[
   {
      "ID":0,
      "text":"Date of last update: Thursday 13 August 2026 at 10:31"
   },
   {
      "ID":1,
      "text":"Are the ulcers multiple or is there a persistent solitary ulcer?",
      "option1":{
         "label":"Multiple",
         "linkID":50
      },
      "option2":{
         "label":"Solitary",
         "linkID":3
      }
   },
   {
      "ID":3,
      "text":"Are there any signs of trauma for example from a broken tooth, restoration, orthodontic appliance or denture?",
      "imageItems":[
         {
            "description":"A traumatic ulcer - red based, well-defined circular with white margin on the lateral border of the tongue, due to a fractured amalgam restoration",
            "photos":[
               "Traumatic2.png"
            ]
         },
         {
            "description":"An ulcer on the lateral border of the tongue due to trauma from a tooth",
            "photos":[
               "Traumatic3.jpg"
            ]
         },
         {
            "description":"An ulcer in the buccal mucosa due to trauma from a sharp upper tooth",
            "photos":[
               "traumatic.jpg"
            ]
         },
         {
            "description":"Traumatic ulcer caused by a thermal burn from hot food",
            "photos":[
               "foodburn.jpg"
            ]
         }
      ],
      "option1":{
         "label":"Yes",
         "linkID":20
      },
      "option2":{
         "label":"No",
         "linkID":4
      }
   },
   {
      "ID":4,
      "text":"Does the ulcer have any features of an oral cancer eg rolled margin, firm to touch, speckled red and/or white appearance, spontaneous bleeding? Is there lymphadenopathy?",
      "imageItems":[
         {
            "description":"Oral cancer - lateral border of tongue with rolled margins",
            "photos":[
               "Suspicious_feature_1.jpg"
            ]
         },
         {
            "description":"Oral cancer - lateral border of tongue which is firm (indurated) on palpation",
            "photos":[
               "Suspicious_feature_2.jpg"
            ]
         },
         {
            "description":"Oral cancer - speckled red and white lesion on the inside corner of lip (commisure)",
            "photos":[
               "Suspicious_feature_3.jpg"
            ]
         },
         {
            "description":"Oral cancer - lateral border of the tongue with pin-point bleeding",
            "photos":[
               "Suspicious_feature_4.jpg"
            ]
         },
         {
            "description":"Oral cancer-ulcer on palate with red,speckled appearance",
            "photos":[
               "OralCancerOnPalate.jpg"
            ]
         },
         {
            "description":"Oral cancer-ulcer on ventral,posterior surface of  tongue, surrounded by white patch",
            "photos":[
               "OralCancerOnTongue1.jpg"
            ]
         },
         {
            "description":"Oral cancer-ulcer on posterior, lateral border of tongue",
            "photos":[
               "OralCancerOnTongue2.jpg"
            ]
         },
         {
            "description":"Oral cancer-ulcer with red,speckled appearance on ventral surface of tongue",
            "photos":[
               "OralCancerOnTongue3.jpg"
            ]
         },
         {
            "description":"Oral cancer - lingual side of lower incisor teeth",
            "photos":[
               "OralCancer.jpg"
            ]
         }
      ],
      "option1":{
         "label":"Yes",
         "linkID":5
      },
      "option2":{
         "label":"No",
         "linkID":10
      }
   },
   {
      "ID":5,
      "text":"URGENT 2 week head and neck suspected cancer referral - see NICE guidelines.<br><br>cks.nice.org.uk/topics/ head-neck-cancers-recognition-referral/",
      "imageItems":[
         {
            "description":"Oral cancer - lateral border of tongue with rolled margins",
            "photos":[
               "Suspicious_feature_1.jpg"
            ]
         },
         {
            "description":"Oral cancer - lateral border of tongue which is firm (indurated) on palpation",
            "photos":[
               "Suspicious_feature_2.jpg"
            ]
         },
         {
            "description":"Oral cancer - speckled red and white lesion on the inside corner of lip (commisure)",
            "photos":[
               "Suspicious_feature_3.jpg"
            ]
         },
         {
            "description":"Oral cancer - lateral border of the tongue with pin-point bleeding",
            "photos":[
               "Suspicious_feature_4.jpg"
            ]
         },
         {
            "description":"Oral cancer-ulcer on palate with red,speckled appearance",
            "photos":[
