BACK TO INDEX Oral Ulcerative diseases NEXT Introduction
BACK TO INDEX 口腔粘膜溃疡类疾病 Oral Ulcerative diseases NEXT
Introduction Recurrent Aphthous Ulcer BehÇet’s disease Traumatic Ulcer & Traumatic Bulla Reiter’s Syndrome Summary & Questions BACK
I. Introduction 1. Ulcers are one of the most common types of lesions seen in oral mucosa. 2. The difference between ulcer and erosion. NEXT
ulcer erosion NEXT
Comparison ulcer erosion continuity of epithelium broken severe superficial basal cells involved free border clear unclear diseases RAU Behcet’s disease Syphilis Pemphigus Herpes simplex BACK
II. Recurrent Aphthous Ulcer 1. Preface • Name recurrent aphthous ulcer RAU recurrent aphthous stomatitis RAS recurrent oral ulcer ROU NEXT
• Typing Lehner’s classification minor aphthous ulcer （Mi. AU） major aphthous ulcer （Mj. AU） herpetiform ulcer （HU） • Characteristic recidivity self-healing periodicity NEXT
2. Etiology unknown • immunity : cellular immunity, humoral immunity, complement, autoantibody • heritage • infection ：HSV • environment: psychology NEXT
• denutrition ：iron, copper, zinc, folic acid, Vit B 12 • hyperoxide dismutase • microcirculation disturbance ：lip, nail, apex linguae • systemic factor ：ulceration of stomach、hepatitis、colonitis、diarrhoea NEXT
3. Clinical features minor aphthous ulcer major aphthous ulcer herpetiform ulcer NEXT
Mi. AU feature yellow red concave painful small (24 mm) Mj. AU big (1 -3 cm) deep scar HU multiple small course 7 -10 days 3 -6 weeks 7 -10 days number 1 -5 1 >10 position nonkeratinized oral mucosa soft palate systemic symptom — lymph nodes swelling tongue lip mouth floor fever headache lymph nodes swelling NEXT
Minor aphthous ulcers NEXT
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Mi. AU feature yellow red concave painful small (24 mm) Mj. AU big (1 -3 cm) deep scar HU multiple small course 7 -10 days 3 -6 weeks 7 -10 days number 1 -5 1 >10 position nonkeratinized oral mucosa soft palate systemic symptom — lymph nodes swelling tongue lip mouth floor fever headache lymph nodes swelling NEXT
Major aphthous ulcers Periadenitis Mucosa Necrotica Recurrens NEXT
Major aphthous ulcers NEXT
Mi. AU feature yellow red concave painful small (24 mm) Mj. AU big (1 -3 cm) deep scar HU multiple small course 7 -10 days 3 -6 weeks 7 -10 days number 1 -5 1 >10 position nonkeratinized oral mucosa soft palate systemic symptom — lymph nodes swelling tongue lip mouth floor fever headache lymph nodes swelling NEXT
Herpetiform ulcers NEXT
• disease-process prodromal stage 24 h ulcerative stage outbreak 10 d-14 d intermission healing NEXT
4. Pathology ： nonspecific inflammation 5. Diagnosis • history • clinical feature NEXT
6. Differential diagnosis • benign ulcer & malignant ulcer • Necrotizing sialadenometaplasia, Behçet’s disease, herpes simplex, hand-foot-and-mouth disease NEXT
Comparison age depth self-healing systemic condition pathology recurrence benign ulcer malignant ulcer youth deep yes the aged Deep or shallow no good cachexy chronic inflammation yes cancer no NEXT
7. Treatment principle：symptomatic treatment Evaluation of curative effect NEXT
Topical application of a steroid ointment reduces discomfort and decreases the duration of the lesions. Topical anesthetics, antibiotics, mouthwashes, etc. , have been used. In severe cases, intralesional steroid injection or systemic steroids in a low dose (10 -20 mg prednisone) for 5 -10 days reduce the pain dramatically. BACK
III. BehÇet’s disease 1. Preface Hulusi Behçet (1937) Behçet’s disease is a chronic multisystemic inflammatory disorder of uncertain cause and prognosis. 2. Etiology Unknown NEXT
3. Clinical features 1) oral mucosa: minor aphthous ulcer 2) genital lesion: ulcer 3) skin lesions: erythema nodosum, epifolliculitis, pustule after needling 4) ocular lesions: conjunctivitis, recurrent iritis 5) others systems: joint, digestive, cardiovascular, nervous, respiratory, urinary NEXT
BehÇet’s disease NEXT
4. Pathology ： Histopathologic changes consist of a perivascular mononuclear cellular infiltrate, endothelial cell swelling or necrosis, partial luminal obliteration and occasional fibrinoid necrosis of the vessels. NEXT
5. Diagnosis 1) recurrent oral ulceration 2) recurrent genital ulceration 3) eye lesions 4) skin lesions 5) positive pathergy test To establish the diagnosis of Behçet’s Disease, recurrent oral ulceration plus any two of the other four major clinical criteria must be present. NEXT
