SEMINAR ON CANCRUM ORIS
AND APTHOUS STOMATITIS
INDIAN DENTAL ACADEMY
Leader in continuing dental education
www.indiandenta...
NOMA OR CANCRUM ORIS:
 It is also called as gangrenous
stomatitis.
 Rapidly spreading gangrene.
 Occur in debilitated o...
PREDISPOSING FACTORS:
 A) undernourished person.
 B)Debilitated person having infections
like Diphtheria,dysentery,measl...
 Noma is considered as a secondary
complication rather then a primary
disease.
 Causative organism-a)vincent‘s
organism
...
 Selye reported the production of a
noma like condition in rats as a result of
simultaneous administration of
cortisone a...
 Condition usually began around the gingiva
and progressed to destruction of the floor of
the mouth and lower lip.
 Susc...
 Clinical features: Start
with the small ulcer in
the gingival mucosa
which rapidly spreads
and involves the
surroundings...
 Initial site is an area of stagnation
around a fixed bridge and crown the
overlying skin becomes inflamed,
edematous and...
out leaving the jaw exposed.
 The commencement of gangrene is
denoted by the appearance of
blackening of the skin.
 Necr...
 Palate and tongue can also be involved
by this process.
 High temperature during the Course of
the disease.
www.indiand...
 Mortality rate:75%
 Treatment:Immediate treatment of
malnutrition.
www.indiandentalacademy.com
APTHOUS STOMATITIS
 Characterized by painful,recurring solitary or
multiple ulceration of the oral mucosa.
 Incidence-20...
 2)Immunologicabnormal
ities:
Lehner:a)autoimmune
response
b)detected IgM
and IgG antibody in
epithelial cell of the
spin...
 Cohen:a) not an
autoimmune
disease.
b)local
immune response
against an
antigenically altered
oral mucosa.
www.indiandent...
 results of diffusion of bacterial toxins, food
and other substance acting as allergen.
 Donatsky-elevated gamma globuli...
 5)focal release of neuropeptide.
 6)viral infection.
 7)deficiency of folic acid and iron-
 Wray reported –after exam...
12)seen in HIVpatients
www.indiandentalacademy.com
 Precipitating factors:Trauma-
Graycowaski-local trauma is an factor in
75% of the cases.
 Self-inflicted bite
 Oral su...
 Endocrine condition-relationship between
occurrence of the menstrual period and
development of apthous ulcer.
 Related ...
 Psychic factors-association with acute
psychological problem and stress.
 Allergic factor-association with asthma
hey f...
 Clinical features:4 forms-1)minor
2)major
3)herpetiform
4)ulcer associated
with Bechets syndrome.
 Main difference betw...
 Minor apthous ulcer-
most commonly
occurred form.
 Age-10 to 30 years.
 Occurrence early in life.
 Disease persist wi...
 Ulcer will not preceded by vesicles and
it appear on the tongue, buccal
mucosa, floor of the mouth.
 Rarely present on ...
 One or two attacks in a year,one or two
attacks in a month ,never free from
lesion.
 Appear as a single,painful
ulcer,d...
 Generalized edema of the oral cavity.
 Parasthesia
 Low grade fever
 Localized lymphoadenopathy
 Vesicle like lesion...
 Common site of occurrence:buccal and
labial mucosa
 Buccal and lingual sulci
 Soft palate,gingiva labial mucosa.
www.i...
 Lateral and ventral
surface of the
tongue is also
affected.
www.indiandentalacademy.com
 Heal in 7 to 1o days without scar
formation.
 Oral manifestation include mucosal
fissure,small multiple hyperplastic
no...
www.indiandentalacademy.com
 Major apthous ulcer:most sever expression of
apthous stomatitis.
 1 to 10 in number present in lips,cheeks
tongue, soft...
 Difficulties in eating,pain and
discomfort.
 Show similar lesion in vagina,penis
larynx.
 No particular age group,fema...
 Herpetiform ulcer-present as a crop of
ulcers.
 100 in numbers.
 Palatal and gingival mucosa are
involved.
 Pain is p...
 Here the ulcer will be preceded by vesicle
and exhibit no virus infected cell.
 Brooke and sapp-numerous small lesion
f...
 Laboratory test-no herpes simplex virus
is cultured.
 Absence of multinucleated giant cell.
 No antibodies against her...
www.indiandentalacademy.com
www.indiandentalacademy.com
 Histopathology:minor apthous ulcer-
fibrinopurulent membrane covering the
ulcerated area.
