IMMUNOLOGIC DISEASES OF ORAL CAVITY

APTHOUS ULCERS

Recurrent apthous ulcers are common painful

mucosal conditions affecting oral mucosa.

The term “aphthous” is derived from a Greek

word “aphtha” which means ulceration

INCIDENCE

CLINICAL PRESENTATION

RAS is characterized by recurrent bouts of solitary or multiple shallow painful ulcers

Minor RAS is also known as Miculiz's aphthae or mild aphthous ulcers.

It is the most common variant, constituting 80% of RAS.

Ulcers vary from 8 to 10 mm in size. It is most commonly seen in the

nonkeratinized mucosal surfaces like labial mucosa, buccal mucosa, and floor of the mouth.

Ulcers heal within 10–14 days without scarring.

Minor apthous ulcer

CLINICAL PRESENTATION

Major RAS is also known as periadenitis mucosa necrotica recurrens or Sutton's disease.

It affects about 10–15% of patients. Ulcers exceed 1 cm in diameter. Most common sites of involvement are lips, soft

palate The ulcers persist for up to 6 weeks and heal with

scarring.

CLINICAL PRESENTATION

Herpetiform ulceration is characterized by

recurrent crops of multiple ulcers

May be up to 100 in number.

These are small in size, measure 2–3 mm in

diameter.

Lesions may coalesce to form large irregular

ulcers.

These ulcers last for about 10–14 days.

HERPITIFORM TYPE OF ULCERS

PREDISPOSING FACTORS

Trauma Genetic factors Tobacco Drugs Hematinic deficiency Gluten sensitivity Stress Hormonal changes Sodium lauryl sulfate containing tooth

pastes

TREATMENT OF APTHOUS ULCERS

Dietary and general measures 1. avoid spicy , hard and salty substances 2. sodium lauryl sulfate free tooth pastesTopical therapy1.  Lidocaine as 1% cream 2. 2% gel or spray;3. Polidocanol as paste4. Benzocaine lozenges.

Antiseptics and anti-inflammatory agents

Mouth wash containing 0.15% triclosan in ethanol and zinc sulfate

Diclofenac 3% in a 2.5% hyaluronic acid gel

Chlorhexidine mouthwash and chamomile extract both reduced the frequency, increased healing speed, and decreased the severity of aphthous ulcers

Topical tetracycline treatment Using a mouthwash containing

chlortetracycline 2.5% increased the number of ulcer-free or pain-free days significantly,

Tetracycline hydrochloride powder 250 mg can be combined with 10 mL of tap water by the patient immediately before use to avoid stabilization problems. Because of the acid pH value, there may be temporary mucosal burning generally followed by clinical improvement. A stable mixture can also be prepared by neutralizing the tetracycline hydrochloride to create a basic product (6).

SYSTEMIC

TOPICAL

BEHCET SYNDROME

REITERS SYNDROME

An inflammatory arthritis of large joints, inflammation of the eyes in the form of conjunctivitis or uveitis, and urethritis in men or cervicitis in women. 

CONTACT STOMATITIS

Manifested by occurrence of itching and burning sensation

Erythema follows vesicle , erosion occurs and may become extensive

Discontinue with the offending contact Materials enlisted- Dentrifices Mouth washes Lipsticks Cough drops Chewing gum