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Immunologic diseses of oral cavity
- 1. IMMUNOLOGIC DISEASES OF ORAL CAVITY
- 2. APTHOUS ULCERS Recurrent apthous ulcers are common painful mucosal conditions affecting oral mucosa. The term “aphthous” is derived from a Greek word “aphtha” which means ulceration
- 5. INCIDENCE
- 6. CLINICAL PRESENTATION RAS is characterized by recurrent bouts of solitary or multiple shallow painful ulcers Minor RAS is also known as Miculiz's aphthae or mild aphthous ulcers. It is the most common variant, constituting 80% of RAS. Ulcers vary from 8 to 10 mm in size. It is most commonly seen in the nonkeratinized mucosal surfaces like labial mucosa, buccal mucosa, and floor of the mouth. Ulcers heal within 10–14 days without scarring.
- 8. CLINICAL PRESENTATION Major RAS is also known as periadenitis mucosa necrotica recurrens or Sutton's disease. It affects about 10–15% of patients. Ulcers exceed 1 cm in diameter. Most common sites of involvement are lips, soft palate The ulcers persist for up to 6 weeks and heal with scarring.
- 10. CLINICAL PRESENTATION Herpetiform ulceration is characterized by recurrent crops of multiple ulcers May be up to 100 in number. These are small in size, measure 2–3 mm in diameter. Lesions may coalesce to form large irregular ulcers. These ulcers last for about 10–14 days.
- 11. HERPITIFORM TYPE OF ULCERS
- 12. PREDISPOSING FACTORS Trauma Genetic factors Tobacco Drugs Hematinic deficiency Gluten sensitivity Stress Hormonal changes Sodium lauryl sulfate containing tooth pastes
- 13. TREATMENT OF APTHOUS ULCERS Dietary and general measures 1. avoid spicy , hard and salty substances 2. sodium lauryl sulfate free tooth pastes Topical therapy 1. Lidocaine as 1% cream 2. 2% gel or spray; 3. Polidocanol as paste 4. Benzocaine lozenges.
- 14. Antiseptics and anti-inflammatory agents Mouth wash containing 0.15% triclosan in ethanol and zinc sulfate Diclofenac 3% in a 2.5% hyaluronic acid gel Chlorhexidine mouthwash and chamomile extract both reduced the frequency, increased healing speed, and decreased the severity of aphthous ulcers
- 15. Topical tetracycline treatment Using a mouthwash containing chlortetracycline 2.5% increased the number of ulcer-free or pain- free days significantly, Tetracycline hydrochloride powder 250 mg can be combined with 10 mL of tap water by the patient immediately before use to avoid stabilization problems. Because of the acid pH value, there may be temporary mucosal burning generally followed by clinical improvement. A stable mixture can also be prepared by neutralizing the tetracycline hydrochloride to create a basic product (6).
- 17. SYSTEMIC TOPICAL
- 20. BEHCET SYNDROME
- 28. REITERS SYNDROME An inflammatory arthritis of large joints, inflammation of the eyes in the form of conjunctivitis or uveitis, and urethritis in men or cervicitis in women.
- 30. CONTACT STOMATITIS Manifested by occurrence of itching and burning sensation Erythema follows vesicle , erosion occurs and may become extensive
- 31. Discontinue with the offending contact Materials enlisted- Dentrifices Mouth washes Lipsticks Cough drops Chewing gum
Editor's Notes
- RAS has been described under three different clinical variants as classified by Stanley in 1972
- opical tetracycline treatment Using a mouthwash containing chlortetracycline 2.5% increased the number of ulcer-free or pain-free days significantly, by 40% compared to a placebo (18) (Table 1) (EL 2A). In regards to pain reduction, a minocycline 0.2% mouthwash was superior to a tetracycline 0.25% mouthwash (19, e13) (Table 2) (EL 2A). Tetracycline hydrochloride powder 250 mg can be combined with 10 mL of tap water by the patient immediately before use to avoid stabilization problems. Because of the acid pH value, there may be temporary mucosal burning generally followed by clinical improvement. A stable mixture can also be prepared by neutralizing the tetracycline hydrochloride to create a basic product (6). Both a standardized formulation—as well as the less-stable freshly prepared solution—can produce rapid healing in some patients, even in those with large ulcers resistant to topical corticosteroids.
- Nd yag and er yag biostimulation
- Behcet's disease is a rare, chronic, lifelong disorder that involves inflammation of blood vessels throughout the body. Symptoms of Behcet's disease include recurrent oral ulcers (resembling canker sores), recurrent genital ulcers, and eye inflammation. The disorder may also cause various types of skin lesions, arthritis, bowel inflammation, and meningitis (inflammation of the membranes of the brain and spinal cord).
- Propolis topical application induced erosions