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

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

I. Introduction 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

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 （MiAU） major aphthous ulcer （MjAU） 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 B12 • 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

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

Minor aphthous ulcers NEXT

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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

Major aphthous ulcers Periadenitis Mucosa Necrotica Recurrens NEXT

Major aphthous ulcers NEXT

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

Herpetiform ulcers NEXT

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

nonspecific inflammation 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 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

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

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

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, As2O3, 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

5. Differential 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 MjAU malignant ulcer 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 2. Etiology unknown 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. Non-steroidal anti-inflammatory drugs, salicylates, and tetracyclines may be helpful, cyclosporin, azathioprine, methotrexate, and systemic steroid in severe case. BACK

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

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

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

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