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1、NEXT,口腔粘膜溃疡类疾病 Oral Ulcerative diseases,BACK TO INDEX,Introduction,Behets disease,Traumatic Ulcer & Traumatic Bulla,Recurrent Aphthous Ulcer,Summary & Questions,BACK,Reiters Syndrome,I. Introduction,Ulcers are one of the most common types of lesions seen in oral mucosa.2. The difference between ulce
2、r and erosion.,NEXT,ulcer,erosion,NEXT,BACK,Comparison,Recurrent Aphthous Ulcer,1.Preface Namerecurrent aphthous ulcer RAUrecurrent aphthous stomatitis RASrecurrent oral ulcer ROU,NEXT, Typing Lehners classification minor aphthous ulcer （MiAU）major aphthous ulcer （MjAU）herpetiform ulcer （HU） Charact
3、eristicrecidivityself-healingperiodicity,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
4、, nail, apex linguae systemic factor ：ulceration of stomach、hepatitis、colonitis、diarrhoea,NEXT,3. Clinical featuresminor aphthous ulcermajor aphthous ulcerherpetiform ulcer,NEXT,NEXT,Minor aphthous ulcers,NEXT,NEXT,NEXT,Major aphthous ulcers,NEXT,Periadenitis Mucosa Necrotica Recurrens,NEXT,Major ap
5、hthous ulcers,NEXT,Herpetiform ulcers,NEXT,disease-process,24h,10d-14d,outbreak,NEXT,intermission,healing,prodromal stage,ulcerative stage,5. Diagnosis,historyclinical feature,NEXT,4. Pathology ：nonspecific inflammation,6. Differential diagnosis,benign ulcer & malignant ulcer Necrotizing sialadenome
6、taplasia, Behets disease, herpes simplex, hand-foot-and-mouth disease,NEXT,Comparison,NEXT,7. Treatment,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, anti
7、biotics, 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. Behets disease,1. PrefaceHulusi Behet (1937)Behets disease is a chronic multisystemic inflammato
8、ry disorder of uncertain cause and prognosis. 2. EtiologyUnknown,NEXT,3. Clinical features1) oral mucosa: minor aphthous ulcer2) genital lesion: ulcer3) skin lesions: erythema nodosum, epifolliculitis, pustule after needling4) ocular lesions: conjunctivitis, recurrent iritis 5) others systems: joint
9、, digestive, cardiovascular, nervous, respiratory, urinary,NEXT,Behets 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.,N
10、EXT,5. Diagnosis1) recurrent oral ulceration2) recurrent genital ulceration3) eye lesions4) skin lesions 5) positive pathergy test To establish the diagnosis of Behets Disease, recurrent oral ulceration plus any two of the other four major clinical criteria must be present.,NEXT,6. Differential diag
11、nosis,NEXT,RAU Herpetic atomatitis Crohns disease Reiters syndrome Stevens-Johnson syndrome,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,
12、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, s
13、harp 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 sour
14、ce of the irritating factors,NEXT,NEXT,traumatic ulcer,traumatic ulcer,NEXT,infants, hard palateimproper feeding,NEXT,2) Bednar ulcer,3) Rida-Fede ulcer,infants lingual frenum ulcer secondary to inferior deciduous incisor,NEXT,4) Factitious ulcer,mentally handicapped patients or those with serous em
15、otional problems oral self-inflicted trauma by biting, fingernails, or by the use of a sharp objecttongue, lower lip, gingivaslow to heal due to perpetuation of the injury by the patientlocal measures and psychiatric therapy,NEXT,5) Chemical burn,the type of chemical utilized, its concentration, and
16、 the durationwhitish surfacedesquamatingpainful erosion or ulcerbone damagehealing within 1-2 weeks,NEXT,NEXT,chemical burn,6) Thermal burn,very hot foods, liquid, or hot metal objectspalate, lips, floor of the mouth, tonguepainful, red, undergoing desquamation, leaving erosionssupportive treatment; self-healing in about a week,NEXT,NEXT,thermal burn,7) Traumatic bulla & traumatic hematoma,caused by biting or prosthetic appliancesbuccal mucosa, soft palate, lips, tongue self-healing in 4-6 days,
