SYN: Vesicular stomatitis , Acute
Cause: Enteroviruses-Coxsackie A, EV 71
Characteristic vesicular rash on tonsillar pillars,
soft palate, uvula, tonsils, posterior pharyngeal
Discrete 1- to 2-mm vesicles and ulcers
Enlarge over 2-3 days to 3-4 mm and are
surrounded by erythematous rings up to 10 mm
1-15 lesions are present, usually around 5
Usually resolve without complications
Syn: orolabial herpes
Clusters of multiple vesicles -> ulcers
Fever, malaise and headache , sore throat and
Vermilion border of the lip > hard palate and gingiva
Reactivation of dormant virus in trigeminal ganglion
Acyclovir, 200 mg, five times a day for 5 days to reduce
Hand, foot and mouth disease
Cause: Coxsackievirus A16 and enterovirus 71 (EV71)
spread via the fecal-oral and perhaps respiratory
primarily in children
vesicular palmoplantar eruption and erosive
Cloudy vesicles with a red halo are highly
characteristic of this disease.
Syn: acute necrotising ulcerative gingivitis, trench
Causative organisms include a fusiform bacillus and a
spirochaete –borrelia vincentii
Affects young adults and middle-aged persons
Starts at the interdental papillae -> free margins of the
Lesions covered with necrotic slough.
Gingivae become red and oedematous.
Similar ulcer and necrotic membrane may also form
over the tonsil (vincent’s angina).
Diagnosis: smear from the affected area.
Systemic antibiotics (penicillin or erythromycin and
Frequent mouth washes (with sodium bicarbonate
solution) and attention to dental hygiene.
caused by Candida albicans
white grey patches on the oral mucosa and
infants and children
systemic malignancy and diabetes or taking
broad spectrum antibiotics, cytotoxic drugs,
steroids or radiation.
Thrush can be treated by topical application of
nystatin or clotrimazole.
Chronic hypertrophic candidiasis. Also called candidal leukoplakia.
White patch which cannot be wiped off.
Mostly affects anterior buccal mucosa just behind the angle of mouth.
Hypertrophic form usually requires excisional surgery.
Recurrent and superficial
Aetiology: Unknown. Autoimmune, Nutritional
(Folate, B12, Iron), Viral, Bacterial, Food
allergies, Hormonal, Stress
usually involving movable mucosa, i.e. inner
surfaces of lips, buccal mucosa, tongue, floor
of mouth and soft palate, sparing mucosa of
the hard palate and gingivae.
ulcers are 2–10 mm in size and multiple with a
central necrotic area and a red
They heal in about 2 weeks without leaving a
Major form, ulcer is very big, 2–4 cm in size,
and heals with a scar but is soon followed by
Topical application of steroids
Cauterisation with 10% silver nitrate.
In severe cases, 250 mg of tetracycline dissolved in 50 ml of water is
given as mouth rinse and then to be swallowed, four times a day.
Local pain can be relieved with lignocaine viscous.
Behcet’s syndrome (Oculo-oro-
Behçet's disease is a complex multisystem disease characterized by
oral and genital ulcers and other systemic features.
Diagnosis is based on the International Criteria for Behçet's Disease
and a positive pathergy test.
Cutaneous lesions should display a neutrophilic vascular reaction on
Seen worldwide, with the highest prevalence reported in Turkey and
prevalence and often the severity is increased in the Middle East
and the Mediterranean
predominantly affect males
Cause and Pathogenesis
Heredity, immunologic factors, infectious agents, inflammatory
mediators, and clotting factors likely contribute.
Oral aphthae, or Canker sores are often the initial
feature of Behçet's disease and constitute a requisite
usually occur in crops of more than 3 to 10s
painful and shallow, and they heal without scarring
over 1 to 3 weeks
Genital ulcers typically occur on the scrotum and penis
in males and on the vulva or vaginal mucosa in
These aphthae are similar in appearance to oral
lesions, but they have a greater tendency to scar and
may recur less frequently.[
erythema nodosum–like lesions,
pyoderma gangrenosum–like lesions,
Sweet's syndrome–like lesions,
cutaneous small vessel vasculitis, and pustular vasculitic
lesions including lesions induced by trauma—the so-called
Pathergy signifies the development of erythematous
pustules or papules 24 to 48 hours following puncture of
the skin with a 20- to 21-gauge sterile needle.
