.It’s the most common non-traumatic ulceration
:Prevalence tend to be higher in
.Professionals.Upper socioeconomic group-
. Non smoker-
:The main cause is unknown, however
focal immune dysfunction .
endogenous or exogenous antigen .
non specific factor, such as trauma .
neuropeptide could mediate lymphocytes infiltration and
epithelial necrosis .
Focal release of cytokines .
B12 , folic acid and iron deficiency .
Hormonal alteration , stress and allergy .
Clinical features :
Topical / systemic
biopsy is usually unnecessary .
Non specific microscopic findings .
Differential diagnosis :
Other painful ulcerative conditions .
2- behcet`s syndrome :
Etiology : unknown , yet: immunodysfunction.
Clinical features : it affect : -nonkeratenized oral mucosa.
-CNS , as headache .
Histopathology : - T lymphocytes are prominent .
- neutrophilic within the vessel wall
Treatment : systemic steroids and immunosuppressive drugs .
3- reiter`s syndrome :
Etiology :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 .
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.
antigen antibody complex.
Clinical features : most common in young adult .
sites: buccal, tongue, lips, and palat.
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
Treatment : minor- symptomatic treatment.
major- topical corticosteroids with antifungal.
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
Histopathology: nonspecific ulcer.
Treatment: antihistamine and occasionally corticosteroids.
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.
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
Treatment: cytotoxic agent cyclophsphamide combined with corticosteroids.
8- 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.
Perforation can be seen.
Histopathology: acute and chronic inflammatory in partially necrotic
Treatment: local radiation.
9- 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.
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.