               "OralCancerOnPalate.jpg"
            ]
         },
         {
            "description":"Oral cancer-ulcer on ventral,posterior surface of  tongue, surrounded by white patch",
            "photos":[
               "OralCancerOnTongue1.jpg"
            ]
         },
         {
            "description":"Oral cancer-ulcer on posterior, lateral border of tongue",
            "photos":[
               "OralCancerOnTongue2.jpg"
            ]
         },
         {
            "description":"Oral cancer-ulcer with red,speckled appearance on ventral surface of tongue",
            "photos":[
               "OralCancerOnTongue3.jpg"
            ]
         },
         {
            "description":"Oral cancer - lingual side of lower incisor teeth",
            "photos":[
               "OralCancer.jpg"
            ]
         }
      ]
   },
   {
      "ID":10,
      "text":"Is the ulcer surrounded by a white area which may be reticular (lace-like) in appearance?",
      "imageItems":[
         {
            "description":"Ulcerative lichen planus on buccal mucosa with white reticular border.",
            "photos":[
               "white_reticular.png"
            ]
         },
         {
            "description":"Ulcerative lichen planus on hard palate with faint white reticular border",
            "photos":[
               "OralLP.png"
            ]
         },
         {
            "description":"Lichenoid reaction to amalgam restoration on the side of the tooth",
            "photos":[
               "lichenoid_contact_lesion.png"
            ]
         },
         {
            "description":"Ulcerative lichen planus - single ulcer surrounded by faint area of reticulation. There is superimposed trauma from upper teeth",
            "photos":[
               "lichen_planus.jpg"
            ]
         }
      ],
      "option1":{
         "label":"Yes",
         "linkID":11
      },
      "option2":{
         "label":"No",
         "linkID":15
      }
   },
   {
      "ID":11,
      "text":"This is suggestive of oral lichen planus, or a lichenoid contact reaction to an amalgam restoration.<br>Oral lichen planus may also present as multiple ulcers.",
      "imageItems":[
         {
            "description":"Ulcerative lichen planus on buccal mucosa with white reticular border",
            "photos":[
               "white_reticular.png"
            ]
         },
         {
            "description":"Ulcerative lichen planus on hard palate with faint white reticular border",
            "photos":[
               "OralLP.png"
            ]
         },
         {
            "description":"Lichenoid reaction to amalgam restoration on the side of the tooth",
            "photos":[
               "lichenoid_contact_lesion.png"
            ]
         },
         {
            "description":"Ulcerative lichen planus - single ulcer surrounded by faint area of reticulation. There is superimposed trauma from upper teeth",
            "photos":[
               "lichen_planus.jpg"
            ]
         }
      ],
      "option1":{
         "label":"Management",
         "linkID":12
      },
      "option2":{
         "label":"Referral guidance",
         "linkID":14
      }
   },
   {
      "ID":12,
      "text":"Therapy for Oral Lichen Planus:<br><br>    Benzydamine mouthwash or spray<br><br>    Betamethasone mouthwash<br><br>    Beclometasone spray 50mcg<br><br>These topical preparations are available for NHS prescribing by dentists and GPs: See current BNF/List of Dental Preparations."
   },
   {
      "ID":912,
      "text":"If ulcer is painful :-<br>Analgesic mouthwash (Difflam)<br><br>Consider topical corticosteroid spray or rinse."
   },
   {
      "ID":13,
      "text":"Refer to Oral and Maxillofacial Surgery - Oral Surgery / Oral Medicine for definitive diagnosis.<br>If patient has gut signs and/or symptoms, refer to GP.",
      "imageItems":[
         {
            "description":"Nicorandil - drug-induced ulceration on dorsum of tongue",
            "photos":[
               "nicorandil.jpg"
            ]
         },
         {
            "description":"Bisphosphonate drug-induced ulceration on lip due to retention of bisphosphonate medication",
            "photos":[
               "bisphos_on_lip.jpg"
            ]
         },
         {
            "description":"Bisphosphonate drug-induced ulceration on tongue due to retention of bisphosphonate medication",
            "photos":[
               "bisphos_on_tongue.jpg"
            ]
         }
      ],
      "option1":{
         "label":"Further information",
         "linkID":30
      }
   },
   {
      "ID":14,
      "text":"Refer to Oral Medicine / Oral and Maxillofacial Surgery or Oral Surgery for definitive diagnosis."
