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NEXT 口腔粘膜溃疡类疾病 Oral Ulcerative diseases BACK TO INDEX.

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Presentation on theme: "NEXT 口腔粘膜溃疡类疾病 Oral Ulcerative diseases BACK TO INDEX."— Presentation transcript:

1 NEXT 口腔粘膜溃疡类疾病 Oral Ulcerative diseases BACK TO INDEX

2 Introduction BehÇet’s disease Traumatic Ulcer & Traumatic Bulla Recurrent Aphthous Ulcer Summary & Questions BACK Reiter’s Syndrome

3 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

4 ulcererosion NEXT

5 ulcererosion continuity of epithelium broken severe superficial basal cellsinvolvedfree borderclearunclear diseasesRAU Behcet’s disease Syphilis Pemphigus Herpes simplex BACK Comparison

6 II.Recurrent Aphthous Ulcer 1.Preface Name recurrent aphthous ulcer RAU recurrent aphthous stomatitis RAS recurrent oral ulcer ROU NEXT

7 Typing Lehner’s classification minor aphthous ulcer ( MiAU ) major aphthous ulcer ( MjAU ) herpetiform ulcer ( HU ) Characteristic recidivity self-healing periodicity NEXT

8 2. Etiology unknown immunity : cellular immunity, humoral immunity, complement, autoantibody heritage infection : HSV environment: psychology NEXT

9 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

10 3. Clinical features minor aphthous ulcer major aphthous ulcer herpetiform ulcer NEXT

11 MiAUMjAUHU feature yellow red concave painful small (2- 4mm) big (1-3cm) deep scar multiple small course7-10 days3-6 weeks7-10 days number 1-51 >10 position nonkeratinized oral mucosa soft palate tongue lip mouth floor systemic symptom — lymph nodes swelling fever headache lymph nodes swelling

12 Minor aphthous ulcers NEXT


14 MiAUMjAUHU feature yellow red concave painful small (2- 4mm) big (1-3cm) deep scar multiple small course7-10 days3-6 weeks7-10 days number 1-51 >10 position nonkeratinized oral mucosa soft palate tongue lip mouth floor systemic symptom — lymph nodes swelling fever headache lymph nodes swelling

15 Major aphthous ulcers NEXT Periadenitis Mucosa Necrotica Recurrens

16 NEXT Major aphthous ulcers

17 NEXT MiAUMjAUHU feature yellow red concave painful small (2- 4mm) big (1-3cm) deep scar multiple small course7-10 days3-6 weeks7-10 days number 1-51 >10 position nonkeratinized oral mucosa soft palate tongue lip mouth floor systemic symptom — lymph nodes swelling fever headache lymph nodes swelling

18 Herpetiform ulcers NEXT

19 disease-process 24h 10d-14d outbreak NEXT intermission healing prodromal stage ulcerative stage

20 5. Diagnosis history clinical feature NEXT 4. Pathology : nonspecific inflammation

21 6. Differential diagnosis benign ulcer & malignant ulcer Necrotizing sialadenometaplasia, Behçet’s disease, herpes simplex, hand-foot-and-mouth disease NEXT

22 benign ulcermalignant ulcer age youththe aged depth deepDeep or shallow self-healing yesno systemic condition goodcachexy pathology chronic inflammationcancer recurrence yesno Comparison NEXT

23 7. Treatment principle : symptomatic treatment Evaluation of curative effect NEXT

24 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

25 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

26 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

27 BehÇet’s disease NEXT

28 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

29 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

30 6. Differential diagnosis NEXT RAU Herpetic atomatitis Crohn’s disease Reiter’s syndrome Stevens-Johnson syndrome

31 7. Treatment Symptomatic in mild cases. Systemic steroids, immunosuppressive drugs, colchicines, thalidomide, and dapsone are administered in severe cases. BACK

32 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

33 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

34 3. Clinical feature 1) Decubital ulcer  mechanical irritating factors  the ulcer conforms in area and linearity to the source of the irritating factors NEXT

35 traumatic ulcer


37  infants, hard palate  improper feeding NEXT 2) Bednar ulcer

38 3) Rida-Fede ulcer  infants  lingual frenum ulcer secondary to inferior deciduous incisor NEXT

39 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

40 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

41 chemical burn

42 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

43 thermal burn

44 7) Traumatic bulla & traumatic hematoma  caused by biting or prosthetic appliances  buccal mucosa, soft palate, lips, tongue  self-healing in 4-6 days NEXT

45 traumatic bulla NEXT

46 4. Diagnosis history clinical features NEXT carcinoma, syphilis, tubercular ulcer, major aphthous ulcer thrombocytopenia, thrombasthenia pemphigus, cicatricial pemphigoid 5. Differential diagnosis

47 malignant ulcer NEXT

48 Traumatic ulcer MjAU malignant ulcer tubercular ulcer etiology feature of ulcer morphology of ulcer pathology 5. Differential diagnosis BACK

49 6. Treatment Removal of the traumatic factors Topical measures NEXT

50 V. Reiter’s Syndrome 1. Preface Reiter’s syndrome is a disease of unknown cause that predominantly affects young men, years of age. NEXT 2. Etiology unknown

51 3. Clinical feature  Major symptoms: nongonococcal urethritis, conjunctivitis, arthritis  Other symptoms: oral ulcer, circinate balanitis, keratoderma blennorrhagicum NEXT

52 oral lesion

53 4. Diagnosis history clinical criteria NEXT

54 5. Differential diagnosis The differential diagnosis the oral lesions includes erythema multiforme, Stevens- Johnson syndrome, psoriasis, Behçet’s Disease, geographic tongue, and stomatitis. NEXT

55 6. Treatment It is nonspecific and symptomatic. Non- steroidal anti-inflammatory drugs, salicylates, and tetracyclines may be helpful, cyclosporin, azathioprine, methotrexate, and systemic steroid in severe case. BACK

56 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

57 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

58 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

59 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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