Oral ulcers

29,018 views
28,377 views

Published on

Published in: Education, Health & Medicine
0 Comments
60 Likes
Statistics
Notes
  • Be the first to comment

No Downloads
Views
Total views
29,018
On SlideShare
0
From Embeds
0
Number of Embeds
21
Actions
Shares
0
Downloads
1,200
Comments
0
Likes
60
Embeds 0
No embeds

No notes for slide

Oral ulcers

  1. 1. ULCERS INJURY TO THE ORAL MUCOSA MAY RESULT IN A LOCALIZED DEFECT OF THE SURFACE IN WHICH THE COVERING EPITHELIUM IS DESTROYED LEAVING AN INFLAMMED AREA OF EXPOSED CONNECTIVE TISSUE. SUCH DEFECTS ARE CALLED ULCERS OR EROSIONS (TERM COMMONLY USED FOR SUPERFICIAL ULCER) THIS MAY EITHER FOLLOW MOLECULAR DEATH OF SURFACE EPITHELIUM OR ITS TRAUMATIC REMOVAL. ULCERATION IS THE MOST COMMON LESION
  2. 2.  THE SURFACE OF AN ULCER IS COVERED BY MASS OF FIBRIN WITH INTERMINGLED, DEAD AND DYING POLYMORPHS WHICH WOULD DRY ON THE SKIN TO FORM A CRUST OR SCAB. A SUPERFICIAL ULCER WITH NO EVIDENCE OF SIGNIFICANT FIBRINOUS EXUDATION ON THE SURFACE OF POLYMORPH EXUDATION SUGGESTS THE POSSIBILITY OF BULLOUS DISORDER. A HEAVY INFLAMMATORY INFILTRATE EXTENDS DEEP INTO THE UNDERLYING CONNECTIVE TISSUE N BLOOD VESSELS MAY SHOW SLIGHT INFLAMMATORY VASCULITIS. GRANULATION TISSUE IS FORMED WITH DILATED BLOOD VESSELS AND HEAVY INFITRATE OF PLASMA
  3. 3. PARTS OF AN ULCER ULCER CONSISTS OF:1. EDGE:-THIS IS AN IMPORTANT FINDING OF AN ULCER WHICH BY ITSELF NOT ONLY GIVES CLUE TO DIAGNOSIS ULCER BUT ALSO TO THE CONDITION OF ULCER.2. FLOOR:- THIS IS THE EXPOSED PART OF AN ULCER. THE COVERING OF FLOOR IS IMPORTANT. RED GRANULATION TISSUE HEALTHY AND HEALING PALE AND SMOOTH SLOW HEALING ULCER GRANULATION TISSUE BLACK MASS MALIGNANT MYELOMA3. BASE (ON WHICH THE ULCER RESTS):- FLOOR IS THE EXPOSED SURFACE OF AN ULCER WHEREAS THE BASE IS ON WHICH THE ULCER RESTS. FLOOR IS SEEN BUT THE BASE IS FELT.4. MARGIN:- IT’S THE POINT WHERE THE ULCER JOINS THE
  4. 4. NON SPECIFIC ULCERS
  5. 5. CLASSIFICATION OF ULCERS TWO TYPES OF CLASSIFICATON OF ULCERS IS POSSIBLE:-1. CLINICAL:TYPES SURROUNDIN ULCER FEATURES OTHER G SKIN FEATUERS1.SPREADI INFLAMED NO GRANULATIONNG TISSUE IS SEEN2.HEALING NOT GRANULATION SLIGHT INFLAMMED TISSUE IS PRESENT SEROUS IN FLOOR DISCHARGE IS SEEN3.CALLOUS INDURATONS PALE GRANULATION NO TENDENCY TISSUE IS SEEN AT TOWARDS FLOOR AND HEALING INDURATIONS ARE SEENAT BASE AND
  6. 6. 2. PATHOLOGIC ULCERS• ULCERATIONS ARE CLASSIFIED ON THE BASIS OF ETIOLOGY.• CAUSES OF ORAL ULCERATIONS:-1. INFECTIVE DISEASES2. TRAUMATIC ULCERATIONS3. IMMUNOLOGIC DISEASES4. NEOPLASTIC
