Presented by:
Yawer Dar
Student of Dental Surgery
ITS Dental College, Hospital and Research Centre
Email: yawerdar@gmail.c...
 Discontinuity in the
oral epithelium or
breach in the
continuity of the oral
epithelium is known
as an Apthous ulcer.
 ...
 They appear as small,
round, or ovoid ulcers.
 They have well
circumscribed and raised
margins.
 They have a erythemat...
Recurrent
Apthous Ulcers
Minor Apthous
Ulcers
Major Apthous
Ulcers
Herpetic
Apthous Ulcers
 The most common type of the
disease seen.
 It is referred as a “Canker sore” by
a lay man or referred as a “chaala”
in ...
 Major Apthous ulcers are
simply more severe form of
minor Apthous ulcer’s.
 They are larger in size
 They are more pai...
 Herpetic ulcer’s are characterized by
crops of multiple small, shallow
ulcers often up to 100 in number.
 It may occur ...
 Etiology of Apthous Ulcer’s is unknown but
following are the factors known to cause Apthous
Ulcer’s:
 Bacterial infecti...
 Barile and Stanley strongly
implicated Streptococcus
Sanguis as the causative
agent of the disease.
 This organism has ...
 There is a positive
family history and
occurrence of
Recurrent Apthous
Ulcer’s is associated
with HLA-B51(Human
leukocyt...
 Lehner has proposed that the
recurrent apthous ulcer’s is the
result of an autoimmune
response of the oral epithelium,
b...
•There has been some evidence
that nutritional deficiencies
might be of significance in the
etiology of recurrent Apthous
...
 Local trauma has
been found to be the
precipitating factor
by Graykowski and
his coworkers.
 The traumatic
incidents in...
 Incidence of Apthous
ulcer’s is greatest
during the
premenstrual period.
 Ulceration is maximal
in the post ovulation
p...
• It is interesting to note that
approximately 55% of a large
group of professional school
students studied by ship and hi...
 In one study, 20 individuals
who had suffered from
recurrent aphthous ulcers,
some for more than 11 years,
were given a ...
 Apthous Ulceration occurs
in various systemic
disease like behcet
syndrome, cyclic
neutropenia, magic
syndrome(major Apt...
 Exhibits a fibrinopurulent membrane
covering the ulcerated area.
 An intense inflammatory cell infiltration
is present ...
 Dosage 250mg per 5ml.
 It is usually taken by
diluting the tetracycline
capsules in 5 ml of water
and is gargled in the...
 Levamisole is an
immunopotentiating agent that
has demonstrated the ability to
normalize the CD4+ cell/CD8+
cell ratio a...
 Amlexanox is an anti-
inflammatory, antiallergic
immunomodulator used to
treat Recurrent Apthous
Ulcers.
 A 2011 review...
 TRIAMCINOLONE a
corticosteroid. It is
used to reduce
swelling and ulcers
in the mouth. It
helps treat and
relieve mouth
...
 Analgesic’s and
Antiseptics such as
Dologel-CT and Hexigel
which contain Choline
salicylate, lignocaine
hydrochloride an...
 Vitamin B12, Folic
Acid
 Iron
 Zinc Sulfate
 Not much of positive
results are found
with administration
of vitamin B1...
Management and Treatment of Recurrent Apthous ulcer’s
Management and Treatment of Recurrent Apthous ulcer’s
Management and Treatment of Recurrent Apthous ulcer’s
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Management and Treatment of Recurrent Apthous ulcer’s

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Management and Treatment modalities of Recurrent Apthous Ulcer's with new treatment modalities.

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Management and Treatment of Recurrent Apthous ulcer’s