 Superficial colonies of micr...
 Lesion begin at the excretory duct of
minor salivary gland.
 Wood-anitschkow cell.
 Mononuclear cell in submucosa and ...
 Presence of macrophages and mast
cells.
 Differential diagnosis:1)herpes simplex
infection.
 Trauma.
 Pemphigus vulga...
 Treatment:mouth rinse-sodium bicarbonate in
warm water.
 Drug-prednisone-20 to 40 mg daily for a week
 Topical cortico...
 Steroid ointment-1.5 %cortisone
acetate applied locally.
 Hydrocortisone acetate antibiotics
lozenges.
 Chemical caute...
 250 mg of capsule in 30 ml of warm
water.(4 times in a day for 4 day)
 Other
drugs:azathioprine,cyclophosphamide.
Thail...
www.indiandentalacademy.com
 BEHCETS SYNDROME:Uncertain
etiology.
 Pleuropnumonia like organism.
 Autoimmune etiology.
 Lehner-immunologic similar...
 Clinical features:between 10 to 45 year
of age.
 Oral and genital ulceration,ocular
lesion,skin lesion.
 Oral lesion-f...
 Size ranging from several millimeter to
centimeter or more in diameter.
 Ulcer have an erythematous border and
covered ...
 Simple conjunctivitis to finally uveitis
and finally popyon
 Skin lesions –small papules on the
trunk and limbs and aro...
www.indiandentalacademy.com
www.indiandentalacademy.com
 Histologic features-similar to recurrent
apthous stomatitis.
 Endothelial proliferation.
 Vasculitis.
 Laboratory fin...
 Treatment and prognosis-supportive
treatment.
 Remission after a period of months to
years.
 Serious complication can ...
For more details please visit
www.indiandentalacademy.com
www.indiandentalacademy.com
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Cancrum /certified fixed orthodontic courses by Indian dental academy

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The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.

Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078

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Cancrum /certified fixed orthodontic courses by Indian dental academy

  1. 1. SEMINAR ON CANCRUM ORIS AND APTHOUS STOMATITIS INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com www.indiandentalacademy.com
  2. 2. NOMA OR CANCRUM ORIS:  It is also called as gangrenous stomatitis.  Rapidly spreading gangrene.  Occur in debilitated or nutritionally deficient person.  Mainly seen in children but also occur in adults. www.indiandentalacademy.com
  3. 3. PREDISPOSING FACTORS:  A) undernourished person.  B)Debilitated person having infections like Diphtheria,dysentery,measles, pneumonia,scarlet fever,syphilis, tuberculosis and blood dyscrasias including anemia. www.indiandentalacademy.com
  4. 4.  Noma is considered as a secondary complication rather then a primary disease.  Causative organism-a)vincent‘s organism  b)secondary infection by streptococci,staphylococci and diphtheria bacilli. www.indiandentalacademy.com
  5. 5.  Selye reported the production of a noma like condition in rats as a result of simultaneous administration of cortisone and clipping of the mandibular incisor forcing the animals to chew with their gingiva and thus to cause excessive mechanical injury to mucosa. www.indiandentalacademy.com
  6. 6.  Condition usually began around the gingiva and progressed to destruction of the floor of the mouth and lower lip.  Susceptibility to tissue injury which was produced by cortisone and this can be eliminated by pituitary growth hormone.  Selye suggested that Noma may not necessarily be due to a specific pathogenic agent but may be due to a pathogenic situation. www.indiandentalacademy.com
  7. 7.  Clinical features: Start with the small ulcer in the gingival mucosa which rapidly spreads and involves the surroundings tissue of the jaws, lips ,and cheeks by gangrenous necrosis. www.indiandentalacademy.com
  8. 8.  Initial site is an area of stagnation around a fixed bridge and crown the overlying skin becomes inflamed, edematous and finally necrotic with the result that a line of demarcation develops between healthy and dead tissue,and large masses of the tissue slough www.indiandentalacademy.com
  9. 9. out leaving the jaw exposed.  The commencement of gangrene is denoted by the appearance of blackening of the skin.  Necrosis of the buccal fat pad and subcutaneous fat pad is reported.  Foul odor has arised from gangrenous tissue. www.indiandentalacademy.com