Specimens from all these lesions demonstrate a
neutrophilic vascular reaction on histopathologic
Ophthalmic (83% to 95% of men and 67% to 73% of
anterior and posterior uveitis,
retinal vasculitis, and hypopyon, with secondary
cataract formation, decreased visual acuity, and
Arthritis of Behçet's disease is typically a nonerosive, inflammatory,
symmetric, or asymmetric oligoarthritis
Central nervous system (CNS) involvement is most commonly
brain stem or corticospinal tract syndromes (neuro-Behçet's syndrome),
venous sinus thrombosis,
increased intracranial pressure
Cardiac complications include
arterial and venous thromboses, and
Miscellaneous lesions of oral cavity
Median rhomboid glossitis
red rhomboid area, devoid of papillae, seen
on the dorsum of tongue in front of foramen
Due to chronic oral candidiasis
lateral border of tongue -jagged tooth or ill-fitting
buccal mucosa -cheek bite;
palate - injury with a foreign object such as pencil
or tooth brush
acute ulcerative lesions of oral and
oropharyngeal mucosa - ingestion of acids or
alkalies or hot fluids.
Aspirin burn - buccal sulcus
Acute, self-limited, polymorphous eruption
Symmetrically distributed macules, papules, and bullae, with
an edematous, petechial, vesicular, or bullous dusky violet
It is probably due to cell-mediated hypersensitivity reaction
to certain drugs or infections, particularly in genetically
predisposed individuals, those immunocompromised or with
Mucosal lesions are ocular (conjunctivitis, keratitis), oral
(stomatitis, cheilitis), nasal, pharyngeal, tracheal, and genital
(balanitis and valvulitis).
Dull red, flat or slightly raised maculopapules, which may
remain small or may increase in size to reach a diameter of 1-
3 cm in 48 h. Typical cases show at least some target (or iris)
The disease is self-limiting and management is mainly
supportive. Steroids are used to treat the severe form.
autoimmune disorder affecting older age group (50–70) [AMBD]
Oral ulcerations are superficial and involve palate, buccal mucosa and
Jagged intraoral erosions->Blisters
Treatment consists of systemic steroids and cytotoxic drugs.
Benign mucous membrane
Most common AMBD
Mucosal lesions involve cheek,
gingivae and palate > Conjunctiva
Bulla filled with clear or haemorrhagic
fluid -> ruptures to form superficial
ulceration covered with shaggy
Skin lesions may be absent.
Treatment consists of steroids.
Oral lichen planus (OLP) can occur without
Onset before middle age is rare; the mean age of
onset is in the sixth decade.
Women outnumber men by more than 2:1.
Mucous membrane involvement is observed in
more than 50% of patients with cutaneous lichen
The most common location of OLP is the buccal
mucosa (80% to 90%) followed by the tongue (30%
Lavy white lesions on buccal mucosa
Also called benign migratory glossitis,
Well-defined areas of atrophied filiform
papillae bordered by arcs of normal or
hyperplastic filiform papillae and by
gradual changes in the location of these
lesions over time
Submucous fibrosis represents a multifactorial disorder;
with the considered chief etiologic factor being the consistent and habitual use
of areca (betel) nut, either in the form of chewing or simply placing a quid of
material (paan masala) in the buccal or labial sulcus several time per day, or in
a packaged powdered form with other components (guthka), over many years.
premalignant condition with transformation rates as high as 7.6%
Etiology and pathogenesis:
failure of collagen remodeling
altered epithelial-mesenchymal interactions ->formation of collagenous bands
and aggregates within the submucosa and lamina propria.
diminished level of functional collagenase levels
Changes of submucous fibrosis are most marked
over soft palate, faucial pillars and buccal mucosa
Initial mucosal alterations: erythema with or without
Later: slow diminishment of erythema and a
progressive decrease in the degree of oral opening
and tongue mobility
Pallor of the normally pink mucosa becomes
evident as the underlying chronic inflammation
recedes and fibrosis and hyalinization progress.
Scar bands may become evident deep within the
buccal soft tissues, further limiting jaw opening and
Development of squamous cell carcinoma is
characterized by a gradual thickening of the
epithelial surface with hyperplastic to verrucous
surface qualities becoming evident.
juxtaposition of atrophic epithelium
surfacing a subjacent fibrosis.
Early connective tissue alterations
are characterized by delicate and
loosely arranged collagen fibers with
progressive degrees of hyalinization
In the late stages:
complete hyalinization of the
supportive connective tissue.
Variable degrees of chronic
inflammation occur in the form
of lymphocytes and plasma
Variable levels of dysplasia have
Management of oral submucous fibrosis is problematic, particularly in advanced
cases and when the use of areca-containing products remains in place.
Avoid irritant factors
Topical injection of steroids-Dexamethasone
Treat existent anaemia or vitamin deficiencies
Encourage jaw opening exercises.
Surgical release procedures of scar bands have been only modestly successful.
More recently collagenase and pentoxifylline administration in separate studies
has been proposed