4DefinitionInjury to the oral mucosa may result in a localized defect of the surface in which the covering epithelium is destroyed leaving an inflammed area of exposed connective tissue. Such defects or erosions are called Ulcers.
5Classification Traumatic Recurrent apthous stomatitis (RAS). Ulcers associated with systemic diseases and vesicolobulous disease(Pemphigus,pemphigoid,erythema multiform)(Dermatitis herpetiformis epidermolysis bullosa)
12Recurrent Aphthous Stomatitis(RAS) Most common ulcerative lesion of oral cavityRecurrent, painful ulcersConfined to soft mucosaSubdivided into three types:Minor aphthaeMajor aphthaeHerpetiform aphthae
13Apthous ulcers contd: Etiology A. Not understood but damaging immune response in increasingly implicated. Some of the factors are related to the causeImmunological factorsHeredity factorsMicrobiological factorsEmotional stressNutritional deficienciesAllergic disordersHematological factorsGastrointestinal factors.
14Recurrent apthous ulcer stomatitis contd: C/F Minor apthous ulcersProdromal signs appear hours before with burning and itching.Comprise more than 80%May be shallow and round affecting theNon-keratinized part of the oral epithelium.Diameter of ulcer is less than 10mm with red margin.Heal without scarring within 7-10 days.Tend to recur with in 1-4 months.Site is usually the tongue, buccal mucosa, soft palate.
16Recurrent apthous stomatitis Contd: Major apthous ulcerLarger than the minor ulcers more than 10 mm in diameter.Site is usually similar to minor pathos ulcer.Also involves the keratinized part of oral mucosal epithelium.Vary in number from 1-10.Take 4-6 weeks to healHeal with scarring.Recur in less than a month time.
18Recurrent apthous ulcer contd: Herpitiform ulcersMultiple small pin head size. Each ulcer 1-2 mm in size.Can occur at any part of the oral cavity and as many as hundreds of small ulcers may be present.The ulcers are present in the form of clusters or crops and some times they join to form a big ulcer.The also heal with scarring.Recur in less than a month timeAssociated with extreme pain and discomfort.
20Recurrent appthous ulcer contd: Histopathology( Minor, Major, Herpetiform)Mononuclear cells are found in the sub mucosa in the pre-ulcerative stage.These mono-nuclear cells are the T4 lymphocytes and soon are outnumbered to T8 lymphocytes when ulcerative stage develops.Macrophages and mast cells are also present in the base of ulcer.
21Treatment Major,Minor,Herpetiform ulcers. Minor apthous ulcers require no treatment only topical gels are used to minimize the pain, as the ulcer is self limiting and heals with in 7-10 days.Anti inflammatory gels and mouth washes are also used to prevent any further infection and to control the inflammation caused by the ulcer.For major apthos ulcers topical steroids may be used.In extreme severe cases systemic steroids such as prednisolone in doses mg daily have giving promising results.
22Behcet’s Symptom complex of: Recurrent aphthous ulcers of the mouth Painful genital ulcersUveitis or conjuctivitis
39Dermatologic Disorders Erythema multiformeRapidly progressiveAntigen-antibody complex deposition in vessels of the dermisTarget lesions of the skinDiffuse ulceration, crusting of lips, tongue, buccal mucosaSelf-limited, heal without scarring
41Dermatologic Disorders Lichen planusChronic disease of skin and mucous membranesDestruction of basal cell layer by activated lymphocytesReticular: fine, lacy appearance on buccal mucosa (Wickman’s striae)Hypertrophic: resembles leukoplakiaAtrophic or erosive: painful
43Dermatologic Disorders Benign mucous membrane pemphigoidTense subepithelial bullae of skin and mucous membranesRupture, large erosions, heal without scarringSloughing (Nikolsky sign)Bullous pemphigoidCutaneous lesions more commonBoth show subepithelial clefting with dissolution of the basement membraneIgG in basement membrane
44Pemphigus vulgaris Severe, potentially fatal Jewish and Italians Intraepithelial bullae and acantholysisNikolsky’s signLoss of intracellular bridgesAutoimmune response to desmoglein 3Intraepithelial clefting