Eosinophilic Ulcer Treatment & Management

Updated: Apr 10, 2017
  • Author: Marc Zachary Handler, MD; Chief Editor: Jeff Burgess, DDS, MSD  more...
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Treatment

Medical Care

Dental-related trauma

The source of chronic irritation must be eliminated when an eosinophilic ulcer is due to obvious trauma. Referral to a dentist is recommended if the lesion is related to a tooth, dental restoration, or appliance.

Although extraction of the anterior primary teeth is not recommended, this may resolve the ulcerations in Riga-Fede disease. However, if the teeth are stable, they should be retained. In these cases, breastfeeding should be discontinued, or a protective shield should be constructed to prevent any further trauma. These measures are usually sufficient to resolve the condition.

Palliative care

Nonsteroidal anti-inflammatory drugs (NSAIDs) or topical anesthetics (eg, viscous lidocaine, benzocaine, dyclonine) may be used to provide temporary relief and comfort when the patient eats. A magic mouthwash may also provide symptomatic relief.

Therapeutic care

Some clinicians suggest that the use of corticosteroids may delay healing; however, a mixture of Orabase and a topical corticosteroid ointment (eg, clobetasol, fluocinonide, triamcinolone) is often effective. Dexamethasone elixir is also effective. Although unnecessary, systemic or intralesional corticosteroids may be used.

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Surgical Care

As a rule, if the lesion does not resolve or it continues to appear ominous after 2 weeks of treatment, biopsy is warranted. After biopsy, rapid healing of the ulcer is often typical, even with large eosinophilic ulcers, and no further treatment is necessary.

Occasionally, lesions may have to be surgically excised.

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Consultations

Consultation with a dentist may be indicated to evaluate and repair fractured teeth or restorations or to alter dentures.

Consultation with an internist may be indicated for the evaluation of an underlying systemic condition in cases in which the ulcer persists, even after biopsy.

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Diet

Advise patients to maintain hydration and nourishment. A soft diet is recommended for patients with painful ulcers and to avoid any further irritation. Nutritional supplements, such as Ensure or Boost, may be necessary. Advise patients to avoid eating acidic or spicy foods because they may cause additional discomfort.

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Prevention

Patients should eliminate the source of the chronic irritation to prevent recurrence (see Causes).

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Long-Term Monitoring

Once treatment is initiated, advise patients to return in 2 weeks for reevaluation. Biopsy is warranted if the lesion does not appear to be resolving with either topical steroid use or removal of the traumatic irritant.

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