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1、NEXT口腔粘膜溃疡类疾病Oral Ulcerative diseasesBACK TO INDEXBehets diseaseTraumatic Ulcer&Traumatic BullaRecurrent Aphthous UlcerSummary&QuestionsBACKReiters Syndrome I.Introduction1.Ulcers are one of the most common types of lesions seen in oral mucosa.2.2.The difference between ulcer and erosion.NEXTulcerer
2、osionNEXTulcererosioncontinuity of epitheliumbroken severesuperficial basal cellsinvolvedfreeborderclearuncleardiseasesRAUBehcets diseaseSyphilis PemphigusHerpes simplex BACKComparisonII.Recurrent Aphthous Ulcer1.Preface Name recurrent aphthous ulcer RAU recurrent aphthous stomatitis RAS recurrent o
3、ral ulcer ROUNEXT Typing Lehners classification minor aphthous ulcer（MiAU）major aphthous ulcer（MjAU）herpetiform ulcer（HU）Characteristic recidivity self-healing periodicityNEXT2.Etiology unknown immunity:cellular immunity,humoral immunity,complement,autoantibody heritage infection：HSV environment:psy
4、chologyNEXT denutrition：iron,copper,zinc,folic acid,Vit B12 hyperoxide dismutase microcirculation disturbance：lip,nail,apex linguae systemic factor：ulceration of stomach、hepatitis、colonitis、diarrhoeaNEXT3.Clinical features minor aphthous ulcer major aphthous ulcer herpetiform ulcerNEXTNEXTMiAUMjAUHU
5、featureyellow red concave painful small(2-4mm)big(1-3cm)deep scarmultiple smallcourse7-10 days3-6 weeks7-10 daysnumber 1-51 10positionnonkeratinized oral mucosa soft palatetongue lip mouth floorsystemic symptomlymph nodes swelling fever headache lymph nodes swelling Minor aphthous ulcersNEXTNEXTNEXT
6、MiAUMjAUHUfeatureyellow red concave painful small(2-4mm)big(1-3cm)deep scarmultiple smallcourse7-10 days3-6 weeks7-10 daysnumber 1-51 10positionnonkeratinized oral mucosa soft palatetongue lip mouth floorsystemic symptomlymph nodes swelling fever headache lymph nodes swelling Major aphthous ulcers N
7、EXT Periadenitis Mucosa Necrotica Recurrens NEXTMajor aphthous ulcers NEXTMiAUMjAUHUfeatureyellow red concave painful small(2-4mm)big(1-3cm)deep scarmultiple smallcourse7-10 days3-6 weeks7-10 daysnumber 1-51 10positionnonkeratinized oral mucosa soft palatetongue lip mouth floorsystemic symptomlymph
8、nodes swelling fever headache lymph nodes swelling Herpetiform ulcers NEXTdisease-process24h10d-14doutbreakNEXTintermissionhealingprodromal stageulcerative stage5.Diagnosis history clinical featureNEXT4.Pathology：nonspecific inflammation6.Differential diagnosisbenign ulcer&malignant ulcerNecrotizing
9、 sialadenometaplasia,Behets disease,herpes simplex,hand-foot-and-mouth disease NEXTbenign ulcermalignant ulcerageyouththe ageddepthdeepDeep or shallowself-healingyesnosystemic conditiongoodcachexypathologychronic inflammationcancerrecurrenceyesnoComparison NEXT7.Treatmentprinciple：symptomatic treatm
10、entEvaluation of curative effectNEXTTopical 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 predn
11、isone)for 5-10 days reduce the pain dramatically.BACKIII.Behets disease1.Preface Hulusi Behet (1937)Behets disease is a chronic multisystemic inflammatory disorder of uncertain cause and prognosis.2.Etiology Unknown NEXT3.Clinical features 1)oral mucosa:minor aphthous ulcer 2)genital lesion:ulcer 3)
12、skin lesions:erythema nodosum,epifolliculitis,pustule after needling 4)ocular lesions:conjunctivitis,recurrent iritis 5)others systems:joint,digestive,cardiovascular,nervous,respiratory,urinaryNEXTBehets diseaseNEXT4.Pathology：Histopathologic changes consist of a perivascular mononuclear cellular in
13、filtrate,endothelial cell swelling or necrosis,partial luminal obliteration and occasional fibrinoid necrosis of the vessels.NEXT5.Diagnosis 1)recurrent oral ulceration 2)recurrent genital ulceration 3)eye lesions 4)skin lesions 5)positive pathergy test To establish the diagnosis of Behets Disease,r
14、ecurrent oral ulceration plus any two of the other four major clinical criteria must be present.NEXT6.Differential diagnosisNEXTRAU Herpetic atomatitis Crohns diseaseReiters syndromeStevens-Johnson syndrome7.Treatment Symptomatic in mild cases.Systemic steroids,immunosuppressive drugs,colchicines,th
15、alidomide,and dapsone are administered in severe cases.BACKIV.Traumatic Ulcer Traumatic Bulla1.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.NEXT2.Etiology Mechanical factors:a s
16、harp 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 burnsChemical factors:strong acid,strong base,As2O3,Ag(NO)3,iodophenolNEXT3.Clinical feature1)Decubital ulcer mechanical irritating factors the ulcer conforms in area and linearity to the source of the irritating factorsNEXTNEXTtraumatic ulcertraumatic ulcerNEXT infants,hard palate improper feedingNEXT2)Bednar u