  10. 10.  Palate and tongue can also be involved by this process.  High temperature during the Course of the disease. www.indiandentalacademy.com
  11. 11.  Mortality rate:75%  Treatment:Immediate treatment of malnutrition. www.indiandentalacademy.com
  12. 12. APTHOUS STOMATITIS  Characterized by painful,recurring solitary or multiple ulceration of the oral mucosa.  Incidence-20 %to 60%.  Prevalence:higher in professional person and socioeconomic group.  Etiology-1)bacterial infection-L form streptococus isolated from lesion.  Herpes simplex virus can not be isolated. Images3.jpg www.indiandentalacademy.com
  13. 13.  2)Immunologicabnormal ities: Lehner:a)autoimmune response b)detected IgM and IgG antibody in epithelial cell of the spinous layer of the oral cavity.  Addy and dolby:normal level of complement and antinuclear factor. www.indiandentalacademy.com
  14. 14.  Cohen:a) not an autoimmune disease. b)local immune response against an antigenically altered oral mucosa. www.indiandentalacademy.com
  15. 15.  results of diffusion of bacterial toxins, food and other substance acting as allergen.  Donatsky-elevated gamma globulin level against sterptococus.  Recurrent apthous stomatitis-altered immune response which is directed against non pathogenic oral flora and host oral tissue.  4)chemical mediator www.indiandentalacademy.com
  16. 16.  5)focal release of neuropeptide.  6)viral infection.  7)deficiency of folic acid and iron-  Wray reported –after examining 330 patients  47-total deficient person  23 deficient in iron,7 deficient in folic acid,6 in vitamin B12 deficiency,11 had combined deficiency.  8)patient with malabsorption condition. www.indiandentalacademy.com
  17. 17. 12)seen in HIVpatients www.indiandentalacademy.com
  18. 18.  Precipitating factors:Trauma- Graycowaski-local trauma is an factor in 75% of the cases.  Self-inflicted bite  Oral surgical procedure  Tooth brushing  Dental procedure,needle injection and needle trauma. www.indiandentalacademy.com
  19. 19.  Endocrine condition-relationship between occurrence of the menstrual period and development of apthous ulcer.  Related with the level of progesterone  Woman have remission of disease during pregnancy.  Onset of disease associated with menopause and menarche. www.indiandentalacademy.com
  20. 20.  Psychic factors-association with acute psychological problem and stress.  Allergic factor-association with asthma hey fever,food or drug allergy. www.indiandentalacademy.com
  21. 21.  Clinical features:4 forms-1)minor 2)major 3)herpetiform 4)ulcer associated with Bechets syndrome.  Main difference between 3 groups-clinically and degree of severity.  Tingling and burning of oral mucosa before starting the treatment. www.indiandentalacademy.com
  22. 22.  Minor apthous ulcer- most commonly occurred form.  Age-10 to 30 years.  Occurrence early in life.  Disease persist with recurring attacks.  20% of population affected.  Mainly in professional school students.  Familial association.www.indiandentalacademy.com
  23. 23.  Ulcer will not preceded by vesicles and it appear on the tongue, buccal mucosa, floor of the mouth.  Rarely present on hard palate and attached gingiva. www.indiandentalacademy.com
  24. 24.  One or two attacks in a year,one or two attacks in a month ,never free from lesion.  Appear as a single,painful ulcer,diameter is less then .5 mm that is covered by yellow fibrinous membrane and surrounded by erythemeatous halo. www.indiandentalacademy.com
  25. 25.  Generalized edema of the oral cavity.  Parasthesia  Low grade fever  Localized lymphoadenopathy  Vesicle like lesion containing mucus.  Difficulties in eating. www.indiandentalacademy.com
  26. 26.  Common site of occurrence:buccal and labial mucosa  Buccal and lingual sulci  Soft palate,gingiva labial mucosa. www.indiandentalacademy.com
  27. 27.  Lateral and ventral surface of the tongue is also affected. www.indiandentalacademy.com
  28. 28.  Heal in 7 to 1o days without scar formation.  Oral manifestation include mucosal fissure,small multiple hyperplastic nodule on the buccle mucosa produce cobbel stone appearance.  Biopsy finding suggest nonceasenting granuloma. www.indiandentalacademy.com
  29. 29. www.indiandentalacademy.com
