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Primary oral ulcerative lesions new


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Primary oral ulcerative lesions new

  1. 1. Oral Ulcerative Diseases
  2. 2.  Ulcers are the most common oral soft tissue lesions.  Traumatic ulcers  Aphthous stomatitis  Behcet’s disease  Viral infections of oral mucosa: Herpes simplex, herpangina, herpes zoster  Erosive lichen planus  Bacterial infections: T.B ulcer, syphilitic ulcerations  Vesiculo-bullous diseases  Malignant ulcers
  3. 3.  Caused by local trauma  Either by ill fitted dentures  Sharp edges of brocken tooth  Lip or tongue biting after heavy anesthesia  Cheek biting
  4. 4.  Most common oral mucosal lesion  Possible etiological factors:  Allergy: food  Genetic predisposition: HLA family  Nutritional deficiency:B12,folate,Iron  Hematological abnormalities  Hormonal influences: Female, menstrual period  Infectious agents: AIDS,HSV,VZV  Trauma  Stress
  5. 5.  Of all the types of nontraumatic ulceration that affect oral mucosa, aphthous ulcers (canker sores) are probably the most common.  incidence ranges from 20% to 60%.  Prevalence tends to be higher in professional persons, in those in upper socioeconomic groups, and in those who do not smoke.
  6. 6.  Onset frequently in childhood but peak in adolescence or early adult life  Attacks at variable but sometimes relatively regular intervals  Most patients are non-smokers  Usually self-limiting eventually
  7. 7.  Three forms of aphthous ulcers have been recognized:  minor, major, and herpetiform  All are believed to be part of the same disease spectrum, and all are believed to have a common etiology. Differences are essentially clinical and correspond to the degree of severity.
  8. 8. Minor Aphthous stomatitis The most common type Non-keratinized mucosa affected Ulcers are shallow, rounded, 5-7mm with erythematous margins and yellowish floor One or several ulcers may be present
  9. 9.  Clinical Features  Minor aphthous ulcers usually appears as a single, painful, oval ulcer that is less than 0.5 cm in diameter, covered by a yellow fibrinous membrane and surrounded by an erythematous halo. Multiple oral aphthae may be seen.  Minor aphthous ulcers generally last 7 to 10 days and heal without scar formation. Recurrences vary from one individual to another. Periods of freedom from disease may range from a matter of weeks to as long as years.
  10. 10.  Uncommon  Ulcers frequently several cms mimic malignant ulcers  Ulcers persist for several months  Masticatory mucosa, dorsum of tongue or gingiva may be involved  Scar follow healing
  11. 11.  Clinical Features  painful recurrent ulcers.  prodromal symptoms of tingling or burning before the appearance of lesions.  The ulcers are not preceded by vesicles and characteristically appear on the vestibular and buccal mucosa, tongue, soft palate, fauces, and floor of mouth.  Only rarely do these lesions occur on the attached gingiva and hard palate, thus providing an important clinical sign for the separation of aphthous ulcers from secondary herpetic ulcers.
  12. 12.  discomfort, systemic health may be compromised because of difficulty in eating and psychological stress. The predilection for movable oral mucosa is as typical for major aphthous ulcers as it is for minor aphthae.  HIV-positive patients may have aphthous lesions at any intraoral site.
  13. 13.  Uncommon  Non-keratinized mucosa affected  Ulcers are 1-2 cm  Dozens or hundreds may be present  May coalesce to form irrigular ulcers  Widespread bright erythemous round ulcers
  14. 14.  Herpetiform Aphthous Ulcers.  Clinically  recurrent crops of small ulcers.  movable mucosa is predominantly affected,  palatal and gingival mucosa may also be involved. Pain may be considerable,  healing generally occurs in 1 to 2 weeks.  Unlike herpes infection, herpetiform aphthous ulcers are not preceded by vesicles and exhibit no virus-infected cells.
  15. 15.  the diagnosis of these ulcers is usually evident clinically, biopsies usually are unnecessary and therefore are rarely performed.  Aphthous ulcers have nonspecific microscopic findings, and no histologic features are diagnostic.  Studies have shown that mononuclear cells are found in submucosa and perivascular tissues in the preulcerative stage. These cells are predominantly CD4 lymphocytes,
  16. 16.  Differential Diagnosis.  Diagnosis of aphthous ulcers is generally based on the history and clinical appearance.  Lesions of secondary (recurrent) oral herpes are often confused with ulcers.  A history of vesicles preceding ulcers, location on the attached gingiva and hard palate, and crops of lesions indicate herpetic rather than aphthous ulcers.  Other painful oral ulcerative conditions include trauma, pemphigus vulgaris, mucous membrane pemphigoid, and neutropenia.
  17. 17.  Treatment.  occasional or few minor aphthous ulcers, usually no treatment is needed apart from a bland mouth rinse such as sodium bicarbonate in warm water to keep the mouth clean.  patients more severely affected, some forms of treatment can provide significant control (but not necessarily a cure) of this
  18. 18.  Behçet’s syndrome is a rare multisystem inflammatory disease (gastrointestinal, cardiovascular, ocular, CNS, a rticular, pulmonary, dermal) in which recurrent oral aphthae are a consistent feature.  Although the oral manifestations are usually relatively minor, involvement of other sites, especially the eyes and CNS, can be serious.
  19. 19.  Disease comprised oral aphthae, genital ulcerations and ocular diseases and other lesions  Major and minor criteria  Affect mostly young adult males between 20-40y  Strong genetic component
  20. 20.  Recurrent oral aphthae  Genital ulceration  Eye lesions  Skin lesions
  21. 21.  Arthralgia or arthritis  Gastrointestinal lesions  Vascular lesions  C.N.S involvement
  22. 22.  Clinical features:  - Rare disease of middle age  - Initial presentation: sinusitis, rhinorrhea, nasal stuffiness & epistaxis.  - Majority of cases, nasal & maxillary sinus ulceration.  - Necrosis & perforation of the nasal septum or palate are occasionally seen.  - Intra-oral lesions consist of red, hyperplastic, granular lesion on attached Gingiva.  - Classical triad : upper respiratory
  23. 23.  Allergic contact stomatitis: many agents cause reactions in the oral cavity as: numerous food, chewing gums, food additives, mouth washes dental materials, oral anasthesia.  Acute or chronic, female predominance  Appearance, mild redness- bright erythematous lesions or vesicls rapture to form areas of erosions
  24. 24.  Anaphylactic stomatitis either alone or in conjunction with urticarial skin lesions.  The affected mucosa show multiple zones of erythema or many aphthous-like ulceration.  Mucosal fixed drug eruptions develop into vesiculo-erosive lesions mostly on the labial mucosa  Most common drugs penicillin, barbiturates and sulfa drugs
  25. 25.  Erythema Multiforme  Anaphylactic stomatitis  Lichenoid drug reactions  Pemphigus-like drug reactions  Non-specific vesiculo-ulcerative lesions