  7. 7. TRAUMATICULCERATON TRAUMATIC INJURY CAN OCCUR BY THE FOLLOWING MEANS:-1. MECHANICAL2. CHEMICAL3. THERMAL4. FACTITIOUS INJURY5. RADIATION6. EOSINOPHILIC ULCER (TRAUMATIC GRANULOMA)
  8. 8. MECHANICAL TRAUMATIC ULCERATION MECHANICAL TRAUMA OCCURS THROUGH BITING, SHARP CUSPS, OUTSTANDING TEETH OR ILL-FITTING INTRAORAL APPLIANCES. SUCH ULCERS DON’T PRESENT A PROBLEM CLINICALLY, BUT 3 CRITERIA MUST BE FOLLOWED.1. A CAUSE OF TRAUMA MUST BE IDENTIFIED.2. THE CAUSE MUST FIT THE SIZE, SITE AND SHAPE OF ULCER.3. ON REMOVAL OF THE CAUSE, THE ULCER MUST SHOW SIGNS OF HEALING WITHIN 10DAYS. CHRONIC TRAUMATIC ULCERS MAY PRESENT FOR SEVERAL WEEKS AND MAY BE DEEP CRATER LIKE LESIONS WITH ROLLED EDGES WHICH ARE INDURATED
  9. 9. CHEMICAL TRAUMATIC ULCERATION A VARIETY OF CHEMICALS MAY CAUSE ORAL ULCERATION. IT INCLUDES IRRITANTS OR CAUSATIVE AGENTS USED IN DENTAL PRACTICE. THE PREPARATIONS USED BY PATIENTS IN SELF TREATMENT OF ORAL COMPLAINTS SUCH AS ANTISEPTIC MOUTHWASHES AND ASPIRIN (MISUSED AS OBTUNDANT FOR TOOTH RELIEF). THE ACTION OF ASPIRIN IS TIME AND DOSE DEPENDENT. THE SEVERITY RANGES FROM ODEMA TO NECROSIS OF THE EPITHELIUM. ODEMATOUS EPITHELIUM RESEMBLES LEUKOEDEMA WHEREAS THE NECROTIC EPITHELIUM RESEMBLES
  10. 10. THERMAL AND FACTITIOUSTRAUMATIC ULCERS  ULCERATION DUE TO THERMAL TRAUMA OCCURS DUE TO VERY HOT FOOD OR DRINKS, CAN OCCUR IN ANY PART OF ORAL MUCOSA BUT MOST COMMONLY SEEN IN PALATE.  FACTITIOUS ULCERS MAY BE THE MANIFESTATION OF STRESS, ANXIETY OR EMOTIONAL DISTURBANCES. COMMON CAUSE ARE BITING OR CHEWING OF LIPS, CHEEKS OR TONGUE AND DAMAGE (TO GINGIVA FROM SHARP NAIL BITES)
  11. 11. FACTITIOUS ULCER-CHRONIC ULCERATION OFTHE MANDIBULARALVEOLAR RIDGE TRAUMATIC ULCER DUESECONDARY TO SELF- TO THERMAL BURNINDUCED TRAUMA
  12. 12. RADIATION TRAUMATIC ULCERATION ORAL MUCOSA MAY SUFFER IMMEDIATE DAMAGE DUE TO DIRECT EFFECTS OF RADIATION ON CELLS OR DELADED EFFECTS DUE TO EPITHELIAL ATROPHY AND DAMAGE TO UNDERLYING VASCULAR BED DURING RADIOTHERAPY OF HEAD N NECK CANCER. THE IMMEDIATE EFFECTS ARE ERYTHEMIA, RADIATION MUCOSITIS AND ULCERATION. OEDEMA DUE TO OBSTRUCTION OF REGIONAL LYMPHATICS MAY OCCUR. RADIATION ULCERS ARE PAINFUL.
  13. 13. EOSINOPHILIC ULCER ITS ALSO REFERRED TO AS TRAUMATIC GRANULOMA OR EOSINOPHILIC GRANULOMA OF SOFT TISSUES. IT IS PARTICULARLY ASSOCIATED WITH TRAUMA N INJURY TO MUSCLE ALTHOUGH THE PATHOGENESIS IS UNCLEAR. IT OCCURS MOST COMMONLY ON THE TONGUE AND PRESENTS CLINICALLY AS CHRONIC, WELL DEMARCATED ULCER WHICH MAY MIMIC A SQ. CELL CARCINOMA.
