Ulcerative conditions


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Oral Pathology I
Third Year

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Ulcerative conditions

  2. 2. Immunological disease :Aphthous ulcer-1 .It’s the most common non-traumatic ulceration :Prevalence tend to be higher in .Professionals.Upper socioeconomic group- . Non smoker-
  3. 3. .Cont :Etiology :The main cause is unknown, however • • • • • • • focal immune dysfunction . endogenous or exogenous antigen . non specific factor, such as trauma . neuropeptide could mediate lymphocytes epithelial necrosis . Focal release of cytokines . B12 , folic acid and iron deficiency . Hormonal alteration , stress and allergy . infiltration and
  4. 4. Clinical features : Minor aphthae Major aphthae Herpetiform aphthae Size <0.5 cm >0.5 cm <0.5 cm Pain painful Sever pain Considerable pain location Nonkeratinized mucosa Nonkeratinized mucosa Any intraoral site Topical / systemic corticosteroids, immuno suppresive Topical/systimic corticosteroids , tetracycline mouth rinse treatment Topical corticosteroids , tetracycline mouth rinse
  5. 5. Histopathology : • biopsy is usually unnecessary . • Non specific microscopic findings . Differential diagnosis : • Other painful ulcerative conditions .
  6. 6. 2- behcet`s syndrome : Etiology : unknown , yet: immunodysfunction. Clinical features : it affect : -nonkeratenized oral mucosa. -eyes. -joints. -CNS , as headache . Histopathology : - T lymphocytes are prominent . - neutrophilic within the vessel wall ( vasiculitis). Treatment : systemic steroids and immunosuppressive drugs .
  7. 7. 3- reiter`s syndrome : Etiology : it’s a triad of nonspecific urethritis , conjuctivitis ,and arthritis that follow bacterial dysentry or sexually transimmible disease. An abnormal immune response to microbial antigen(s) is likely to be the mechanism for this syndrom . Clinical features : painless aphthous ulcer , its occurrence predominantly in white men in their third decayed . Treatment: NSAID .
  8. 8. 4- erythema multiform : it’s a hypersensitivity reaction that target skin lesion and/or ulcerative oral lesion . Etiology : minor form – HSV trigger. major form – triggered by certain drugs. hypersensitivity reaction. antigen antibody complex. Clinical features : most common in young adult . sites: buccal, tongue, lips, and palat.
  9. 9. .Cont Histopathology : Epithelial hyperplasia. Basal and parabasal apoptotic keratinocytes. Vesicle at epithelium-connective tissue interface. Infiltration of lymphocytes and macrophages. Differential diagnosis: for the oral expression of the disease: HSV infection , aphthous ulcers and pemphigus valgaris. Treatment : minor- symptomatic treatment. major- topical corticosteroids with antifungal.
  10. 10. 5- drug reaction: Etiology: 1-immunologic response (allergy), related to drug immunogenicity, frequency, rout of adminstration. 2-nonimmunologic response , realated to over dose, toxicity, side effect. Clinical features: urticaria, maculopopular rash,erythema,vesicle ulcers. angioedema appears as soft diffuse painless with swelling. Histopathology: nonspecific ulcer. Treatment: antihistamine and occasionally corticosteroids.
  11. 11. Contact allergy: It occurs directly adjacent to the causative agent (erythematous,vesicular, ulcerative lesion). Clinical features :mainly skin but when its in the oral cavity its due to mouth paste, mouth wash and chewing gum . Histopathology: nonspecific ulcer. Treatment : eleminate the causative agent. topical steroids may hasten the healing.
  12. 12. 6-Wegner`s granuloma: A systemic inflammatory condition of unknown etiology. Clinical features:upper respiratory tract,lung and kidney involvement Intraoral lesion consists of red, hyperplastic, granular lesion the attached gingiva. Histopathology: granulomatous lesion , necrosis and multinucleated giant cells. Treatment: cytotoxic agent cyclophsphamide combined with corticosteroids.
  13. 13. 7- midline granuloma : Etiology: occult T-cell lymphomas. Clinical features: a unifocal destructive process, generally in the midline of the oronasal region. Aggressive necrotic ulcer that is nonhealing. Proflation can be seen. Histopathology:acute and chronic inflammatory in partially necrotic tissue. Treatment: local radiation.
  14. 14. 8- chronic granulmatous: It’s a rare systemic disease caused by defect of (NADPH) oxidate complex that result in altered neutrophil and macrophages function . Manifistation appear during childhood, it affect the lymph nodes, lung, liver, spleen, bone and skin.
  15. 15. 9-Cyclic neutropenia: Its presented as sever cyclic depletions of neutrophils from the blood and marrow with periodicity of 21 days. Fever , malaise, oral ulcer and cervical lymphadenopathy can be seen.