Patient: Good afternoon, Doctor. I have an appointment at 4.00 p.m. today.

Doctor: Good afternoon. Yes, I remember. It was about consultation.

Patient: Yes, that’s right. I have had a painful change on my tongue for the last two weeks. Unfortnately, it does not want to heal.

Doctor: Sit down, please. I’ll be with you momentarily.

In a while

Doctor: Well, now I’m available to you. I understand that this change on the tongue has been present for two weeks?

Patient: Yes, that’s right

Doctor: Open your mouth wide, please. First let me take a look at it, and in a moment we’ll talk a bit more.

Doctor: Well, yes. It is quite a big change. It is nearly two centimeters in diameter. I suppose that it is very painful.

Patient: Oh yes, very much. And it is not the first time. Three months ago, I had a similar change, but on the other side of the tongue. It was identical and painful, too. I could not even swallow saliva. The doctor said that my lymph nodes were swollen, and therefore I experienced pain while swallowing. Fortunately, it cleared after 3 weeks.

Doctor: I think that this change will clear as well, but we can not just leave like that. We have to look for the cause, but it is not so easy. In my opinion this is Sutton’s aphthae. In comparison with a typical aphthae, it is larger and very painful. It often occurs on the cheeks and on the palate. Oh, yes. On the other side, I can see a scar after a previous change. This is also a characteristic of such a change.

Patient: So the case is clear?

Doctor: Well, let’s say yes. I will direct you to your GP, who will refer you for some blood tests. He may also refer you to a gastroenterologist. We will meet you in a few days. I’ll see if this change heals. We have to watch it.

Patient: And if it does not heal?

Doctor: I think it will. If not, then you will need to run additional tests. Maybe even take a sample. During the test, I noticed sharp edges of the teeth close the boarders of the change. I’ll smoothen them. The point is not to irritate the change further.

Patient: Is there anything special I should do?

Doctor: I’ll write a prescription for a protective ointment, which will speed up the healing. Of course, try not to eat acidic or spicy foods, please.

Patient: Doctor, I have already paid attention to it. When I ate acidic and spicy food, it hurt me more, so I started avoiding them.

Doctor: Then we meet next Tuesday, also at 4 p.m. It would be good if you were after your visit to an internist.

Patient: I will try. Thank you for your help and goodbye.

Doctor: See you.

VOCABULARY PRACTICE

Read these pieces of information about aphthous ulcers. Decide if they are true of false. Mark T for True, F for False

1. Aphthous ulcers are classified as minor or major. Minor aphthous ulcers are small, superficial and heal slowly. Major lesions are large, often as big as 10 mm, deep, severely painful and sometimes very fast to heal. _____

2. Aphthous ulceration is a dangerous condition. _____

3. The typical aphthous ulcer is irregular in shape with a yellow, base and a red rim. ______

4. Aphthae commonly runs in family. _______

5. Sutton’s aphthae is most often seen in pre­‍‑adolescent or adolescent girls. _____

6. Sutton’s aphthae is often preceded by fever. ______

7. Aphthae is recurrent ranging from infrequent to very frequent, to the point where they are almost constant. ______

8. Sutton’s aphthae is infectious. ______

Guess what word is being described? One dash stands for one letter.

1. _ _ C _ _ _ _ _ _ – an adjective describing that something is bout to return, come back again.

2. D _ _ _ _ _ _ _ – a straight line segment that passes through the center of a circle or sphere from one side to the other.

3. _ _ _ _R – a sore on the skin or a mucous membrane, accompanied by the disintegration of tissue, the formation of pus, etc.

4. M _ _ _ _ ulcer­‍ – another name given to Sutton’s aphthae.

5. O _ _ _ – resembling an ellipse in shape.

6. _ _ _ L­‍ – a medical verb describing a process of repairing by natural processes, as by scar formation.

7. _ _ S _ T­‍ – the begining or start of something.

8. C _ _ _ _ _ _ O _ _ – capable of being passed on by direct contact with a diseased individual.

9. I _ _ _ _ _ _ _ U S­‍ – capable of being transmitted thanks to viruses, bacteria and other microorganisms.

10. _ _ S _ _ _ – any localized, usually well­‍‑defined area of diseased or injured tissue or of abnormal structural change.

 
Complete the text about standard treatment of Sutton’s aphthae with words from the table

The 1)____________ treatment of Sutton disease II involves the 2)___________ of topical anesthetic (i.e., lidocaine viscous) directly on the 3)__________ areas or a thorough mouth rinsing with a special anesthetic 4)________ that helps to reduce irritation and pain. The application of topical steroids may also give symptomatic relief. A dental protective paste (i.e., triamcinolone acetonide or Orabase) may prevent teeth, dental appliances and oral fluids from 5)__________ the ulcers.

In severe cases of Sutton disease II, oral and topical steroids may be 6)___________. A mouthrinse that contains the antibiotic tetracycline may also be prescribed to 7)_______ painful mouth sores. However, the use of antibiotics and steroids may promote the development of the 8)___________ that can cause thrush or oral candidiasis.

If treatment is started early, symptomatic relief may occur during the first day of treatment and new lesions may be healed. 9)________ oral ulcers generally require renewed efforts at treatment. Other treatment is symptomatic and supportive.

Translate these pieces of information/advice into Polish.

1. Rinsing with a warm­‍‑water solution and eating bland foods can minimize discomfort from major ulcers. …..........................................................................................................................................................................................................

2. If you have severe, recurring aphthaous ulcers, or if they are becoming worse, consult your dentist or physician. …...................................................................................................................................................................................................

3. Some research has shown that aphthae improve when deficiencies of iron, folate or vitamin B12 are treated. …................................................................................................................................................................................................................

4. Anesthetic medications or over­‍‑the­‍‑counter agents that are placed directly on the sores to coat them may help to remove discomfort. ….................................................................................................................................................................................................

5. Some steroid medications significantly shorten the healing time of the ulcers and prevent them from becoming larger. ….....................................................................................................................................................................................................

Lesson 54 answers