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

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

3. I. Introduction
Ulcers are one of the most common types of lesions seen in oral mucosa.
2. The difference between ulcer and erosion.
NEXT

4. ulcer
erosion
NEXT

5. 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

6. 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 B12
• 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. nonkeratinized oral mucosa
MiAU
MjAU HU
feature
yellow red concave painful small (2-4mm)
big (1-3cm) deep scar
multiple small
course
7-10 days
3-6 weeks
number
1-5 1
>10
position
nonkeratinized oral mucosa
soft palate
tongue lip mouth floor
systemic symptom —
lymph nodes swelling
fever headache lymph nodes swelling
NEXT

12. Minor aphthous ulcers
NEXT

13. NEXT

14. nonkeratinized oral mucosa
MiAU
MjAU HU
feature
yellow red concave painful small (2-4mm)
big (1-3cm) deep scar
multiple small
course
7-10 days
3-6 weeks
number
1-5 1
>10
position
nonkeratinized oral mucosa
soft palate
tongue lip mouth floor
systemic symptom —
lymph nodes swelling
fever headache lymph nodes swelling
NEXT

15. Major aphthous ulcers
Periadenitis Mucosa Necrotica Recurrens
NEXT

16. Major aphthous ulcers
NEXT

17. nonkeratinized oral mucosa
MiAU
MjAU HU
feature
yellow red concave painful small (2-4mm)
big (1-3cm) deep scar
multiple small
course
7-10 days
3-6 weeks
number
1-5 1
>10
position
nonkeratinized oral mucosa
soft palate
tongue lip mouth floor
systemic symptom —
lymph nodes swelling
fever headache lymph nodes swelling
NEXT

18. Herpetiform ulcers
NEXT

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

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

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

22. Comparison benign ulcer malignant ulcer age youth the aged depth deep
Deep or shallow
self-healing
yes no
systemic condition
good
cachexy
pathology
chronic inflammation
cancer
recurrence
NEXT

23. 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 2. Etiology Unknown
Hulusi Behçet (1937)
Behçet’s disease is a chronic multisystemic inflammatory disorder of uncertain cause and prognosis.
2. Etiology
Unknown
NEXT

26. 1) oral mucosa: minor aphthous ulcer 2) genital lesion: ulcer
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
RAU
Herpetic atomatitis
Crohn’s disease
Reiter’s syndrome
Stevens-Johnson syndrome
NEXT

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, As2O3, 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
NEXT

36. traumatic ulcer
NEXT

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

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
NEXT

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
NEXT

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

47. malignant ulcer
NEXT

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

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

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

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

52. oral lesion
NEXT

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
To compare the characteristics of major Aphthous ulcer, traumatic ulcer, carcinoma and tuberculous ulcer. (etiology, pathology, clinical feature, treatment, prognosis) .
To master the treatment principle of ulcerative diseases by taking RAU for example.
NEXT

57. To master the effect, usage, contraindication and side-effect of corticosteroid in treating ulcerative diseases.
To establish the conception of oral mucosal syndrome by means of learning Behçet’s disease.
NEXT

58. Questions
Which is the most common form of Recurrent Aphthous Ulcer? What’s the characteristic of its lesion?
What’s the effect of corticosteroid in treating oral ulcerative diseases?
What’s the primary treatment to traumatic ulcer?
NEXT

59. Taking major Aphthous ulcer and carcinoma for example, try to tell the difference between benign ulcer and malignant ulcer.
What are the oral lesions of Behçet’s Disease and Reiter’s Syndrome ? What are their clinical systemic features?
BACK