  14. 14.  HISTOLOGICAL EXAMINATION SHOWS AN ULCER COVERED BY THICK LAYER OF FIBROUS EXUDATE WITH A DENSE, CHRONIC INFLAMMATORY CELL INFILTRATE IN ITS BASE INVOLVING UNDERLYING DAMAGED MUSCLE. THE DEEPER PARTS CONTAIN INFILTRATE RICH IN HISTIOCYTES AND EOSINOPHILS. TRUE GRANULOMAS
  15. 15. IMMUNOLOGIC DISEASES IDIOPATHIC ULCERS BEHCET’S SYNDROME REITER’S SYNDROME ERTHEMA MULTIFORME DRUG REACTIONS CONTACT ALLERGIES WEGNER’S GRANULOMATOSIS MIDLINE GRANULOMA CHRONIC GRANULOMATOUS DISEASE CYCLIC NEUTROPENIA
  16. 16. IDIOPATHIC ULCERS THERE ARE A GROUP OF IDIOPATHIC ULCERS WHOSE IS CHARACTERISED BY FREQUENT REOCCURANCES. SUCH ULCERS ARE TERMED AS RECURRENT APHTHOUS STOMATITIS(RAS). BASED ON PRIMARILY THEIR CLINICAL FEATURES, 3 TYPES OF ULCERS ARE RECOGNISED:-1. MINOR APHTHOUS ULCERS2. MAJOR APHTHOUS ULCES3. HERPETIFORM ULCERS
  17. 17. ETIOLOGY OF RECURRENTAPHTHOUS STOMSTITIS1. HEREDITARY PREDISPOSITION2. TRAUMA3. EMOTIONAL STRESS AND PSYCOLOGICAL FACTORS4. BACTERIAL AND VIRAL INFECTIONS5. ALLERGIC DISORDERS6. HAEMATOLOGICAL AND DEFICIENCY DISORDERS7. GASTROINTESTINAL DISORDERS8. HORMONAL DISORDERS.
  18. 18. CLINICAL FEATUERS OF RECURRENTAPHTHOUS STOMATITIS MINOR MAJOR HERPETIFORMAGE OF ONSET 10-19 10-19 20-29(YEARS)NUMBER OF 1-5 1-10 10-100ULCERSPRINCIPAL LIPS, CHEEKS, PALATE, PHARYNX FLOOR OF MOUTH,SITES TONGUE PALATE, PHARYNX, GINGIVASIZE OF <10 >10 1-2 BUT OFTENULCERS(MM) COALEASEDURATION IN 7-14 >30 10-30DAYS
  19. 19. MINOR APHTHOUS ULCERATION THIS ACCOUNTS FOR 80% OR MORE CASES OF RAS. ITS CHARACTERISED BY ROUND OR OVAL ULCERS WHICH AFFECT NON-KERATINISED AREAS OF ORAL MUCOSA AND THEY HAVE GREY/YELLOW BASE WITH ERYTHEMATOUS MARGIN. THEY HEAL WITHOUT SCARRING AND TEND TO RECUR AT 1-4 MONTH INTERVALS, WHICH IS VARIABLE
  20. 20. MINOR APHTHOUS ULCERATION
  21. 21. MAJOR APHTHOUS ULCERATION THEY OCCUR ANYWHERE IN MOUTH INCLUDING THE KERATINISED ORAL MUCOSA BUT THE LIPS, SOFT PALATE, TONSILLAR AREAS AND OROPHARYNX ARE COMMON SITES. THEY HEAL WITH SCARRING AND TEND TO RECUR AT LESS MONTHLY INTERVALS AND MAY BE ASSOCIATED WITH SEVERE DISCOMFORT AND WITH DIFFICULTY IN EATING AND SPEAKING. THE EXTENSION IS DEEPER AND MAY PRESENT AS CRATER LIKE ULCERS WITH ROLLED MARGINS WHICH ARE INDURATED ON PALPATION BECAUSE OF UNDERLYING FIBROSIS.
  22. 22. MAJOR APHTHOUS LCERS
  23. 23. HERPTIFORM ULCERATION ITS CHARACTERISED BY MULTIPLE, SMALL, PIN- HEADED ULCERS THAT CAN OCCUR N ANY PART OF ORAL MUCOSA. WHEN HUNDREDS OF ULCERS ARE CLUSTERED TOGETHER, CONFLUENCE TOGETHER WHICH RESULTS IN LARGER AREAS OF ULCERATION WITH IRREGULAR OUTLINE. THEY HEAL WITHIN 2-3WEEKS WITH SCARRING. THE ULCERS TEND TO RECUR AT LESS THAN MONTHLY INTERVEL AND MAY BE ASSOCIATED WITH SEVERE DISCOMFORT.
