this autoimmune disorder, are observed as painful erythematous erosions and ulcers, which is also the case in Pemphigus and Pemphigoid (bullous dermatoses that also cause ulcerations of the tongue and oral cavity), but also Crohn's disease [1] [4]. In addition, Lichen planus is also an important autoimmune etiology or tongue ulcers, having a similar clinical picture to SLE, but a diffuse pattern of ulceration is seen in this disorder [1] [4] [7].
  • Malignant diseases - The lateral border of the tongue is the predominant location of the squamous carcinoma of the oral cavity, the single most important malignant etiology of tongue ulcers [1] [8]. The presence of risk factors such as cigarette smoking, alcohol abuse, increased age, male gender, and the absence of other conditions to which ulcers can be attributed, significantly increases suspicion toward a neoplasia [1] [3]. A painless, non-healing ulcer that persists for several weeks is highly suggestive of a tumor [1] [4] [7].
  • Drug-induced - Aspirin, chemotherapeutic drugs, bisphosphonates and nicorandil (a vasodilatory drug) are known to cause ulcers in the oral cavity and tongue [1] [7].

In most cases, tongue ulcers have a benign and self-limiting course with spontaneous resolution within several days or a few weeks [1], but in the setting of persistent, more severe damage to the tongue and oral mucosa, the cause of ulceration may require specific treatment.

Hunting
  • Good hunting ..you will succeed with perseverance Thnx for your positive support and suggestions. K8 Jaffar Dental - Trusted and Established since 1997.[healthshare.com.au]
Vascular Disease
  • diseases ( I73.- ) gangrene of certain specified sites - see Alphabetical Index gas gangrene ( A48.0 ) pyoderma gangrenosum ( L88 ) Type 2 Excludes gangrene in diabetes mellitus ( E08-E13 with .52) glossitis K14.0 Gingivoglossitis K14.0 Glossitis (chronic[icd10data.com]
Hepatomegaly
  • Abstract A 51-year old man presented with a persistent tongue ulcer, fever, cervical lymphadenopathy and hepatomegaly. The diagnosis was initially thought to be tuberculosis.[ncbi.nlm.nih.gov]
Lesion of the Tongue
  • Ulcerations in the oral cavity are relatively common in general practice, with estimates suggesting that up to 4% of the population in the United States suffer from some form of ulcerative lesion, and the tongue is one of the sites where they may develop[symptoma.com]
  • Painful red lesions on the tongue are one of the classic symptoms of hand, foot and mouth disease too. Very rarely, a tuberculous ulcer may form on the tongue in a patient suffering from tuberculosis.[thehealthsite.com]
  • Mary, my wife, has some lesions on her tongue that don't hurt. They are on the tip and top surface in the middle and one side. Irregular shapes, with light (not white) edges, and of various sizes. About 6 lesions.[medhelp.org]
  • The lesions on the tongue, usually ulcers, may be single or multiple, are usually painful, grayish-yellow, with irregular margins, firm and slightly indurated [1], [6].[dx.doi.org]
  • The lesions on the tongue, usually ulcers, may be single or multiple, are usually painful, grayish-yellow, with irregular margins, firm and slightly indurated [1] , [6] .[ijdr.in]
Quickening
  • Antimicrobial mouthwash may quicken the healing time and also help prevent infection of the ulcer. Multivitamin medications can help make up for the nutritional deficiencies. Avoid spicy and sour foods.[thehealthsite.com]
  • The ulcers will typically heal on their own, but remedies can be used to limit the pain and quicken the time it takes to rid the sore. Rinsing the mouth with salt water is a common recommendation for those suffering from ulcers in the mouth.[md-health.com]

Workup

The diagnostic workup of tongue ulcers must be detailed and comprehensive. The physician must obtain a thorough patient history, which will encompass the onset, course, and progression of ulcers [1] [5] [6] [7]. Furthermore, patients should be asked about their sexual habits (to exclude syphilis and HIV), recent dental or medical procedures in the oral cavity (to exclude trauma), and the use of drugs such as aspirin and cytotoxic agents [1] [7]. Conversely, a full inspection of the oral cavity, and not only the tongue, will warrant visualization of oral ulcers that might be missed without appropriate illumination and clinical suspicion. The size, shape, location, and the appearance (color, induration, and other associated features) should be assessed [1] [7]. The initial diagnosis is made based on clinical criteria, but laboratory studies might be employed to assist in determining the underlying pathology, including a complete blood count (CBC), serum inflammatory markers (C-reactive protein and erythrocyte sedimentation rate, or CRP and ESR, respectively), anti-nuclear antibodies (ANA), and a basic biochemical panel. Vitamin deficiencies (primarily B12 and folate, but also iron) are well-established risk factors for ulcers of the tongue and oral cavity [1], and their levels should be evaluated as well. Biopsy of the tongue ulcer, however, and subsequent histopathological examination is quite useful, and is recommended whenever possible [1] [5] [6].

