口腔粘膜溃疡类疾病 Oral Ulcerative diseases

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

2. 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 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

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12. Minor aphthous ulcers NEXT

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15. Major aphthous ulcers Periadenitis Mucosa Necrotica Recurrens NEXT

16. Major aphthous ulcers NEXT

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18. Herpetiform ulcers NEXT

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

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

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

22. 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. RAU Herpetic atomatitis Crohn’s disease Reiter’s syndrome Stevens-Johnson syndrome 6. Differential diagnosis 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. 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 2. Etiology NEXT

34. 1) Decubital ulcer 3. Clinical feature • 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. 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 4) Factitious ulcer 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. 4. 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 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, 20-30 years of age. 2. Etiology unknown NEXT