   },
   {
      "ID":15,
      "text":"Has the patient started any new medication (for example Nicorandil), had a change of dosage or are medications being held in the mouth before swallowing?",
      "option1":{
         "label":"Yes",
         "linkID":40
      },
      "option2":{
         "label":"No",
         "linkID":16
      },
      "imageItems":[
         {
            "description":"Nicorandil - drug-induced ulceration on dorsum of tongue",
            "photos":[
               "nicorandil.jpg"
            ]
         },
         {
            "description":"Nicorandil - drug-induced ulceration on side of tongue",
            "photos":[
               "Nicorandil_ulceration_diffuse_tongue.jpg"
            ]
         },
         {
            "description":"Bisphosphonate drug-induced ulceration on lip due to retention of bisphosphonate medication",
            "photos":[
               "bisphos_on_lip.jpg"
            ]
         },
         {
            "description":"Bisphosphonate drug-induced ulceration on tongue due to retention of bisphosphonate medication",
            "photos":[
               "bisphos_on_tongue.jpg"
            ]
         }
      ]
   },
   {
      "ID":16,
      "text":"Does the patient have any signs/symptoms of Oral Crohn's disease / OroFacial Granulomatosis (OFG), including linear ulceration in sulci, cobblestoning of mucosa, persistent swelling of lip(s)?",
      "option1":{
         "label":"Yes",
         "linkID":25
      },
      "option2":{
         "label":"No",
         "linkID":17
      },
      "imageItems":[
         {
            "description":"Oral Crohn's - slit-like, linear ulceration in sulcus",
            "photos":[
               "ofg.jpg"
            ]
         },
         {
            "description":"Oral Crohn's - slit-like, linear ulceration in sulcus",
            "photos":[
               "linear_ulcer.jpg"
            ]
         },
         {
            "description":"Orofacial Granulomatosis (OFG) - cobblestoning on buccal mucosa",
            "photos":[
               "cobblestoning.jpg"
            ]
         },
         {
            "description":"OroFacial Granulomatosis (OFG) - persistent lip swelling",
            "photos":[
               "lip_swelling.jpg"
            ]
         }
      ]
   },
   {
      "ID":17,
      "text":"Consider other, less common causes of a persistent oral ulcer, e.g.<br>  tuberculosis<br>  syphilis<br>  sarcoidosis<br>  HIV<br>  lymphoma<br>  oral metastasis<br><br>and refer to Oral Medicine / Oral and Maxillofacial Surgery or Oral Surgery for definitive diagnosis.",
      "imageItems":[
         {
            "description":"non-specific oral ulceration on the left posterior buccal mucosa in a patient with HIV",
            "photos":[
               "HIV_oral_ulceration.jpg"
            ]
         },
         {
            "description":"Primary syphilis - chancre on lip",
            "photos":[
               "primary_syphillis.jpg"
            ]
         },
         {
            "description":"Secondary syphilis - snail-track ulcer",
            "photos":[
               "snailtrackulcer.png"
            ]
         },
         {
            "description":"Oral metastasis from lung cancer, ulcer on alveolar mucosa: non-healing extraction socket",
            "photos":[
               "metastasis.jpg"
            ]
         }
      ]
   },
   {
      "ID":20,
      "text":"Management:<br><br>Remove cause of trauma and review in 2 weeks.<br><br>Is it resolved or improving?",
      "option1":{
         "label":"Yes",
         "linkID":21
      },
      "option2":{
         "label":"No",
         "linkID":4
      },
      "imageItems":[
         {
            "description":"A traumatic ulcer - red based, well-defined circular with white margin on the lateral border of the tongue, due to a fractured amalgam restoration.",
            "photos":[
               "Traumatic2.png"
            ]
         },
         {
            "description":"An ulcer on the lateral border of the tongue due to trauma from a tooth",
