2. outlines
Definition
Classification of Oral ulcer (D.D)
New approach in classification (S – C - D)
Medical History /Family History
Chief Complain
Patient Examination
Investigation
Management
3. Oral ulcer
• Def :
• Sorness in oral mucosal tissue
• Cause :Epith layer removed
Leaving tissue exposed
4. Classification of oral ulcers
• According to Etiological factors
• According to primary or secondary ulcers
• According to sign & symptoms
• New Diagnostic Approach (S-C-D)
33. Viral Infections
•
Primary Herpetic Gingivostomatitis :
• Transmitted by direct intimate contact with
lesions or secretions from an asymptomatic
carrier.
• Tiny vesicles on the perioral skin vermillion
border of the lips and oral mucosa.
35. Primary Herpetic Gingivostomatitis
• Most common viral infection especially in
childhood ,adolescent .
• Preceded by prodromal symptoms.
• Redness mucosa turn to vesicles then to shallow
painful ulcers
• Self limiting / pain managed by supportive therapy
• After healing virus is transported from mucosal or
cutaneous nerve endings by neurons to ganglia
where HSV viral genome remains in Latent form
• Reactivation of the latent virus results in localized
lesions (Herpes libialis).
37. Varicella Zoster Virus (VZV)
• A-Chickenpox (varicella) :Prodromal symptoms
• (Fever, Sore throat ,Malaise ,Headache)
• generalized intense pruritic macuolopapular
eruptions, developed into vesicles ruptured into
ulcers.
• oral ulcers also present.
• Looklike aphthous like ulcer
• Ulcer/notpainful
• Heal with scar
• self limiting treated
symptomatically
38. Complication of Herpes zoster virus
• Facial paralysis
• Viscular eruption in oral cavity &oropharynx
• Pain external auditory meatus,Ear
• Hoarseness of voice
• Tinnitus
• Vertigo
39. Shingles (herpes zoster [HZ])
• Reactivation of HZV which latent in dorsal root
ganglia of spinal nerves /ganglia of cranial n.
• Sever neurologic pain
• Clinical feature: Prodromal syptoms (fever,malaise
,painful lymphadenopathy)
• Cluster of vesicles on one side of face follow course
of sensory nerve ,while other side completely free of
symptoms.
• Vesicular rupture leaving painful ulcer
• Ulcer heal with scar.
• self limiting treated symptomatically
51. Many of these diseases have a similar
clinical appearance
• How to reach the accurate diagnosis ??
Record Patient medical history is a must
clinical Examination
Investigation
52. Recording the patient history
• Biographic and Demographic information:
(Name ,age ,sex)
• Diseases mainly affect male /female
• Diseases mainly affect Diseases mainly affect
young / Old ages
53. Chief complaint and its History
• Painful
• Onset
• Size
• Distribution
• Associated phenomena
• Associated systemic condition
• Remission &relapse
• History of prodromal symptoms
54. Medical history
• systemic conditions have oral ulceration:
Blood disorders: Leukemia
GIT diseases : Inflammatory bowel disease
Neoplasms : Metastatic ulcerative lesions
Chemotherapy
Diabetes mellitus
55. Family History
• Diseases that have genetic predisposition:
Behçet’s syndrome
Reiter's syndrome
Lupus erthymatosis
59. Laboratory investigations
• Immunoflurescent test : to detect autoantibodies in autoimmune
diseases
• Direct :biobsy from patient tissue
• Indirect :from patient serum
• Pemphigus :circulating antibodies against intercellular desmosome
between keratocytes and cement tissue
• Pemphigoid :autoantibodies against desmosome in cell membrane
• +Nikolsky sign :vesicle formation on applied normal tissue pressure
which cause sliding to superficial layer
• Patch test : place allergens in aluminum disk on skin for 24 h
• No reaction : negative response
• Inflamatory reaction (erthema ,edema,vesicles): Positive
• Biobsy : sq cell carcinoma : show epith dysplasia
62. Important Notes
• Any persistant non healing ulcer more than 3
weeks should be refered (suspect cancer )
63. Oral Cancer Awarness
• One of most common cancer all over the world
• Squamous cell carcinoma is the most common oral cancer.
• Affect especially older age
• Evaluation of head &neck area is a fundamental part in patient
examination
• Dentist play critical role in detect sinister sign in head & neck
region
•
64. RED Flages Sign
• Nonhealing ulcer
• Indurated ulcer
• Painless persistant ulcer more than 3 weeks
• Numbeness in mouth/face
• Non healing sore in lip
• Exophytic ,proliferative , papillomatous lesions
67. References
• 1. Scully C. Clinical practice: aphthous ulceration. N
Engl J Med. 2006 Jul 13;355(2):165-72
• 2. Arduino PG, Porter SR. Oral and Perioral Herpes
simplex virus type 1 (HSV-1) infection. Overview of
its management. Oral Dis 2006; 12: 254–70.
• 3. Chattopadhyay A, Shetty KV. Recurrent
aphthous stomatitis. Otolaryngol Clin North Am.
2011 Feb;44(1):79-88, v. doi:
10.1016/j.otc.2010.09.003. PMID: 21093624.
68. Thank you
• By
Dr . Shaimaa H R Kotb
M RCSI ,M RCSEng ,M RCSEd ,M RCPSG,
Master degree in Oral Medicine ,Periodontology ,Oral Diagnosis
and Dental Radiology