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Ulcerative condiion

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Oral Pathology I
Third Year

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Ulcerative condiion

  1. 1. ULCERATIVE CONDITION :Done By Abdullah Alsaad Saleh Al Abbas
  2. 2. INTRODUCTION Definition : An ulcer is defined simply as loss of epithelium . Ulcerative lesions are commonly found in dental patient .
  3. 3.  Types of ulcerative lesion :  Reactive lesion Bacterial infection Fungal infection Immunologic disease Neoplasm    
  4. 4. REACTIVE LESION Traumatic Ulceration . Etiology : It is an ulcer that is caused by simple mechanical trauma .  Trauma can be caused by : 1. Prostheses , most commonly dentures can cause acute or chronic ulcers . 2. Abnormal habits , self-induced in psychological problems . 3. Iatrogenic . 
  5. 5. .CONT 4. 5. 6. Chemicals , e.g. Aspirin Burns are still sean Induced by patient to relief pain . Therapeutic radiation ( High dose ) . Other traumatic factors can also be associated like , ulcers in ant. Portion of tongue in infants caused by natal teeth .
  6. 6. Reactive Ulcers can be either chronic Acute
  7. 7. :ACUTE REACTIVE ULCERS :Clinical feature Including variable degrees of pain , redness & swelling . Covered by yellow wight fibrinous exudate and surrounded erythematous halo .
  8. 8. .CONT  Histopathology :  Loss of surface epithelium . Neutrophils infiltration . Dilated blood vessels . Regeneration of the epithelium begins at the ulcer margins .   
  9. 9. CHRONIC REACTIVE ULCER  Clinical features :  Little or no pain . Covered by yellow membrane surrounded by elevated margins . Scar formation .  
  10. 10. .CONT  Histopathology : Granulation tissue .  Chronic inflammatory cell infiltration .  Epithelial regeneration may not occur because of continued trauma . 
  11. 11. .CONT   Treatment : Topical corticosteroids ( to relief pain ) .
  12. 12. BACTERIAL INFECTIONS Syphilis  Gonorrhea  Tuberculosis  Leprosy  Actinomycosis  Noma 
  13. 13. SYPHILIS  Syphilis is a sexual transmitted disease . Syphilis Primary Congenital Secondary Tertiary Etiology :  Caused by ( spirochete treponema pallidum ) .  Sexual contact, Transfusion infected blood or Through placenta to fetus . 
  14. 14. CLINICAL FEATURES  Primary syphilis :  Painless, fixed ulcer with rolled margins(chancre)  Painless lymphadenopathy .  Heals in 3 to 12 weeks .  Secondary syphilis :  Begins after 2 to 10 weeks after primary .  Reddish brown maculopapular skin rash .  Fever .
  15. 15.  Tertiary syphilis :  Take many years to appear (rare) .  Including CVS & CNS .  Congenital syphilis :  May affect any organ system in fetus .  Mucocutaneos rash may be seen .  Hutchinson’s triad .
  16. 16. HISTOPATHOLOGY Infiltration of inflammatory cells (Plasma cells, lymphocytes and macrophages ) .  Narrowing of arterioles and small arteries .  Necrosis may be seen in (Gummas) .   Treatment : Penicillin .
  17. 17. GONORRHEA Etiology :  Caused by (Neisseria Gonorrhoeae) .  Transmitted by direct sexual contact .  May transmitted to oral or pharyngeal mucous membrane by orogenital contact .  Clinical features :  No specific signs ( Asymptomatic ) .  Multiple ulceration and generalized erythema .  In pharyngeal infection ( sore throught &cervical lymphadenopathy).  Treatment : Antibiotics . 
  18. 18. TUBERCULOSIS  Etiology :  It is caused by (bacillus myobacterium tuberculosis) Transmitted by inhalation of infected droplets . It may occur in lung, lymph node, skin, bone or oral mucosa .  
  19. 19. .CONT  Clinical features :  Fever , night sweats and weight loss (low grade). Hemoptysis, cough and chest pain . May appear orally on any mucosal surface (tongue) Chronic non-healing painful ulcer .   
  20. 20. .CONT Histopathology :  Granulomatous inflammation .  Central caseous necrosis .  Epithelioid cells .  Langhans giant cells .  Treatment :  First line drug like isoniazid, rifampin & ethambutol . 
  21. 21. LEPROSY Etiology :  Caused by (mycobacterium leprae ) .  Enter the body through the nose and broken skin by direct contact with infected individual for a long period .  Clinical features :  Skin and peripheral nerves are affected .  Erythematous nodules .  Similar lesions may appear intraorally .  Damage to peripheral nerves(truama to extremities, bone resorption ) . 
  22. 22. .CONT  Histopathology :   Multinucleated giant cells . Lymphocytic cell infiltration . Well formed Granulomas (Tuberculoid leprosy) . Poor formed Granulomas ( leproid leprosy ) .  Treatment : dapsone, rifampin & minocycline .  
  23. 23. ACTINOMYCOSIS       Etiology : caused by ( Actinomycosis Israelii) . It is normal present in the oral cavity. If it enters the tissues like in: Tooth extraction. RCT. Tooth disease, poor dental hygiene.
  24. 24. .CONT     Clincal features Swelling The pus may contain small yellow granules X-ray present as a radioluecency with ill defined margins .
  25. 25. .CONT       Histopathology : A granulomatous inflammatory response with central abscess formation . In the center of the abscess colonies of G+ organism may be seen . Treatment : long term, high dose penicillin . Drainage of abscess & and surgical excision of scar .
  26. 26. NOMA It is characterized by destruction process of the orofacial tissues .  Etiology:  Caused by (Fusobacterium necrophorum & other m.o. ) .  Clinical features :  Mostly affect children .  Painful ulceration usually of gingiva and buccal mucosa that spreads rapidly and become necrotic.  Treatment :  Treating predisposing condition & Infection . 
  27. 27. FUNGAL INFECTION Deep fungal infection .  Subcutaneous fungal infection .  Opportunistic fungal infection . 
  28. 28. DEEP FUNGAL INFECTION Histoplamosis  Coccidiodomycosis  Blasomycosis  Cryptococcosis 
  29. 29. DEEP FUNGAL INFECTION The usual oral lesion are ulcerative (single, multiple) .  Non healing .  Painful .   Treatment : Antifungal (ketaconazole) .
  30. 30. SUBCUTANEOUS FUNGAL INFECTION Etiology :  It is caused by (sprothrix schenckii )  Clinical features :  Red nodule on skin .  Exudate production & ulceration .  Lymphadenopathy  Histopathology : • Central abscess in granulomas . • Pseudoepithiliomatous hyperplasia . • Small round to oval fungus . 
  31. 31.  • • •    Histopathology : Central abscess in granulomas . Pseudoepithiliomatous hyperplasia . Small round to oval fungus . Treatment : Solution of pottasium iodide . In allergy ( ketoconazole )
  32. 32. OPPORTUNISTIC FUNGAL INFECTION Etiology :  Caused by (Genera muco & Rhizopus )  Clinical features :  Head & neck , most likely in nasal cavity & paranasal sinus .  Pain & swelling precedes ulceration .  Histopathology :  Acute & chronic inflammatory infiltrate in response to the fungus .  Treatment :  Antifungal ( amphotrecin B ) 

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