            "photos":[
               "Traumatic3.jpg"
            ]
         },
         {
            "description":"An ulcer on the buccal mucosa due to trauma from a sharp upper tooth",
            "photos":[
               "traumatic.jpg"
            ]
         },
         {
            "description":"Traumatic ulcer caused by a thermal burn from hot food.",
            "photos":[
               "foodburn.jpg"
            ]
         }
      ]
   },
   {
      "ID":21,
      "text":"Likely to be a traumatic ulcer – reassure and review until completely resolved.<br><br>If no resolution, or there are suspicious features, refer on urgent 2-week Head and Neck suspected cancer referral.<br>See NICE guidelines.<br><br>cks.nice.org.uk/topics/ head-neck-cancers-recognition-referral/"
   },
   {
      "ID":25,
      "text":"This is likely to be OFG / Oral Crohn's:<br>Sulcular ulceration may be bilateral. Patient may also present with recurrent oral ulceration.",
      "option1":{
         "label":"Management",
         "linkID":26
      },
      "option2":{
         "label":"Referral guidance",
         "linkID":27
      },
      "imageItems":[
         {
            "description":"Oral Crohn's - slit-like, linear ulceration in sulcus",
            "photos":[
               "ofg.jpg"
            ]
         },
         {
            "description":"Oral Crohn's - slit-like, linear ulceration in sulcus",
            "photos":[
               "linear_ulcer.jpg"
            ]
         },
         {
            "description":"Orofacial Granulomatosis (OFG) - cobblestoning on buccal mucosa",
            "photos":[
               "cobblestoning.jpg"
            ]
         },
         {
            "description":"OroFacial Granulomatosis (OFG) - persistent lip swelling",
            "photos":[
               "lip_swelling.jpg"
            ]
         }
      ]
   },
   {
      "ID":26,
      "text":"Therapy for OFG / oral Crohn's-related oral ulceration<br><br>    Benzydamine mouthwash or spray<br><br>    Betamethasone mouthwash<br><br>    Beclometasone spray 50mcg<br><br>These topical preparations are available for NHS prescribing by dentists and GPs: See current BNF/List of Dental Preparations."
   },
   {
      "ID":27,
      "text":"Refer to Oral Medicine / Oral and Maxillofacial Surgery or Oral Surgery for definitive diagnosis.<br>If patient has gut signs and/or symptoms, refer to GP."
   },
   {
      "ID":30,
      "text":"Examples of drugs that may cause oral ulceration:<br><br>Systemic:<br>  Nicorandil<br>  Chemotherapeutic Agents<br><br>Topical:<br>  Bisphosphonates<br>  Aspirin"
   },
   {
      "ID":40,
      "text":"This could be drug-induced oral ulceration.",
      "option1":{
         "label":"Management",
         "linkID":41
      },
      "option2":{
         "label":"Referral guidance",
         "linkID":45
      },
      "imageItems":[
         {
            "description":"Nicorandil - drug-induced ulceration on dorsum of tongue",
            "photos":[
               "nicorandil.jpg"
            ]
         },
         {
            "description":"Nicorandil - drug-induced ulceration on side of tongue",
            "photos":[
               "Nicorandil_ulceration_diffuse_tongue.jpg"
            ]
         },
         {
            "description":"Bisphosphonate drug-induced ulceration on lip due to retention of bisphosphonate medication",
            "photos":[
               "bisphos_on_lip.jpg"
            ]
         },
         {
            "description":"Bisphosphonate drug-induced ulceration on tongue due to retention of bisphosphonate medication",
            "photos":[
               "bisphos_on_tongue.jpg"
            ]
         }
      ]
   },
   {
      "ID":41,
      "text":"If ulcer is painful :<br><br>    Benzydamine mouthwash or spray<br><br>    Betamethasone mouthwash<br><br>    Beclometasone spray 50mcg<br><br>These topical preparations are available for NHS prescribing by dentists and GPs: See current BNF/List of Dental Preparations.<br><br>Do not stop any medication without advice from GP or specialist."