6. Differential diagnosis RAU Herpetic atomatitis Crohn’s disease Reiter’s syndrome Stevens-Johnson syndrome NEXT
7. Treatment Symptomatic in mild cases. Systemic steroids, immunosuppressive drugs, colchicines, thalidomide, and dapsone are administered in severe cases. BACK
IV. Traumatic Ulcer Traumatic Bulla 1. Preface Because of the constant motion of the masticatory mucosa over the teeth and the introduction of hard objects into the oral cavity, traumatic ulcers are frequent. NEXT
2. Etiology Mechanical factors: a sharp or broken tooth, rough fillings, clumsy use of cutting dental instruments, hard foodstuffs, sharp foreign bodies, biting of the mucosa, and denture irritation etc. Physical factors: thermal burns Chemical factors: strong acid, strong base, As 2 O 3, Ag(NO)3, iodophenol NEXT
3. Clinical feature 1) Decubital ulcer § mechanical irritating factors § the ulcer conforms in area and linearity to the source of the irritating factors NEXT
traumatic ulcer NEXT
traumatic ulcer NEXT
2) Bednar ulcer § infants, hard palate § improper feeding NEXT
3) Rida-Fede ulcer § infants § lingual frenum ulcer secondary to inferior deciduous incisor NEXT
4) Factitious ulcer § mentally handicapped patients or those with serous emotional problems § oral self-inflicted trauma by biting, fingernails, or by the use of a sharp object § tongue, lower lip, gingiva § slow to heal due to perpetuation of the injury by the patient § local measures and psychiatric therapy NEXT
5) Chemical burn § the type of chemical utilized, its concentration, and the duration § whitish surface desquamating painful erosion or ulcer bone damage § healing within 1 -2 weeks NEXT
chemical burn NEXT
6) Thermal burn § very hot foods, liquid, or hot metal objects § palate, lips, floor of the mouth, tongue § painful, red, undergoing desquamation, leaving erosions § supportive treatment; self-healing in about a week NEXT
thermal burn NEXT
7) Traumatic bulla & traumatic hematoma § caused by biting or prosthetic appliances § buccal mucosa, soft palate, lips, tongue § self-healing in 4 -6 days NEXT
traumatic bulla NEXT
4. Diagnosis history clinical features 5. Differential diagnosis carcinoma, syphilis, tubercular ulcer, major aphthous ulcer thrombocytopenia, thrombasthenia pemphigus, cicatricial pemphigoid NEXT
malignant ulcer NEXT
5. Differential diagnosis Traumatic ulcer Mj. AU malignant tubercular ulcer etiology feature of ulcer morphology of ulcer pathology BACK
6. Treatment Removal of the traumatic factors Topical measures NEXT
V. Reiter’s Syndrome 1. Preface Reiter’s syndrome is a disease of unknown cause that predominantly affects young men, 20 -30 years of age. 2. Etiology unknown NEXT
3. Clinical feature § Major symptoms: nongonococcal urethritis, conjunctivitis, arthritis § Other symptoms: oral ulcer, circinate balanitis, keratoderma blennorrhagicum NEXT
oral lesion NEXT
4. Diagnosis history clinical criteria NEXT
5. Differential diagnosis The differential diagnosis the oral lesions includes erythema multiforme, Stevens. Johnson syndrome, psoriasis, Behçet’s Disease, geographic tongue, and stomatitis. NEXT
6. Treatment It is nonspecific and symptomatic. Nonsteroidal anti-inflammatory drugs, salicylates, and tetracyclines may be helpful, cyclosporin, azathioprine, methotrexate, and systemic steroid in severe case. BACK
Summary 1. To compare the characteristics of major Aphthous ulcer, traumatic ulcer, carcinoma and tuberculous ulcer. (etiology, pathology, clinical feature, treatment, prognosis). 2. To master the treatment principle of ulcerative diseases by taking RAU for example. NEXT
3. To master the effect, usage, contraindication and side-effect of corticosteroid in treating ulcerative diseases. 4. To establish the conception of oral mucosal syndrome by means of learning Behçet’s disease. NEXT
Questions 1. Which is the most common form of Recurrent Aphthous Ulcer? What’s the characteristic of its lesion? 2. What’s the effect of corticosteroid in treating oral ulcerative diseases? 3. What’s the primary treatment to traumatic ulcer? NEXT
4. Taking major Aphthous ulcer and carcinoma for example, try to tell the difference between benign ulcer and malignant ulcer. 5. What are the oral lesions of Behçet’s Disease and Reiter’s Syndrome ? What are their clinical systemic features? BACK
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