  1. 1. Presented by: Yawer Dar Student of Dental Surgery ITS Dental College, Hospital and Research Centre Email: yawerdar@gmail.com
  2. 2.  Discontinuity in the oral epithelium or breach in the continuity of the oral epithelium is known as an Apthous ulcer.  It shows cell by cell destruction pattern.  Development of painful solitary or multiple ulcerations of the oral mucosa.
  3. 3.  They appear as small, round, or ovoid ulcers.  They have well circumscribed and raised margins.  They have a erythematous halo and a necrotic centre.  They have Yellow or gray floors.  They are very painful and the pain is aggravated by taking spicy foods and acidic drinks.  There is difficulty in speech due to pain.
  4. 4. Recurrent Apthous Ulcers Minor Apthous Ulcers Major Apthous Ulcers Herpetic Apthous Ulcers
  5. 5.  The most common type of the disease seen.  It is referred as a “Canker sore” by a lay man or referred as a “chaala” in Hindi.  It has all the basic characteristics of an Apthous ulcer.  Occurs somewhat more frequently in females than males between the age of 10 to 30 years.  Nearly 20% of the world population is affected by this disease and commonly seen in professional school students.  Size: 2-3mm to 10 mm in diameter.
  6. 6.  Major Apthous ulcers are simply more severe form of minor Apthous ulcer’s.  They are larger in size  They are more painful.  Seen commonly on the lips, cheeks, tongue, soft palate and rarely on the hard palate.  More common in HIV infected patients.  They are more ulcerated lesions and take a longer time to heal than the usual time.  Size: They can exceed 1cm in Diameter and can leave a scar upon healing.
  7. 7.  Herpetic ulcer’s are characterized by crops of multiple small, shallow ulcers often up to 100 in number.  It may occur at any site in the oral cavity.  The lesions are more painful than suspected by there small size.  First described by Cooke in 1960. Lehner, Brooke and Sapp expanded it later.  They look like lesions of herpes simplex but they are not associated with herpes virus and look more like Apthous ulcers.  Females have a greater predilection.  The exact nature of this disease is yet unknown.
  8. 8.  Etiology of Apthous Ulcer’s is unknown but following are the factors known to cause Apthous Ulcer’s:  Bacterial infections  Genetic predisposition  Immunologic Abnormalities  Iron, Vitamin B12 or Folic Acid deficiency  Trauma  Endocrine Conditions  Stress and Emotional upset  Allergic Factors  Systemic Diseases
  9. 9.  Barile and Stanley strongly implicated Streptococcus Sanguis as the causative agent of the disease.  This organism has been consistently isolated from the lesions of patients with typical Apthous ulcer’s.  It has been suggested that there is a T-cell mediated response to the bacteria that produces cross-reaction between streptococcal heat shock protein and oral mucosa and leads to mucosal damage.
  10. 10.  There is a positive family history and occurrence of Recurrent Apthous Ulcer’s is associated with HLA-B51(Human leukocyte antigen)  Individuals with positive family history develop the ulcer’s at an early stage of their life.
  11. 11.  Lehner has proposed that the recurrent apthous ulcer’s is the result of an autoimmune response of the oral epithelium, by using fluorescent antibody technique he has shown both IgG and IgM binding by epithelial cells of the spinious layer of oral mucosa in patients suffering from Recurrent Apthous Ulcer’s.  It’s is suggested that the disease is the result of diffusion of bacterial toxins, food and other substances acting allergens and haptens which initiate an immune response causing ulcer’s.
  12. 12. •There has been some evidence that nutritional deficiencies might be of significance in the etiology of recurrent Apthous stomatitis. •A study reported by Wray and his colleagues suggested that patients deficient with Iron and vitamin B12 have a greater risk of Apthous ulcer’s and on appropriate vitamin therapy showed improved results.
  13. 13.  Local trauma has been found to be the precipitating factor by Graykowski and his coworkers.  The traumatic incidents include self inflicted bites, oral surgical prodedures, tooth brushing, dental procedures, needle injections and dental trauma.
  14. 14.  Incidence of Apthous ulcer’s is greatest during the premenstrual period.  Ulceration is maximal in the post ovulation period and it is related to blood level of progesterone.  On rare occasions the onset of the disease has been associated with menarche and menopause.
  15. 15. • It is interesting to note that approximately 55% of a large group of professional school students studied by ship and his associates gave a positive history of recurrent Apthous Ulcer’s, therefore making Stress and educational pressure as a major factor in Recurrent Apthous Ulcer’s •Recurrent Apthous are also commonly seen in People who stay emotionally upset and isolated.
  16. 16.  In one study, 20 individuals who had suffered from recurrent aphthous ulcers, some for more than 11 years, were given a gluten-free diet to follow. Five of these, 25%, became ulcer free and when challenge tested with gluten the ulcers returned.  In a 1990 study tomatoes, oranges, nuts, eggplant, tea, cola , cinnamon oil, pineapple and flavouring agents were known to cause Apthous Ulcer’s.  Sodium lauryl sulfate present in toothpaste’s is also suggestive of causing Apthous ulcers.
  17. 17.  Apthous Ulceration occurs in various systemic disease like behcet syndrome, cyclic neutropenia, magic syndrome(major Apthous and generalized inflamed cartilage) and HIV infection..  Apthous ulcer’s occur in patients with systemic illness like crohn’s disease, ulcerative colitis and gluten sensitive enteropathy.
  18. 18.  Exhibits a fibrinopurulent membrane covering the ulcerated area.  An intense inflammatory cell infiltration is present in the connective tissue beneath the ulcer with considerable necrosis of tissue near the surface of the lesion.  Granulation tissue may be noted near the base of the lesion.  Epithelial proliferation is present at the margin’s of the lesion.
  19. 19.  Dosage 250mg per 5ml.  It is usually taken by diluting the tetracycline capsules in 5 ml of water and is gargled in the mouth four times a day for 5 to 7 days.  This treatment produced a good response in nearly 70 % of the Patients tested, by reliving the pain, reducing the size of the lesions and reducing the healing time.
  20. 20.  Levamisole is an immunopotentiating agent that has demonstrated the ability to normalize the CD4+ cell/CD8+ cell ratio and improve symptoms in Recurrent Apthous ulcer patients. Correction of T- suppressor-cell deficiency may reduce the inflammatory response resulting from cellular immunity and promote resolution of aphthae.  It is taken once a week for a period of 10 months.
  21. 21.  Amlexanox is an anti- inflammatory, antiallergic immunomodulator used to treat Recurrent Apthous Ulcers.  A 2011 review found it to be the most effective treatment of the eight treatments investigated for recurrent canker sores.  It is applied on the Ulcer’s directly 3-4 times a day.  In India Apthasol comes under the brand name Lexanox.
  22. 22.  TRIAMCINOLONE a corticosteroid. It is used to reduce swelling and ulcers in the mouth. It helps treat and relieve mouth sores.  Applied 3-4 times a day on the ulcer.
  23. 23.  Analgesic’s and Antiseptics such as Dologel-CT and Hexigel which contain Choline salicylate, lignocaine hydrochloride and chlorohexidine gluconanate(Hexigel) helps in reliving pain and help preventing secondary infections.  Analgesics are applied prior to meals so that the patient feels comfortable while eating.
  24. 24.  Vitamin B12, Folic Acid  Iron  Zinc Sulfate  Not much of positive results are found with administration of vitamin B12 in patients with Recurrent Apthous Ulcer’s

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