   },
   {
      "ID":45,
      "text":"Refer to Oral Medicine / Oral and Maxillofacial Surgery or Oral Surgery for definitive diagnosis."
   },
   {
      "ID":50,
      "text":"Have the ulcers been recurrent with an ulcer-free period?",
      "option1":{
         "label":"Yes",
         "linkID":61
      },
      "option2":{
         "label":"No",
         "linkID":53
      }
   },
   {
      "ID":51,
      "text":"Consider acute viral infection or Erythema Multiforme.",
      "option1":{
         "label":"Viral infections",
         "linkID":80
      },
      "option2":{
         "label":"Erythema Multiforme",
         "linkID":81
      }
   },
   {
      "ID":53,
      "text":"Is this a single episode of multiple oral ulcers?",
      "option1":{
         "label":"Yes",
         "linkID":51
      },
      "option2":{
         "label":"No",
         "linkID":55
      }
   },
   {
      "ID":55,
      "text":"Are the ulcers surrounded by a white area which may be reticular (lace-like) in appearance?",
      "imageItems":[
         {
            "description":"Ulcerative lichen planus on buccal mucosa with white reticular border.",
            "photos":[
               "white_reticular.png"
            ]
         },
         {
            "description":"Ulcerative lichen planus on side of tongue",
            "photos":[
               "OLP large ulcer on side of tongue.jpg"
            ]
         },
         {
            "description":"Ulcerative lichen planus on the buccal mucosa",
            "photos":[
               "OLP buccal mucosa.jpg"
            ]
         },
         {
            "description":"Lichenoid drug reaction.",
            "photos":[
               "LDR1.png"
            ]
         },
         {
            "description":"Lichenoid drug reaction.",
            "photos":[
               "LDR2.png"
            ]
         }
      ],
      "option1":{
         "label":"Yes",
         "linkID":56
      },
      "option2":{
         "label":"No",
         "linkID":65
      }
   },
   {
      "ID":56,
      "text":"This is suggestive of oral lichen planus, or a lichenoid drug reaction.<br>Oral lichen planus may also present as a solitary ulcer.",
      "imageItems":[
         {
            "description":"Ulcerative lichen planus on buccal mucosa with white reticular border.",
            "photos":[
               "white_reticular.png"
            ]
         },
         {
            "description":"Ulcerative lichen planus on side of tongue",
            "photos":[
               "OLP large ulcer on side of tongue.jpg"
            ]
         },
         {
            "description":"Ulcerative lichen planus on the buccal mucosa",
            "photos":[
               "OLP buccal mucosa.jpg"
            ]
         },
         {
            "description":"Lichenoid drug reaction.",
            "photos":[
               "LDR1.png"
            ]
         },
         {
            "description":"Lichenoid drug reaction.",
            "photos":[
               "LDR2.png"
            ]
         }
      ],
      "option1":{
         "label":"Management",
         "linkID":12
      },
      "option2":{
         "label":"Referral guidance",
         "linkID":14
      }
   },
   {
      "ID":60,
      "text":"[not used] Is there an ulcer-free period?",
      "option1":{
         "label":"Yes",
         "linkID":61
      },
      "option2":{
         "label":"No",
         "linkID":65
      }
   },
   {
      "ID":61,
      "text":"The most likely diagnosis is Recurrent Aphthous Stomatitis RAS (Recurrent Oral Ulceration), which generally has three clinical presentations.",
      "option1":{
         "label":"Management & information",
         "linkID":70
      },
      "option2":{
         "label":"Referral guidance",
         "linkID":71
      },
      "imageItems":[
         {
            "description":"Minor RAS-multiple ulcers on buccal mucosa",
            "photos":[
               "minorRAS1.jpg"
            ]
         },
         {
            "description":"Minor RAS - multiple ulcers on tongue",
            "photos":[
               "MinorRAS2.jpg"
            ]
         },
         {
            "description":"Minor RAS - two ulcers on tongue",
            "photos":[
               "minor_tip_tongue.jpg"
            ]
         },
         {
            "description":"Minor RAS - with marked erythematous border",
            "photos":[
               "minor_tongue.jpg"
            ]