  30. 30.  Major apthous ulcer:most sever expression of apthous stomatitis.  1 to 10 in number present in lips,cheeks tongue, soft palate.  Painful and larger lesion and persist for longer time  Heal with scar formation.  6 weeks to heal as soon as one disappear another will appear www.indiandentalacademy.com
  31. 31.  Difficulties in eating,pain and discomfort.  Show similar lesion in vagina,penis larynx.  No particular age group,females affected more then males. www.indiandentalacademy.com
  32. 32.  Herpetiform ulcer-present as a crop of ulcers.  100 in numbers.  Palatal and gingival mucosa are involved.  Pain is present and healing will occur in 1 or 2 weeks. www.indiandentalacademy.com
  33. 33.  Here the ulcer will be preceded by vesicle and exhibit no virus infected cell.  Brooke and sapp-numerous small lesion found in oral mucosa.  Small pinhead sized erosion that gradually enlarge and coalesce  Painful lesion present for one to three years.  Immediate relief from tetracycline mouthwash. www.indiandentalacademy.com
  34. 34.  Laboratory test-no herpes simplex virus is cultured.  Absence of multinucleated giant cell.  No antibodies against herpes virus. www.indiandentalacademy.com
  35. 35. www.indiandentalacademy.com
  36. 36. www.indiandentalacademy.com
  37. 37.  Histopathology:minor apthous ulcer- fibrinopurulent membrane covering the ulcerated area.  Superficial colonies of microorganism present in this membrane.  Inflammatory cell infiltration in connective tissue.  Granulation tissue at the base of the lesion.  Epithelial proliferation at margins. www.indiandentalacademy.com
  38. 38.  Lesion begin at the excretory duct of minor salivary gland.  Wood-anitschkow cell.  Mononuclear cell in submucosa and in perivascular tissue in preulcerative stage.  In ulcerative stage-CD4and CD8 lymphocyte. www.indiandentalacademy.com
  39. 39.  Presence of macrophages and mast cells.  Differential diagnosis:1)herpes simplex infection.  Trauma.  Pemphigus vulgaris.  Mucous membrane pemphigoid. www.indiandentalacademy.com
  40. 40.  Treatment:mouth rinse-sodium bicarbonate in warm water.  Drug-prednisone-20 to 40 mg daily for a week  Topical corticosteroid.  Intralesional injection of triamicolone.  Antibiotics-tetracycline suspension.  Tetracycline mouthwash-250 mg per 5 ml used 4 times daily for 5 to 7 days . www.indiandentalacademy.com
  41. 41.  Steroid ointment-1.5 %cortisone acetate applied locally.  Hydrocortisone acetate antibiotics lozenges.  Chemical cautery. www.indiandentalacademy.com
  42. 42.  250 mg of capsule in 30 ml of warm water.(4 times in a day for 4 day)  Other drugs:azathioprine,cyclophosphamide. Thailodomide,pentixyfilline www.indiandentalacademy.com
  43. 43. www.indiandentalacademy.com
  44. 44.  BEHCETS SYNDROME:Uncertain etiology.  Pleuropnumonia like organism.  Autoimmune etiology.  Lehner-immunologic similarities between this syndrome and recurrent apthous stomatitis. www.indiandentalacademy.com
  45. 45.  Clinical features:between 10 to 45 year of age.  Oral and genital ulceration,ocular lesion,skin lesion.  Oral lesion-first occurrence  Painful and similar in appearance to recurrent apthous stomatitis. www.indiandentalacademy.com
  46. 46.  Size ranging from several millimeter to centimeter or more in diameter.  Ulcer have an erythematous border and covered by gray or yellow exudates.  Genital ulcer are small and located on scortum,root of the penis.  Ocular lesions-photophobia and irritation www.indiandentalacademy.com
  47. 47.  Simple conjunctivitis to finally uveitis and finally popyon  Skin lesions –small papules on the trunk and limbs and around the genitalia.  Involvement of CNS and cardiac and pulmonary involvement is seen. www.indiandentalacademy.com
  48. 48. www.indiandentalacademy.com
  49. 49. www.indiandentalacademy.com
  50. 50.  Histologic features-similar to recurrent apthous stomatitis.  Endothelial proliferation.  Vasculitis.  Laboratory findings: hypergammaglobulinemia leucocytosis eosinophilia elevated sedimentation rate. www.indiandentalacademy.com
  51. 51.  Treatment and prognosis-supportive treatment.  Remission after a period of months to years.  Serious complication can lead to death. www.indiandentalacademy.com
  52. 52. For more details please visit www.indiandentalacademy.com www.indiandentalacademy.com

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