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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. 3.2. The difference between ulcer and erosion.4.
2、 NEXTulcererosionNEXTulcererosioncontinuity of epitheliumbroken severesuperficial basal cellsinvolvedfreeborderclearuncleardiseasesRAUBehcets diseaseSyphilis PemphigusHerpes simplex BACKComparisonII.Recurrent Aphthous Ulcer1.Preface Name recurrent aphthous ulcer RAU recurrent aphthous stomatitis RAS
3、 recurrent oral 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 ：
4、HSV environment: psychologyNEXT 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 herpe
5、tiform ulcerNEXTNEXTMiAUMjAUHUfeatureyellow 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
6、Minor aphthous ulcersNEXTNEXTNEXTMiAUMjAUHUfeatureyellow 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 no
7、des swelling Major aphthous ulcers NEXT 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 palatetongu
8、e lip mouth floorsystemic symptomlymph nodes swelling fever headache lymph nodes swelling Herpetiform ulcers NEXTdisease-process24h10d-14doutbreakNEXTintermissionhealingprodromal stageulcerative stage5. Diagnosis history clinical featureNEXT4. Pathology ： nonspecific inflammation6. Differential diag
9、nosisbenign ulcer & malignant ulcerNecrotizing sialadenometaplasia, Behets disease, herpes simplex, hand-foot-and-mouth disease NEXTbenign ulcermalignant ulcerageyouththe ageddepthdeepDeep or shallowself-healingyesnosystemic conditiongoodcachexypathologychronic inflammationcancerrecurrenceyesnoCompa
10、rison NEXT7. Treatmentprinciple：symptomatic treatmentEvaluation 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 in
11、jection or systemic steroids in a low dose (10-20 mg prednisone) 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 fea
12、tures 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, urinaryNEXTBehets diseaseNEXT4
13、. 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. NEXT5. Diagnosis 1) recurrent oral ulceration 2) recurrent genital ulceration 3) eye
14、lesions 4) 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. NEXT6. Differential diagnosisNEXTRAU Herpetic atomatitis Crohns diseaseReiters syndromeStevens-Johnson syn
15、drome7. Treatment Symptomatic in mild cases. Systemic steroids, immunosuppressive drugs, colchicines, thalidomide, 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 introduct
16、ion of hard objects into the oral cavity, traumatic ulcers are frequent.NEXT2. 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: the
17、rmal 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 impr
18、oper feedingNEXT2) Bednar ulcer3) Rida-Fede ulcer infants lingual frenum ulcer secondary to inferior deciduous incisorNEXT4) 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 tongu
19、e, lower lip, gingiva slow to heal due to perpetuation of the injury by the patient local measures and psychiatric therapy NEXT5) Chemical burn the type of chemical utilized, its concentration, and the duration whitish surfacedesquamatingpainful erosion or ulcerbone damage healing within 1-2 weeksNE
20、XTNEXTchemical burn6) 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 weekNEXTNEXTthermal burn7) Traumatic bulla & traumatic hematoma caused by bit
21、ing or prosthetic appliances buccal mucosa, soft palate, lips, tongue self-healing in 4-6 days NEXTtraumatic bullaNEXT4. Diagnosis historyclinical featuresNEXTcarcinoma, syphilis, tubercular ulcer, major aphthous ulcerthrombocytopenia, thrombastheniapemphigus, cicatricial pemphigoid 5. Differential
22、diagnosis malignant ulcerNEXTTraumatic ulcerMjAUmalignant ulcertubercular ulceretiologyfeature of ulcermorphology of ulcerpathology5. Differential diagnosisBACK6. Treatment Removal of the traumatic factorsTopical measures NEXTV. Reiters Syndrome1. PrefaceReiters syndrome is a disease of unknown caus
23、e that predominantly affects young men, 20-30 years of age. NEXT2. Etiologyunknown3. Clinical feature Major symptoms: nongonococcal urethritis, conjunctivitis, arthritis Other symptoms: oral ulcer, circinate balanitis, keratoderma blennorrhagicumNEXTNEXToral lesion4. Diagnosis history clinical crite
24、riaNEXT5. Differential diagnosis The differential diagnosis the oral lesions includes erythema multiforme, Stevens-Johnson syndrome, psoriasis, Behets Disease, geographic tongue, and stomatitis. NEXT6. Treatment It is nonspecific and symptomatic. Non-steroidal anti-inflammatory drugs, salicylates, a
25、nd tetracyclines may be helpful, cyclosporin, azathioprine, methotrexate, and systemic steroid in severe case. BACKSummary 1.To compare the characteristics of major Aphthous ulcer, traumatic ulcer, carcinoma and tuberculous ulcer. (etiology, pathology, clinical feature, treatment, prognosis) .2.To m
26、aster the treatment principle of ulcerative diseases by taking RAU for example. NEXT3.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 Behets disease. NEXTQuest
27、ions1.Which is the most common form of Recurrent Aphthous Ulcer? Whats the characteristic of its lesion? 2.Whats the effect of corticosteroid in treating oral ulcerative diseases? 3.Whats the primary treatment to traumatic ulcer? NEXT4.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 Behets Disease and Reiters Syndrome ? What are their clinical systemic features? BACK