  24. 24. HERPTIFORM ULCERS
  25. 25. BEHCET SYNDROME IT’S A RARE DISORDER CHARACTERISED BY RECURRENT APHTHOUS STOMATITIS. IT MAY BE SEEN AS GENITAL ULCERS, EYE LESIONS, SKIN LESIONS OR RAPID ACUTE INFLAMMATION OF SKIN IN RESPONSE TO MINOR TRAUMA. IMMUNE MEDIATED MUCOSAL DAMAGE AND VASCULITIS ASSOCIATED WITH HYPERACTIVITY OF NEUTROPHILS ARE INVOLVED IN PATHOGENESIS OF LESIONS.
  26. 26.  THERE IS A CONSIDERABLE LOSS OF TISSUE DEPRESSING ULCER WELL BELOW THE SURFACE AND INFLAMMETION EXTENDS DEEPLY INTO SUBCUTANEOUS FAT. THE SURFACE IS COVERED BY FIBRINOUS EXUDATE INFILTRATED BY POLYMORPHS FORMING SCAB. A LAYER OF GRANULATION TISSUE WITH DILATED CAPILLARIES AND EDEMA IS SEEN. SOME BLOOD VESSELS SHOW EXTENSIVE FIBROUS PROLIFERATION OF SUBENDOTHELIAL CONECTIVE TISSUE.
  27. 27. REITER’S SYNDROME CLINICAL FEATURES INCLUDE ARTHRITIS, URETHRITIS, CONJUNCTIVITIS OR UVEITIS, ORAL ULCERS. THE CAUSE IS UNKNOWN BUT IT S IMMUNE RESPONSE TO BACTERIAL ANTIGENWHICH USUALLY FOLLOWS STD OR SHIGELLA DYSENTARY. IT MAY RECUR . THE DURATION IS WEEKS TO MONTHS. ORAL LESIONS HAVE BEEN DESCRIBED AS RELATIVELY PAINLESS APHTHOUS ULCERS OCCURING ALMOST ANYWHERE IN THE MOUTH.
  28. 28.  DIAGNOSIS IS DEPENDENT ON RECOGNITION OF THE VARIOUS SIGNS AND SYMPTOMS ASSOCIATED WITH THE SYNDROME. THE ERYTHROCYTE SEDIMENTATION RATE IS ELEVATED IN THE ACUTE PHASE OF THE DISEASE BUT PERSISTS AFTER ARTHRITIS RESOLVES.
  29. 29. ERYTHEMA MULTIFORME (EM) EM IS A SELF LIMITING HYPERSENSITIVITY REACTION CHARACTERISED BY TARGET SKIN LESIONS AND ORAL ULCERATIVE LESIONS. ITS DIVIDED INTO A MINOR FORM USUALLY ASSOCIATED WITH HSV TRIGGER AND A SEVERE FORM TRIGGERED BY CERTAIN SYSTEMIC DRUGS. OTHER FACTORS LIKE MALIGNANCY, AUTOIMMUNE DISEASES, RADIOTHERAPY TRIGGER EM. DRUGS PRECIPITATING EM ARE BARBITURATES, SULFONAMIDES AND ANTISEIZURE MEDICATIONS.
  30. 30.  EM IS USUALLY ACUTE, SELF LIMITED PROCESS THAT AFFECTS SKIN OR MUCOUS MEMBRANE AFFECTING MOSTLY YOUNG ADULTS. THE TERM ERYTHEMA MULTIFORME WAS COINED TO INDICATE THE MULTIPLE N VARIED CLINICAL APPEARANCES THAT ARE ASSOCIATED WITH CUTANEOUS MANIFESTATIONS. THE CLASSIC SKIN LESION CONSISTS OF CONCENTRIC ERYTHEMATOUS RINGS SEPARATED BY RINGS OF NEAR NORMAL COLOR. OTHER TYPE OF MANIFESTATIONS INCLUDE MACULES, PAPULES, VESICLES, BULLAE AND URTICARIAL PLAQUES.
  31. 31.  EM PRESENTS AS ULCERATIVE DISEASE VARYING FROM APHTHOUS TYPE LESIONS TO MULTIPLE WIDE SPREAD ULCERS. LIPS BUCCAL MUCOSA, PALATE AND TONGUE ARE MOSTLY AFFECTED. FROM MILD DISCOMFORT TO SEVERE PAIN IT MAY EVEN LEAD TO HEADACHE, HIGH BODY TEMPERATURE AND LYMPHADENOPATHY. STEVENS-JOHNSONS SYNDROME A MAJOR FORM OF EM IS CHARACTERISED BY CRUSTING ULCERATON AT VERMILION BORDER THAT MAY CAUSE IMMENSE PAIN.