         },
         {
            "description":"Major RAS - labial mucosa",
            "photos":[
               "mjau.png"
            ]
         },
         {
            "description":"Major RAS on palate",
            "photos":[
               "major_palate.png"
            ]
         },
         {
            "description":"Mixed Major and Minor RAS on hard and  soft palate",
            "photos":[
               "MinorRAS3.jpg"
            ]
         },
         {
            "description":"RAS herpetiform ulceration",
            "photos":[
               "RAS edit.jpg"
            ]
         }
      ]
   },
   {
      "ID":65,
      "text":"Consider other possible diagnoses for widespread oral ulceration - these include Immunobullous disease (e.g. oral pemphigus, or pemphigoid) and HIV infection.",
      "option1":{
         "label":"Management",
         "linkID":66
      },
      "option2":{
         "label":"Referral",
         "linkID":67
      },
      "imageItems":[
         {
            "description":"Oral pemphigus - ulceration on tongue and lips",
            "photos":[
               "OPonTongueAndLips1.jpg"
            ]
         },
         {
            "description":"Oral pemphigus - ulceration on tongue and lips",
            "photos":[
               "OPonTongueAndLips2.jpg"
            ]
         },
         {
            "description":"Oral pemphigus - extensive palatal ulceration",
            "photos":[
               "pv.jpg"
            ]
         },
         {
            "description":"Pemphigoid - ulceration and scarring on palate",
            "photos":[
               "mmp.jpg"
            ]
         },
         {
            "description":"Pemphigoid - palatal ulceration",
            "photos":[
               "MMP 2.jpg"
            ]
         }
      ]
   },
   {
      "ID":66,
      "text":"Check history for extra-oral signs/symptoms including skin, eye and genital involvement.<br><br>Therapy for widespread oral ulceration:<br><br>    Benzydamine mouthwash or spray<br><br>    Betamethasone mouthwash<br><br>    Beclometasone spray 50mcg<br><br>These topical preparations are available for NHS prescribing by dentists and GPs: See current BNF/List of Dental Preparations."
   },
   {
      "ID":67,
      "text":"Refer to Oral Medicine / Oral and Maxillofacial Surgery or Oral Surgery for definitive diagnosis."
   },
   {
      "ID":70,
      "text":"Therapy for RAS:<br><br>    Chlorhexidine mouthwash or spray<br><br>    Benzydamine mouthwash or spray<br><br>    Betamethasone mouthwash<br><br>    Beclometasone spray 50mcg<br><br>    Doxycycline mouthwash<br><br>These topical preparations are available for NHS prescribing by dentists and GPs. See current BNF / List of Dental Preparations.",
      "option2":{
         "label":"Additional information",
         "linkID":200
      },
      "imageItems":[
         {
            "description":"Minor RAS-multiple ulcers on buccal mucosa",
            "photos":[
               "minorRAS1.jpg"
            ]
         },
         {
            "description":"Minor RAS - multiple ulcers on tongue",
            "photos":[
               "MinorRAS2.jpg"
            ]
         },
         {
            "description":"Minor RAS - two ulcers on tongue",
            "photos":[
               "minor_tip_tongue.jpg"
            ]
         },
         {
            "description":"Minor RAS - with marked erythematous border",
            "photos":[
               "minor_tongue.jpg"
            ]
         },
         {
            "description":"Major RAS - labial mucosa",
            "photos":[
               "mjau.png"
            ]
         },
         {
            "description":"Major RAS on palate",
            "photos":[
               "major_palate.png"
            ]
         },
         {
            "description":"Mixed Major and Minor RAS on hard and  soft palate",
            "photos":[
               "MinorRAS3.jpg"
            ]
         },
         {
            "description":"RAS herpetiform ulceration",
            "photos":[
               "RAS edit.jpg"
            ]
         }
      ]
   },
   {
      "ID":71,
      "text":"Refer to Oral Medicine / Oral and Maxillofacial Surgery or Oral Surgery if:<br><br>No response to topical therapy<br>Severe ulceration<br>Atypical presentation<br>Genital and/or eye symptoms (Behçet's disease?)<br><br>GMP to consider blood tests:<br>Full Blood Count<br>Haematinics<br>Coeliac screen."
