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口腔粘膜溃疡类疾病Oral Ulcerative diseases

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Introduction

BehÇet’s disease

Traumatic Ulcer & Traumatic Bulla

Recurrent Aphthous Ulcer

Summary & Questions

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Reiter’s Syndrome

I. Introduction

1. Ulcers are one of the most common types of lesions seen in oral mucosa.

2. The difference between ulcer and erosion.

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ulcer erosion

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ulcer erosioncontinuity of epithelium

broken severe

superficial

basal cells involved freeborder clear uncleardiseases RAU

Behcet’s diseaseSyphilis

PemphigusHerpes simplex

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Comparison

II.Recurrent Aphthous Ulcer

1.Preface • Name recurrent aphthous ulcer RAU recurrent aphthous stomatitis RAS recurrent oral ulcer ROU

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

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2. Etiology unknown • immunity : cellular immunity, humor

al immunity, complement, autoantibody

• heritage • infection ： HSV

• environment: psychology

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• denutrition ： iron, copper, zinc, folic acid, Vit B12

• hyperoxide dismutase• microcirculation disturbance ： lip,

nail, apex linguae

• systemic factor ： ulceration of stomach、 hepatitis、 colonitis、 diarrhoea

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3. Clinical features

minor aphthous ulcer major aphthous ulcer herpetiform ulcer

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MiAU MjAU HU

featureyellow red concave painful small (2-4mm)

big (1-3cm) deep scar multiple small

course 7-10 days 3-6 weeks 7-10 days

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

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Minor aphthous ulcers

Major aphthous ulcers

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Periadenitis Mucosa Necrotica Recurrens

Herpetiform ulcers

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•disease-process

24h

10d-14doutbreak

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intermissionhealing

prodromal stage

ulcerative stage

5. Diagnosis• history

• clinical feature

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4. Pathology ： nonspecific inflammation

6. Differential diagnosis

• benign ulcer & malignant ulcer• Necrotizing sialadenometaplasia, Be

hçet’s disease, herpes simplex, hand-foot-and-mouth disease

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benign ulcer malignant ulcerage youth the ageddepth deep Deep or shallowself-healing yes nosystemic condition good cachexy

pathology chronic inflammation cancerrecurrence yes no

Comparison

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7. Treatment

• principle： symptomatic treatment

• Evaluation of curative effect

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• 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.

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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

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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

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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.

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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.

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6. Differential diagnosis

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RAU Herpetic atomatitis Crohn’s diseaseReiter’s syndromeStevens-Johnson syndrome

7. Treatment

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

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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.

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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

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3. Clinical feature

1) Decubital ulcer

mechanical irritating factors

the ulcer conforms in area and linearity to the s

ource of the irritating factors

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traumatic ulcer

infants, hard palate

improper feeding

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2) Bednar ulcer

3) Rida-Fede ulcer

infants

lingual frenum ulcer secondary to inferior decidu

ous incisor

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4) Factitious ulcer mentally handicapped patients or those with ser

ous emotional problems

oral self-inflicted trauma by biting, fingernails, o

r by the use of a sharp object

tongue, lower lip, gingiva

slow to heal due to perpetuation of the injury by t

he patient

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5) Chemical burn

the type of chemical utilized, its concentration,

and the duration

whitish surfacedesquamatingpainful erosion

or ulcerbone damage

healing within 1-2 weeks

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6) Thermal burn

very hot foods, liquid, or hot metal objects

palate, lips, floor of the mouth, tongue

painful, red, undergoing desquamation, leaving er

osions

supportive treatment; self-healing in about a week

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7) Traumatic bulla & traumatic hematoma

caused by biting or prosthetic appliances buccal mucosa, soft palate, lips, tongue self-healing in 4-6 days

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traumatic bulla

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4. Diagnosis • history• clinical features

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carcinoma, syphilis, tubercular ulcer, major aphthous ulcerthrombocytopenia, thrombastheniapemphigus, cicatricial pemphigoid

5. Differential diagnosis

malignant ulcer

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Traumatic ulcer MjAU malignant

ulcertubercular

ulcer

etiology

feature of ulcermorphology of ulcer

pathology

5. Differential diagnosis

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6. Treatment

• Removal of the traumatic factors• Topical measures

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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.

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2. Etiology

unknown

3. Clinical feature

Major symptoms: nongonococcal urethritis,

conjunctivitis, arthritis

Other symptoms: oral ulcer, circinate balan

itis, keratoderma blennorrhagicum

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4. Diagnosis

• history • clinical criteria

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5. Differential diagnosis

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

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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.

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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.

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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.

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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?

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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?

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