  32. 32.  THE MICROSCOPIC PATTERN OF EM CONSISTS OF EPITHELIAL HYPERPLASIA AND SPONGIOSIS. EPITHELIAL NECROSIS IS SEEN. CONNECTIVE TISSUE CHANGES USUALLY APPEAR AS INFILTRATES OF LYMPHOCYTES AND ORAL ERYTHEMIA MULTIFORME MACROPHAGES IN BIOPSY SPECIMEN SHOWING PERIVASCULAR SPACES EPITHELIAL EDEMA AND LYMPHOID AND IN CONNECTIVE INFILTRATE TISSUE PAPILLAE.
  33. 33. DRUG REACTIONS IT AFFECTS SKIN OR MUCOSA. ERYTHEMIA , WHITE LESIONS, VESICLES OR ULCERS MAY BE SEEN. HISTORY OF DRUG INGESTIONS IS IMPORTANT. THIS IS CAUSED BY POTENTIALLY ANY DRUG VIA STIMULATON OF IMMUNE SYSTEM. REACTIONS SUCH AS ANAPHYLAXIS OR ANGIOEDEMA MAY REQUIRE EMERGENCY CARE; AND HIGHLY VARIABLE CLINICAL PICTURE CAN MAKE DIAGNOSIS DIFFICULT. THE PATHOGENESIS OF DRUG REACTIONS MAY BE IMMUNOLOGIC OR NONIMMUNOLOGIC. THE IMMUNOLOGIC MECHANISMS ARE TRIGGERED BY AN ANTIGENIC C OMPONENT ON DRUG MOLECULE RESULTING IN IMMUNE RESPONSE OR DRUG ALLERGY. DRUG REACTIONS THAT ARE NONIMMUNOLOGIC IN NATURE DON’T STIMULATE AN IMMUNE RESPONSE BUT THEY DIRECTLY AFFECT MAST CELLS CAUSING RELEASE OF CHEMICAL MEDIATORS.
  34. 34.  ACQUIRED ANGIOEDEMA IS IgE-MEDIATED REACTION THAT IS PRECIPATED BY DRUGS OR FOODS(NUTS AND SHELL FISH) HERIDITARY ANGIOEDEMA IS A RARE AUTOSOMAL-DOMINANT TRAIT DEVELOPING A SPONTANEOUS MUTATON. THIS RESULTS IN DEFICIENCY OF INHIBITOR OF THE FIRST COMPONENT OF COMPLEMENT C1 ESTERASE LEADING TO SERIOUS CLINICAL MANIFESTATIONS. ANGIOEDEMA BY EITHER PATHWAY APPEARS AS SOFT, DIFFUSE, PAINLESS SWELLING USUALLY OF LIPS, NECK OR FACE.
  35. 35.  ORAL MANIFESTATIONS MAY BE ERYTHEMATOUS, VESICULAR OR ULCERATIVE. THEY MAY ALSO MIMIC LICHEN PLANUS SO, THEY ARE KNOWN AS LICHENOID DRUG REACTIONS. THE NONSPECIFIC FEATURES INCLUDE SPONGIOSIS, APOPTOTIC KERATINOCYTES, LYMPHOID INFILTRATES, EOSINOPHILS AND ULCERATION.
  36. 36. CONTACT ALLERGIES LESIONS ARE CAUSED BY DIRECT CONTACT WITH FOREIGN ANTIGEN; ERYTHEMA, VESICLES AND ULCERS MAY BE SEEN ITS CAUSED BY POTENTIALLY ANY FOREIGN ANTIGEN THAT CONTACTS SKIN OR MUCOSA; CINNAMON IS FREQUENTLY CITED IN ORAL CONTACT STOMATITIS. THE IMMNUNE RESPONSE IS PREDOMINANTLY T-CELL MEDIATED. PATCH TESTIN G MAY BE HELPUL FOR DIAGNOSIS; HISTORY IS IMPORTANT.
