This document discusses several immunologic diseases that can affect the oral cavity, including recurrent aphthous ulcers, Behcet's syndrome, and Reiter's syndrome. It focuses on recurrent aphthous ulcers, describing their three clinical presentations (minor, major, herpetiform), prevalence, predisposing factors, and treatment options including dietary modifications, topical anesthetics and anti-inflammatories, mouthwashes, and systemic steroids or tetracycline. It also briefly mentions Behcet's syndrome, Reiter's syndrome, and contact stomatitis.

1. IMMUNOLOGIC DISEASES OF ORAL
CAVITY

2. APTHOUS ULCERS
 Recurrent apthous ulcers are common painful
mucosal conditions affecting oral mucosa.
 The term “aphthous” is derived from a Greek word
“aphtha” which means ulceration

5. INCIDENCE

6. CLINICAL PRESENTATION
 RAS is characterized by recurrent bouts of solitary
or multiple shallow painful ulcers
 Minor RAS is also known as Miculiz's aphthae or
mild aphthous ulcers.
 It is the most common variant, constituting 80% of
RAS.
 Ulcers vary from 8 to 10 mm in size.
 It is most commonly seen in the nonkeratinized
mucosal surfaces like labial mucosa, buccal
mucosa, and floor of the mouth.
 Ulcers heal within 10–14 days without scarring.

7. Minor apthous ulcer

8. CLINICAL PRESENTATION
 Major RAS is also known as periadenitis mucosa
necrotica recurrens or Sutton's disease.
 It affects about 10–15% of patients.
 Ulcers exceed 1 cm in diameter.
 Most common sites of involvement are lips, soft palate
 The ulcers persist for up to 6 weeks and heal with
scarring.

10. CLINICAL PRESENTATION
 Herpetiform ulceration is characterized by
recurrent crops of multiple ulcers
 May be up to 100 in number.
 These are small in size, measure 2–3 mm in
diameter.
 Lesions may coalesce to form large irregular ulcers.
 These ulcers last for about 10–14 days.

11. HERPITIFORM TYPE OF ULCERS

12. PREDISPOSING FACTORS
 Trauma
 Genetic factors
 Tobacco
 Drugs
 Hematinic deficiency
 Gluten sensitivity
 Stress
 Hormonal changes
 Sodium lauryl sulfate containing tooth pastes

13. TREATMENT OF APTHOUS ULCERS
 Dietary and general measures
 1. avoid spicy , hard and salty substances
 2. sodium lauryl sulfate free tooth pastes
Topical therapy
1. Lidocaine as 1% cream
2. 2% gel or spray;
3. Polidocanol as paste
4. Benzocaine lozenges.

14.  Antiseptics and anti-inflammatory agents
 Mouth wash containing 0.15% triclosan in
ethanol and zinc sulfate
 Diclofenac 3% in a 2.5% hyaluronic acid gel
 Chlorhexidine mouthwash and chamomile
extract both reduced the frequency, increased
healing speed, and decreased the severity of
aphthous ulcers

15.  Topical tetracycline treatment
 Using a mouthwash containing chlortetracycline
2.5% increased the number of ulcer-free or pain-
free days significantly,
 Tetracycline hydrochloride powder 250 mg can be
combined with 10 mL of tap water by the patient
immediately before use to avoid stabilization
problems. Because of the acid pH value, there may
be temporary mucosal burning generally followed
by clinical improvement. A stable mixture can also
be prepared by neutralizing the tetracycline
hydrochloride to create a basic product (6).

17. SYSTEMIC
TOPICAL

20. BEHCET SYNDROME

28. REITERS SYNDROME
 An inflammatory arthritis of large joints,
inflammation of the eyes in the form
of conjunctivitis or uveitis, and urethritis in men
or cervicitis in women.

30. CONTACT STOMATITIS
 Manifested by occurrence of itching and burning
sensation
 Erythema follows vesicle , erosion occurs and may
become extensive

31.  Discontinue with the offending contact
 Materials enlisted-
 Dentrifices
 Mouth washes
 Lipsticks
 Cough drops
 Chewing gum