Treatment

  • He responded to treatment with amphotericin B.[ncbi.nlm.nih.gov]
  • The lesions healed during treatment with oral penicillin and azithromycin.[ncbi.nlm.nih.gov]
  • Treatment: Different treatments work differently for every patient. Treatment works to reduce swelling. Anti-inflammatory drugs include mesalamine, sulfasalazine and corticosteroids will be prescribed. 4.[newhealthguide.org]
  • Oral viscous lidocaine is useful for the treatment of symptoms induced by oral inflamed mucosa, such as radiation- or chemotherapy-induced mucositis. The toxic reactions associated with an accidental overdose have been reported in pediatric cases.[ncbi.nlm.nih.gov]
  • Tongue Ulcer Treatment • Application of butter for Tongue Ulcers treatment is one of the best natural remedies for this irritating problem. Items like butter and glycerin tend to ease the burning sensation and facilitate the process of healing.[speedyremedies.com]

Prognosis

  • Prognosis Most canker sores clear up without treatment and do not leave scars, although they usually return.[colgateprofessional.com]
  • Cancers of the lower lip have a better prognosis than those of the upper lip. Chronic sun exposure is the most common cause, but smoking can also be an etiology.[entusa.com]

Etiology

  • The reason for this rather high prevalence rate is the diverse etiology: Trauma - Mechanical trauma (for example tongue biting) or chemical/thermal irritation.[symptoma.com]
  • Aphthous ulcers that occur in conjunction with symptoms of uveitis, genital ulcerations, conjunctivitis, arthritis, fever or adenopathy should prompt a search for a serious etiology.[ghorayeb.com]
  • The etiology of RAS is still unknown; the condition may in fact manifest from a group of disorders of quite different etiologies rather than from a single entity. [3] Despite many studies trying to identify a causal microorganism, RAS does not appear[emedicine.medscape.com]
  • Most lesions are round ulcers with elevated and indurated borders; sometimes EUOM appears as a nodular-ulcerated lesion or simply as an induration; the last one can represent an early phase in the development of the typical ulcer. 6 To date, the etiology[scielo.br]
  • Chronic sun exposure is the most common cause, but smoking can also be an etiology. The picture on the right shows a T2 N0 (tumor size between 2 to 4 cm, with no lymph node spread) squamous cell carcinoma of the lower lip.[entusa.com]

Prevention

  • Treatment The intake of B-complex vitamins is most often recommended as a method of prevention as well as in the process of healing the ulcers. The direct application of glycerin on the affected surfaces may also show significant positive results.[ic.steadyhealth.com]
  • Antimicrobial mouthwash may quicken the healing time and also help prevent infection of the ulcer. Multivitamin medications can help make up for the nutritional deficiencies. Avoid spicy and sour foods.[thehealthsite.com]
  • It also acts as a coating agent on top of mouth ulcer under tongue so that it prevents any external viral or micro organic agents from doing damage to your ulcer tongue.[tongue-ulcer.50webs.com]
  • Still, preventing outbreaks has value for others as well as yourself. How to Prevent Oral Herpes Outbreaks Herpes becomes contagious from the prodrome stage.[authoritydental.org]

References

Article

  1. Paleri V, Staines K, Sloan P, Douglas A, Wilson J. Evaluation of oral ulceration in primary care. BMJ. 2010;340:c2639.
  2. Shulman JD, Beach MM, Rivera-Hidalgo F. The prevalence of oral mucosal lesions in U.S. adults: data from the Third National Health and Nutrition Examination Survey, 1988-1994. J Am Dent Assoc. 2004;135(9):1279-86.
  3. Reamy BV, Derby R, Bunt CW. Common tongue conditions in primary care. Am Fam Physician. 2010;81(5):627-634.
  4. Chi AC, Neville BW, Krayer JW, Gonsalves WC. Oral manifestations of systemic disease. Am Fam Physician. 2010;82(11):1381-1388.
  5. Gambino A, Carbone M, Arduino P-G, et al. Clinical features and histological description of tongue lesions in a large Northern Italian population. Med Oral Patol Oral Cir Bucal. 2015;20(5):e560-e565.
  6. Preeti L, Magesh K, Rajkumar K, Karthik R. Recurrent aphthous stomatitis. J Oral Maxillofac Pathol. 2011;15(3):252-256.
  7. Flint S. Oral ulceration: GP guide to diagnosis and treatment. Prescriber. 2006;17(5).
  8. Monteiro LS, do Amaral JB, Vizcaíno JR, Lopes CA, Torres FO. A clinical-pathological and survival study of oral squamous cell carcinomas from a population of the north of Portugal. Medicina Oral, Patología Oral y Cirugía Bucal. 2014;19(2):e120-e126.

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Last updated: 2019-07-11 22:22