  37. 37.  CONTACT ALLERGY IS FREQUENTLY SEEN ON SKIN AND ITS UNCOMMON INTRAORALLY. MATERIALS CAUSING INTRAORAL ALLERGY ARE TOOTHPASTE, MOUTHWASH, CANDY, TOPICAL ANTIMICROBIALS, TOPICAL STEROIDS, IODINE, DENTURE BASE MATERIAL ETC. THIS CONDITION PRIMARILY AFFECTS ATTACHED GINGIVA AS BRIGHT BILATERAL BAND. MICROSCOPICALLY, EPITHELIUM AND CONNACTIVE TISSUE SHOW INFLAMMATORY CHANGES. BLOOD VESSELS MAY BE DILATED AND EOSINOPHILS MAY BE SEEN.
  38. 38. WEGENER’ GRANULOMATOSIS CLINICAL FEATURES INCLUDE INFLAMMATORY LESIONS OF LUNG, KIDNEY AND UPPER AIRWAY; MAY AFFECT GINGIVA WHEN INTRAORAL. THE HEAD AND NECK MANIFESTATIONS ARE SINUSITIS, RHINORRHEA, NASAL STIFFNESS AND EPITAXIS. INTRAORAL LESONS CONSIST OF RED, HYPERPLASTIC, GRANULAR LESONS OF ATTACHED GINGIVA. KIDNEY INVOLVEMENT CONSISTS OF FOCAL NECROTIZING GLOMERULITIS AND THE FINAL OUTCOME IS RENAL FAILURE. THIS IS A RARE DISEASE OF MIDDLE AGE. THE CAUSE IS POSSIBLY IMMUNE DEFECT OR INFECTION. IT MAY BECOME LIFE THREATING AS A RESULT OF TISSUE DESTRUCTION IN ANY OF 3 INVOLVED SITES.
  39. 39.  THE BASIC PATHOLOGIC PROCESS IS GRANULOMATOUS WITH CHARACTERISTIC NECROTIZING VASCULITIS. NECROSIS AND MULTINUCLEATED GIANT CELLS MAY BE SEEN IN THE GRANULOMATOUS AREAS. DIAGNOSIS MAY BE MADE BY EXCLUSION OF OTHER DISEASES PARTICULARLY MIDLINE GRANULOMA.
  40. 40. MIDLINE GRANULOMA THIS IS RARE BUT DESTRUCTIVE, NECROTIC, NONHEALING LESIONS OF NOSE, PALATE AND SINUSES. BIOPSY SHOWS NONSPECIFIC INFLAMMATION DISTINCT FROM WEGENER’S GRANULOMATOSIS. MIDLINE GRANULOMA REPRESENTS NK/T- CELL LYMPHOMA. PROGNOSIS IS POOR; DEATH MAY FOLOW WHEN ERODED INTO MAJOR BLOOD VESSELS.
  41. 41.  MIDLINE GRANULOMA IS A UNIFOCAL DESTRUCTIVE DISEASE IN THE MIDLINE OF ORONASAL REGION. OTHER DISEASES THAT PRODUCE THIS KIND OF LESIONS ARE WEGENER’S GRANULOMATOSIS, INFETIOUS DISEASE AND CARCINOMA. MICROSCOPICALLY THIS PROCESS APPEARS AS ACUTE AND CHRONIC INFLAMMATION IN PARTIALLY NECROTIC TISSUE WITH ANGIOCENTRIC INFLAMMATION AS COMMON FINDING.
  42. 42. CHRONIC GRANULOMATOUSDISEASE THIS DISEASE IS RARE AND PRESENTS AS RECURRENT INFECTIONS IN VARIOUS ORGANS. MOSTLY OCCCURS IN MALES. IT’S A GENETIC DISEASE (X-LINKED) THIS IS CAUSED BY THE DEFECT IN NICOTINAMIDE ADENINE DINUCLEOTIDE PHOSPHATE OXIDASE COMPLEX THAT RESULTS IN ALTERED NEUTROPHIL AND MACROPHAGE FUNCTION RESULTING IN INABILITY TO KILL BACERIA AND FUNGI. MANIFESTATIONS APPEAR DURING CHILDHOOD DUE TO MORE FREQUENT X-LINKED INHERITANCE PATTERN.
  43. 43. CYCLIC NEUTROPENIA THE CLINICAL FEATURES INCLUDE ORAL ULCERS WITH PERIODICITY; INFECTIONS, ADENOPATHY; PERIODONTAL DISEASE. THIS IS CAUSED BY MUTATIONS IN NEUTROPHIL ELASTASE GENE. CYCLIC NEUTROPENIA RESULTS IN RARE BLOOD DYSCRASIA. FEVER, MALAISE, ORAL ULCERS, CERVICAL LYMPHADENOPATHY AND INFECTIONS CAN OCCUR.
