SINGLE ULCERS

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ORAL MEDICINE

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SINGLE ULCERS

  1. 1. GOOD MORNING
  2. 2. SEMINAR
  3. 3. SINGLE ULCERS YA S M I N M O I D I N 2 0 0 8 B ATC H A L A Z H A R D E N TA L C O L L E G E THODUPUZHA
  4. 4. INTRODUCTION  The most common cause of single ulcers on the oral mucosa is trauma
  5. 5. TYPES  Traumatic ulcer  Eosinophilic ulcer of tongue  Histoplasmosis  Blastomycosis  Mucormycosis  Syphilitic ulcer
  6. 6. TRAUMATIC ULCER  Most common oral mucosal ulcer  Types of trauma  Mechanical  Chemical  Thermal  Radiation  Self-inflicted  Iatrogenic
  7. 7.  CLINICAL FEATURES  Tenderness or pain in the area of lesion  Sites : tongue, lips, mucobuccal fold, gingiva and palate  Persist for few days or lasts for weeks  Vary in size and shape  Borders are raised and reddish  Bases are yellowish necrotic surface  Frequently, a painful regional lymphadenitis occur as a result of contamination of ulcer by oral flora
  8. 8.  DIFFERENTIAL DIAGNOSIS  Carcinomatous ulcer  Recurrent aphthous ulcerations  MANAGEMENT  Removal of traumatic factor  Most traumatic ulcer become painless within 3 to 4 days  After the injury producing agent has been eliminated, most heal with 10 days
  9. 9.  Less serious varieties, treat with triamicinolone acetonide with emolient before bed time and after meals usually relieves the pain and hastens the healing  Orabase protects the denuded CT from continued contamination by oral liquids and cortisone component tend to arrest the inflammatory cycle  Persistent ulcers are surgically excised
  10. 10. EOSINOPHILIC ULCER OF TONGUE  ETIOLOGYAND PATHOGENESIS  Inflicting crush injury on tongue-most common site  Deep and penetrating
  11. 11.  RIGA-FEDE DISEASE  Lesion seen on ventral tongue  Infants  Cause- tongue rasping against newly erupted primary incisors
  12. 12.  CLINICAL MANIFESTATIONS  Bimodal age distribution  1st group- in 1st 2 years of life-lesion associated with erupting primary dentition  2nd group – adults – 5th and 6th decades
  13. 13.  ORAL FINDINGS  Children – anterior ventral or dorsal tongue associated with erupting mandibular or maxillary incisors  Adults – posterior and lateral aspect of tongue  Ulcer – not painful & persist for months  History of trauma
  14. 14.  Appear cleanly punched out, with surrounding erythema & whiteness  Size – 0.5cm  Surrounding tissue is indurated  5 % - multifocal and recurrences are not uncommon  In some cases , lesions are ulcerated , mushroom- shaped , polypoid mass on the lateral tongue
  15. 15.  DIFFERENTIAL DIAGNOSIS  Recurrent aphthous ulcers  Squamous cell carcinoma  T-cell lymphomas
  16. 16.  LABORATORY FINDINGS  Biopsy is needed to make diagnosis  MANAGEMENT  Intralesional steroid injections  Wound debridement  Use of nightguard on lower incisor – reduce nighttime trauma
  17. 17. HISTOPLASMOSIS  ETIOLOGY AND PATHOGENESIS  Caused by fungus Histoplasma capsulatum  Infection results from inhaling dust contaminated with droppings, from infected birds or bats
  18. 18.  CLINICAL MANIFESTATIONS  The expression of the disease depends on the quantity of spores inhaled, the immune status of the host and the strains of the organism  Asymptomatic and mild flulike illness for 1 to 2 weeks  The inhaled spores are ingested by macrophages within 24 to 48 hours and specific T lymphocyte immunity develops in 2 to 3 weeks
  19. 19.  TYPES  Acute histoplasmosis  Self –limited pulmonary infection  Acute symptoms are fever, headache, myalgia, nonproductive cough, anorexia  Patient is ill for 2 weeks  Calcification of hilar lymph nodes
  20. 20.  Chronic histoplasmosis  Primarily affects the lungs  Affects older, emphysematous, white men or immunosuppressed patients  Patients typically exhibit cough, weight loss, fever, dyspnoea, chest pain, hemoptysis, weakness and fatigue
  21. 21.  Disseminated histoplasmosis  Less common  It is characterized by progressive spread of the infection to extrapulmonary sites  It occurs in older, debilitated, immunosuppressed patients and patients with AIDS  Tissues that affect include: spleen , adrenal glands, liver, lymph nodes, GIT, CNS, kidneys and oral mucosa
  22. 22.  Common sites – tongue, palate, buccal mucosa  It appears as a solitary, painful ulceration of several weeks duration  Some lesions appear erythematous or white with an irregular surface  Ulcerated lesions have firm, rolled margins
  23. 23.  ORAL FINDINGS  Oral lesion begin as an area of erythema , becomes papule & forms Painful , granulomatous –appearing ulcer  Cervical lymph nodes are enlarged and firm  Patients with HIV has an ulcer with border, seen on gingiva , palate , tongue indurated
  24. 24.  DIFFERENTIAL DIAGNOSIS  Traumatic ulcerative granuloma  Squamous cell carcinoma  Lymphoma
