J Can Dent Assoc 2014;80:e9
jcda
ca
ESSENTIAL DENTAL KNOWLEDGE
Published by
The Canadian Dental Association
• Hand-foot-and-mouth disease
• Varicella
• Measles
Chronic Ulcerative and Vesiculobullous Conditions
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Recurrent aphthous stomatitis
Juvenile bullous pemphigoid
Childhood linear IgA disease
Hereditary epidermolysis bullosa
Juvenile dermatitis herpetiform
Riga–Fede disease
jadc
DES CONNAISSANCES
DENTAIRES INDISPENSABLES
Publié par
l’Association dentaire canadienne
Associated with Systemic Conditions
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Congenital neutropenia
Autoimmune disorders (e.g., lupus erythematosus, Crohn disease)
Behçet syndrome
PFAPA syndrome, a clinical disorder characterized by periodic fever, aphthous stomatitis, pharyngitis
and cervical adenitis.
• Metabolic deficiency diseases
• HIV/AIDS
Treatment
Common Initial Treatments
• Palliative treatment:
– Monitor nutritional intake and ensure adequate hydration.
– Manage fever with over-the-counter antipyretics (i.e. acetaminophen).
– Consider use of antimicrobial mouthwash to prevent secondary infection of ulcers (if the patient
can swish and spit).
• If you can confirm a specific diagnosis for the oral ulcers, consider treatment with appropriate medications, such as antibiotics, antiviral agents and topical corticosteroids, within your scope of expertise.
• If the patient appears to be significantly dehydrated, lethargic or demonstrates signs of failure-tothrive, refer the patient to an acute care facility for urgent evaluation.
• The patient should be clinically re-evaluated 2 weeks after initial presentation.
Alternate Treatments
• If a systemic condition is suspected as the cause of oral ulcers, the patient should be referred to his/her
primary care physician and/or pediatrician for further evaluation and management.
• Consider referring patients with organ-specific ulcers to medical subspecialists (i.e., dermatologist,
gastroenterologist, otorhinolaryngologist) for evaluation and management, if necessary.
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Advice
Provide supportive advice to the patient and family.
Encourage frequent hydration and nutritional intake.
Monitor for resolution of oral lesions and/or systemic symptoms.
If the patient appears to be significantly dehydrated, weak and/or demonstrates signs of failureto-thrive, the patient should be taken to the family physician or an acute care facility for urgent
evaluation.
• If the ulcers have not resolved in more than 2 weeks, refer the patient to his/her family physician,
pediatrician and/or oral medicine specialist for further evaluation and management.
jcda
ca | 2014 | Vol. 80, No. 1 |
ESSENTIAL DENTAL KNOWLEDGE
Published by
The Canadian Dental Association
jcdaf
ca
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