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Mouth ulcers in practice

Case 1

Mouth ulcers in practiceAnthony Jarvis, a man in his early fifties, asks you to recommend something for painful mouth ulcers. On questioning, he tells you that he has two ulcers at the moment and has occasionally suffered from the problem over many years. Usually he gets one or two ulcers inside the cheek or lips and they last for about 1 week. Mr Jarvis is not taking any medicines and has no other symptoms. You ask to see the lesions and note that there are two small white patches, each with an angry-looking red border. One ulcer is located on the edge of the tongue and the other inside the cheek. Mr Jarvis cannot remember any trauma or injury to the mouth and has had the ulcers for a couple of days. He tells you that he has used pain-killing gels in the past and they have provided some relief.

The pharmacist’s view

From what he has told you, it would be reasonable to assume that Mr Jarvis suffers from recurrent minor aphthous ulcers. Treatment with hydrocortisone pellets (one pellet dissolved in contact with the ulcers four times a day), with triamcinolone in carmellose dental paste, or with a local anaesthetic or analgesic gel applied when needed, would help to relieve the discomfort until the ulcers healed. Mr Jarvis should see his doctor if the ulcers have not healed within 3 weeks.

The doctor’s view

Mr Jarvis is most likely suffering from recurrent aphthous ulceration. As always, it is worthwhile enquiring about his general health, checking, in particular, that he does not have a recurrent bowel upset or weight loss. These ulcers can be helped by a topical steroid preparation.

Case 2

One of your counter assistants asks you to recommend a strong treatment for mouth ulcers for a woman who has already tried several treatments. The woman tells you that she has a troublesome ulcer that has persisted for a few weeks. She has used some pastilles containing a local anaesthetic and an antiseptic mouthwash but with no improvement.

The pharmacist’s view

This woman should be advised to see her doctor for further investigation. The ulcer has been present for several weeks, with no sign of improvement, suggesting the possibility of a serious cause.

The doctor’s view

Referral is correct. It is likely that the doctor will refer her to an oral surgeon for further assessment and probable biopsy as the ulcer could be malignant. Cancer of the mouth accounts for approximately 2% of all cancers of the body in Britain. It is most common after the sixth decade and is more common in men, especially pipe or cigar smokers. Cancer of the mouth is most often found on the tongue or lower lip. It may be painless initially.

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