aphthous ulcer
TRANSCRIPT
PRESENTED BY – DR.ManjulaMuthurajmanju
SYNONYMS -
RECURRENT APHTHOUS STOMATITIS
APHTHAECANKER SORES
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The term "aphthous"
Greek word "aphtha"
ulceration.
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CANKER
LATIN WORD
CANCER
BUT NOT A TYPE OF CANCER
DEFINITION
It is a most common disease charecterized by the development of painful,recurring ,solitary or multiple ulcerations of the oral mucosa.
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ETIOLOGYBACTERIAL INFECTION- a pleomorphic transitional L-form of an α-hemolytic streptococci,streptococcus
sanguis play a significant role.
IMMUNOLOGIC ABNORMALITIES
Iron, vitamin B12, folic acid deficiency
TRAUMA- due to self –inflicted bites,oral surgical procedures,tooth brushing,dental procedures,needle
injections,dental trauma
ENDOCRINE CONDITION-during premenstrual period and at postovulation period.
ALLERGIC FACTORS-hay fever,asthma,drug/food allergy.
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SURBHI
PATHOGENESIS
PRIMARY IMMUNO
DYSRETIONGULA
REDDUCTION OF CD4 + T LYMPHOCYT
E
DECREASE IN MUCOSAL BARRIER
TRAUMA
NUTRITIONAL DEFICIENCY
INCREASE IN ANTIGENIC EXPOSURE
↑ CYTOTOXIC DESTRUCTIO
N OF MUCOSA
TYPES
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SURBHI
CLINICAL FEATURESRECURRENT APHTHOUS MINOR
AGE-10-30yr GENDER-women>men SITE-common on non-keratinized mucosa e.g –buccal
&labial mucosa,buccal & lingual sulci,tongue,soft palate,pharynx,gingiva.
APPEARANCE-begins as a single or multiple superficial erosions covered by greyish – white removable fibrinopurulent membrane encircled by erythematous halo.
SIZE-2-3 mm to 10 mm in diameter. Persist for 7-14 days & heal without scarring.
MINOR APHTHOUS ULCER
Area of ulceration with surrounding erythema present on movable mucosa of left maxillary muco-buccal fold.
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MINOR APHHOUS ULCER.
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RECURRRNT APHTHOUS MAJOR
Previously it represent a separate disease entity k/n as periadenitis mucosa necrotica recurrens (mikulicz’s scarring aphthae or sutton’s disease)
It is now regarded as severe expression of aphthous stomatitis.
COMMON SITE- lips,cheeks,tongue,soft palate,fauces,cause severe pain & dysphagia.
Also involve keratinized mucosa INCIDENCE – common in HIV patient. SIZE – Larger than the minor apthous ulcer diameter more
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Continued......
NO.-1-10 in no.Takes 4-6 weeks to heal.Heal with scarringRecurrs in less than a month time.APPEARANCE- extend deeper and may present
as crater-like ulcers with rolled margins which are indurated on palpation because of underlying fibrosis.
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MAJOR APHTHOUS ULCER
MAJOR APHTHOUS ULCER
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RECURRENT HERPETIFORM ULCERS
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Clinical features
SITE- any intra oral siteSIZE-1-3 mm in diameterAPPEARANCE – charecterized by crop of
small,shallow ulcers ,that may be joined together and form large ulcer.
No. – 10 – 100Healing occur in 1 to 2 weeks.Heal with scarring.Lesions persist for 1 to 3 year,with short remissions
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RECURRENT HERPETIFORM ULCERATIONS
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CONTRASTING FEATURES
MINOR MAJOR HERPETIFORM
SIZE <0.5 cm >0.5 cm <0.5 cm
SHAPE Oval Ragged oval,crateriform
oval
NUMBER 1-5 1-10 10-100
LOCATION Non-keratinized mucosa
Non-keratinized mucosa
Any intra oral site
TREATMENT Topical corticosteroids,tetracycline mouthrinse
Topical/systemic/intralesionalcorticosteroids, immunosuppressives
Topical/systemiccorticosteroids, tetracyclinemouthrinse
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HISTOPATHOLOGY
Central zone of ulceration.
Fibrinopurulent membrane covers the
ulcer.
Inflammatory cells –
neutrophils and lymphocytes seen in C.T
CYTOLOGICAL SMEAR• Anitschkow
cells.
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ANITSCHKOW CELL
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