  44. 44. INFECTIVE ORAL ULCERATIONS  BACTERIAL:-  FUNGAL:-  SYPHILIS  DEEP FUNGAL  GONORRHEA INFECTIONS  TUBERCULOSIS  SUBCUTANEOUS: SPOROTRICHOSIS  LEPROSY  ACTINOMYCOSIS  OPPORTUNISTIC: PHYCOMYCOSIS  NOMA AND ASPERGILLOSIS
  45. 45. BACTERIAL - SYPHILIS THIS IS SEXUALLY TRANSMITTED BY A SPIROCHETE-TREPONEMA. CLASSIFICATION:-1. PRIMARY(CHANCRE)- SINGLE, INDURATED NONPAINFUL ULCER AT THE SITE OF SRIROCHETE ENTRY, SPONTANEOUSLY HEALS IN 4-6 WEEKS.2. SECONDARY- MACULOPAPULAR RASH ON SKIN, ORAL ULCERS COVERED BY MEMBRANE(MUCOUS PATCHES)3. TERTIARY- GUMMAS, CARDIOVASCULAR AND CNS LESIONS.4. CONGENITAL- HUTCHINSON TRIAD(DEAFNESS, INTESTINAL KERATITIS, DENTAL ANOMALIES)
  46. 46. SYPHILIS PRIMARY AND SECONDARY FORMS ARE HIGHLY INFECTIOUS. SECONDARY FORM DEVELOPS IN 2-10 WEEKS. LATENCY PERIODS ARE SEEN BETWEEN PRIMARY AND SECONDARY STAGES AND BETWEEN SECONDARY AND TERTIARY STAGES.
  47. 47. OTHER CLINICAL FEATURE CAUSE SIGNIFICANCEINFEC-TIONSGONORRHEA GENITAL LESIONS WITH RARE N.gonorrhea MAY BE CONFUSED WITH ORAL MANIFESTATIONS; OTHER ULCERATIVE ERYTHEMA OR ULCERS DISEASESTUBERCULOS INDURATED, CHRONIC ULCER M.tuberculosis INFECTIOUS ORALIS THAT MAY BEPAINFUL- ON ANY LESIONS ARE ALWAYS MUCOSAL SURFACE RESULT OF LUNG LESIONSLEPROSY SKIN DISEASE WITH RARE M.leprae COMMON IN SOUTHEAST NODULES OR ULCERS ASIA, INDIA, SOUTHAMERICAACTINOMYCO TYPICALLY SEEN IN A.israelii INFECTION FOLLOWSSIS MANDINLE, WOOD HARD ENTRY THROUGH NODULE WITH SULFUR SURGICAL SITE, GRANULES PERIODONTAL DISEASE OR OPEN ROOT CANALNOMA NECROTIC, NONHEALING ANAEROBES IN OFTEN ASSOCIATED WITH ULCER OF GINGIVA OR PATIENT WHOSE MALNUTRITION; MAY BUCCAL MUCOSA; RARE; SYSTEMIC HEALTH IS RESULT IN TISSUE AFFECTS CHILDREN COMPROMISED DESTRUCTION
  48. 48. DEEP FUNGAL INFECTIONS DEEP FUNGAL INFECTIONS ARE CHARACTERISED BY PRIMARY INVOLVEMENT OF THE LUNGS. ORAL INFECTIONS FOLLOW IMPLANTATION OF INFECTED SPUTUM IN ORAL MUCOSA. ORAL LESIONS ARE USUALLY PRECEDED BY PULMONARY INFECTION. PRIMARY INVOLVEMENT OF ORAL MUCOUS MEMBRANE IS UNLIKELY MODE OF INFECTION.
  49. 49.  DEEP FUNGAL INFECTIONS INCLUDE HISTOPLSMOSIS, COCCIDIOMYCOSIS, BLASTOMYCOSIS, CRYPTOMYCOSIS
  50. 50.  THE BASIC INFLAMMATORY RESPONSE IN A DDEP FUNGAL INFECTION IS GRANULOMATOUS. MACROPHAGES AND MULTINUCLEATED GIANT CELLS DOMINATE THE HISTOLOGIC PICTURE. PECULIAR TO BLASTOMYCOSIS IS PSEUDOEPITHELIO- MATOUS HYPERPLASIA ASSOCIATED WITH SUPERFICIAL INFECTION .