  25. 25.  LABORATORY FINDINGS  Biopsy – stained with PAS OR methanamine silver – reveal presence of fungi  MANAGEMENT  Immunocompromised patients -IV amphotericin B  AIDS – itraconazole & maintenance therapy  Immunocompetent – itraconazole or ketoconazole for 6 to 12 months
  26. 26. BLASTOMYCOSIS  ETIOLOGY AND PATHOGENESIS  Caused by Blastomyces dermatitidis  Infection results from inhalation and is found in agricultural and construction workers
  27. 27.  CLINICAL MANIFESTATIONS  It is acquired by inhalation of spores , particularly after rain  The spores reach the alveoli of lungs, where they begin to grow as yeasts  The infection is halted and contained in the lungs  The sites of dissemination include skin, bone, prostate, meninges, oropharyngeal mucosa and abdominal organs
  28. 28.  Types  Acute blastomycosis  Resembles pneumonia, characterised by high fever, chest pain, malaise, night sweats and productive cough with mucopurulent sputum  Rarely, the infection may precipitate life-threatening adult respiratory distress syndrome
  29. 29.  Chronic blastomycosis  More common  Characterisezd by low grade fever, night sweats, weight loss and productive cough  Chest radiographs shows diffuse infiltrates or pulmonary or hilar masses  Calcification is not typically present  Lesion begins as erythematous nodules that enlarge , becoming verrucous or ulcerated
  30. 30.  ORAL FINDINGS  It may result from either extrapulmonary dissemination or local inoculation with the organism  Lesions have an irregular, erythematous or white intact surface  Appear as ulcerations with irregular rolled borders and varying degree of pain
  31. 31.  LABORATORY FINDINGS  Diagnosis by biopsy and culture demonstrates presence of multinucleated yeast cells with dark cytoplasm & colorless cell walls with characteristic of B.dematitidis  TREATMENT  Disseminated or progressive – ketoconazole , fluconazole , itraconazole for mild to moderate  Amphotericin B – sever disease
  32. 32. MUCORMYCOSIS  ZYGOMYCOSIS/ PHYCOMYCOSIS  ETIOLOGY AND PATHOGENESIS  Caused by saprophytic fungi  Occurs in soil or as a mold on decaying food  Fungus is nonpathogenic
  33. 33.  CLINICAL MANIFESTATIONS  Rhinocerebral zygomycosis  Patient experiences nasal obstruction, bloody nasal discharge, facial pain or headache, facial swelling or cellulitis and visual disturbances with concurrent proptosis  With progression of disease into the cranial vault, blindness, lethargy and seizures may develop followed by death
  34. 34.  If maxillary sinus is involved, the initial presentation may seen as intraoral swelling of maxillary alveolar process & palate  If the condition is untreated, palatal ulceration, appears as black and necrotic and massive destruction
  35. 35.  ORAL FINDINGS  Ulceration of the palate  Lesion is large & deep, causing denudation of underlying bone  Other sites- gingiva, lip , alveolar ridge  Initial manifestation confused with dental pain or bacterial maxillary sinusitis caused by maxillary sinus invasion of
  36. 36.  LABORATORY FINDINGS  Biopsy is split into culture & histopathology  Histopathologic findings- necrosis & nonseptate hyphae  Necrosis & occlusion of vessels is present
  37. 37.  MANAGEMENT  Combination of surgical debridement of the infected area  Amphotericin B for 3 months  Observed for renal toxicity  Posaconazole , antifungal agent is used for patients unable to tolerate toxicity of amphotericin
  38. 38. SYPHILITIC ULCER  Syphilis is a sexually transmitted disease , caused by Treponema pallidum  CHANCRE  Seen in genital region  Other sites- lips , tongue, palate, tonsillar regions  In initial stage- papule seen which subsequently erodes  Typical syphilitic ulcer is punched-out, non tender, indurated and associated with yellowish discharge
  39. 39.  Associated nodes are firm & non tender on palpation  Self-limiting & last for 2 weeks  Heal with minimum scar formation  MUCOUS PATCHES  Appears after a latency period of 6 months  Patient complains of fever, headache, bodyache & sore throat  Cutaneous maculopapular lymphadenopathy rashes associated with
  40. 40.  Oral lesions are characterised by appearance of oval red macules (palate) or papules (buccal mucosa & commissures) and mucous patches  Mucous patches are seen as raised erosive areas covered by a grayish white pseudomembraneous and surrpunded by an erythematous halo  Measure about 1 cm in diameter  Small lesions join together to give rise to snail track ulcers  severe & generalised form – lues maligna, also termed ulceronodular disease
  41. 41.  Oral mucosa reveals shallow crater like ulcers  Common sites – palate , buccal mucosa, tongue, lower lip, and gingiva  GUMMA  It is a highly destructive lesion  It occurs 8 to 10 years after initial infection  Common sites – hard palate , tongue
  42. 42.  MANAGEMENT  Parenteral pencillin G Allergic to pencillin, treated with doxycycline  , tetracycline , erythromycin

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