   },
   {
      "ID":80,
      "text":"Viral infections, for example Primary Herpetic Gingivostomatitis, Herpes Zoster (oral involvement), Coxsackie viruses.",
      "option1":{
         "label":"Management",
         "linkID":121
      },
      "option2":{
         "label":"Referral guidance",
         "linkID":120
      },
      "imageItems":[
         {
            "description":"Primary Herpetic Gingivostomatitis - widespread gingival / oral ulceration",
            "photos":[
               "HSV_a.png"
            ]
         },
         {
            "description":"Primary Herpetic Gingivostomatitis-multiple ulcers on oral mucosa with lip ulceration and crusting",
            "photos":[
               "primaryHerpeticGingivostomatitis.jpg"
            ]
         },
         {
            "description":"Primary Herpetic Gingivostomatitis - multiple ulcers on the tongue",
            "photos":[
               "HSV_b.jpg"
            ]
         },
         {
            "description":"Coxsackievirus infection - multiple vesicles affecting the soft palate",
            "photos":[
               "Viral Ulceration.jpg"
            ]
         },
         {
            "description":"Herpes Zoster (shingles) - unilateral oral ulceration on palate",
            "photos":[
               "HZ.jpg"
            ]
         }
      ]
   },
   {
      "ID":81,
      "text":"Erythema Multiforme: oral involvement with/without skin lesions.",
      "imageItems":[
         {
            "description":"Erythema Multiforme - widepsread oral ulceration and crusting of the lips",
            "photos":[
               "oral_EM.jpg"
            ]
         },
         {
            "description":"Erythema Multiforme - ulceration and crusting of the lip",
            "photos":[
               "EMcrustingOfLip.jpg"
            ]
         },
         {
            "description":"Erythema Multiforme - erythematous target lesion on skin",
            "photos":[
               "Target Lesion.jpg"
            ]
         },
         {
            "description":"Erythema Multiforme - skin involvement (target lesions)",
            "photos":[
               "skin_EM.jpg"
            ]
         }
      ],
      "option2":{
         "label":"Referral guidance",
         "linkID":95
      },
      "option1":{
         "label":"Management",
         "linkID":110
      }
   },
   {
      "ID":95,
      "text":"Consider referral to Oral Medicine / Oral and Maxillofacial Surgery, Oral Surgery or GP. If acutely unwell/dehydrated, may need hospitalisation."
   },
   {
      "ID":110,
      "text":"Management of Erythema Multiforme<br><br>    Chlorhexidine mouthwash or spray<br><br>    Benzydamine mouthwash or spray<br><br>    Betamethasone mouthwash<br><br>    Beclometasone spray 50mcg<br><br>Systemic corticosteroids if severe - via GP or Secondary Care.<br><br>For more details, see current BNF / List of Dental Preparations."
   },
   {
      "ID":120,
      "text":"Consider referral to Oral Medicine / Oral and Maxillofacial Surgery, Oral Surgery or GP. If acutely unwell/dehydrated, may need hospitalisation."
   },
   {
      "ID":121,
      "text":"Management of acute viral infections.<br><br><br>Fluids, analgesics (systemic and Benzydamine mouthwash or spray).<br><br>Consider systemic aciclovir for Primary Herpetic Gingivostomatitis.<br><br>High-dose systemic aciclovir for Herpes Zoster - risk of ocular spread."
   },
   {
      "ID":200,
      "text":"Clinical features of RAS: Size, Duration Number of Ulcers - these may vary.<br><br>Minor RAS<br>    10mm or less<br>    7 - 14 days<br>    1 - 5 ulcers<br><br>Major RAS<br>    10mm or more<br>    1 - 3 months<br>    1 - 3 ulcers<br>    (often heals with scarring)<br><br>RAS-Herpetiform<br>    1 - 2mm<br>    7 - 14 days<br>    multiple ulcers"
   }
]