  51. 51. SUBCUTANANEOUS FUNGALINFECTIONS - SPOROTRICHOSIS THIS IS CAUSED BY SPOROTHIX SCHENCKII AND RESULTS FROM INOCULATION OF SKIN OR MUCOSA BY CONTAMINATE SOIL OR THRONY PLANTS. LESIONS APPEAR AT SITE OF INOCULATION AND SPREAD ALONG LYMPHATIC CHANNELS. THE INFLAMMATORY RESPONSE IS GRANULOMATOUS. CENTRAL ABSCESSES MAY BE FOUND IN SOME OF GRANULOMAS AND OVERLING EPITHELIUM EXHIBITS PSEUDOEPITHELIOMATOUS HYPERPLASIA.
  52. 52. OPPURTUNISTIC FUNGAL INFECTIONS:PHYCOMYCOSIS AND ASPERGILLOSIS PHYCOMYCOSIS (MUCORMYCOSIS) IS CAUSED BY GENERA MUCOR AND RHIZOPUS.ASPERGILLOUS IS UBIQUITOUS IN THE ENVIRONMENT THE ROUTE OF INFECTION IS THROUGH GASTROINTESTINAL TRACT OR RESPIRATORY TRACT. IN HEAD AND NECK, LESIONS ARE MOST LIKELY TO OCCUR IN NASAL CAVITY, PARANASAL SINUSES AND OROPHARYNX.
  53. 53.  ACUTE AND CHRONIC INFLAMMATORY INFILTRATE IS SEEN IN RESPONSE TO FUNGUS. CHARACTERISTIC NECROTIC WALLS CONTAINING THROMBI AND FUNGI MAY BE EVIDENT. THE FUNGUS CONSISTS OF LARGE PALE STAINING NON - SEPTATE HYPHAE THAT TEND TO BRANCH AT 90 DEGREES.
  54. 54.  THE NEOPLASMS INCLUDE1. SQUAMOUS CELL CARCINOMA2. CARCINOMA OF MAXILLARY SINUS3. OTHER CARCINOMAS
  55. 55.  ORAL AND OROPHARYNGEAL SQUAMOUS CELL CARCINOMAS REPRESENT ABOUT 3% OF CANCERS IN MEN AND 2% IN WOMEN. OF ALL THE FACTORS, TOBACCO IS REGARDED AS THE MOST IMPORTANT ESP THE CIGAR, PIPE AND REVERSE SMOKING. THE TIME-DOSE RELATIONSHIP OF CARCINOGENS FOUND IN TOBACCO IS OF MUCH IMPORTANCE IN THE CAUSE OF ORAL CANCER. MICRO ORGANISMS SUCH AS CANDIDA ALBICANS PRODUCES N-NITROSOBENZYLMETHYLAMINE CARCINOGEN AND HPV SUBTYPES 16 AND 18 PRODUCES ORAL SQUAMOUS CELL CARCINOMAS.
  56. 56.  CARCINOMAS OF LOWER LIPS ARE MORE COMMON THAN UPPER LIP LESIONS BUT THE GROWTH RATE IS SLOWER. THEY APPEAR COMMONLY IN ELDERLY PATIENTS MOSTLY AFFECTING MEN
  57. 57.  SQUAMOUS CELL CARCINOMA OF TONGUE IS THE MOST COMMON INTRAORAL MALIGNANCY THESE PRESENT AS AN INDURATED, NON HEALING ULCER, AS A RED LESION, AS A WHITE LESION OR AS A RED-WHITE LESION.
  58. 58.  MALIGNANCIES OF PARANASAL SINUSES OCCUR MOST COMMONLY IN MAXILLARY SINUS. THIS AFFECTS ELDER PEOPLE AND GENERALLY MEN. PAST HISTORY FREQUENTLY INCLUDES SINUSITIS. AS THE NEOPLASM EXTENDS TOWARDS APICES OF MAXILLARY POSTERIOR TEETH, REFERRED PAIN MAY OCCUR. TOOTHACHE WHICH ACTUALLY REPRESENTS NEOPLASTIC MOVEMENT OF SUPERIOR ALVEOLAR NERVE IS THE COMMON SYMPTOM OF MAXILLARY SINUS MALIGNANCIES. OCCASIONALLY IT MAY PRESENT AS PALATAL ULCER AND MASS REPRESENTING EXTENSION THROUGH THE BONE AND SOFT TISSUE OF PALATE.

×