oral ulceration and vb disease(3)
TRANSCRIPT
8/3/2019 Oral Ulceration and Vb Disease(3)
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ORAL ULCERATIONORAL ULCERATIONANDAND
VESICULLOBULLOUSVESICULLOBULLOUSDISEASEDISEASE
BY : DR.KHURRAM ZAFFARBY : DR.KHURRAM ZAFFAR
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Oral eptitheliumOral eptithelium
It is stratified sqamous
Can be keratinized,para or or thokeratinized even non
keratinized.
LAYERS: Stratum basale (sinosidal cuboidal cells)
Stratum spinosum (irregularly polyhedral cells)
Stratum granulosum (flatter and wider cells)
Stratum cornium (keratinized squames)
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Oral eptitheliumOral eptithelium
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Oral ulcerationsOral ulcerations
DefinitionDefinition
ClassificationClassification
CausesCauses
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Oral ulcerationOral ulceration
DEFINITION:
Injury to the oral mucosa may r esult in a localized defectof the sur f ace in which the cover ing epithelium is
destr oyed leaving an inf lamed ar ea of exposed
connective tissue .
Such defects or er osions ar e called ULCERS.
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Oral ulceration/cont««dOral ulceration/cont««d
CLASSIFICATION
Traumatic ulcer s
Recurr ent apthous stomatitis (RAS)
Ulcer s associated with systemic diseases and
vesiculobullous diseases
( Pemphigus ,pemphgoid ,erythema multiforme)
(Dermatitis herpetiformis Epidermolysis bullosa ).
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Oral ulceration/cont««dOral ulceration/cont««d
CAUSES OF ORAL ULCERATION
1. INFECTIVE viral , bacter ial , fungal
2. TRAUMATIC
Mechanical, chemical, ther mal
Factitious injury Radiation
Eosinophillic ulcer or traumatic granuloma
3. IDIOP ATHIC
Recurr ent aphthous stomatitis
Minor aphthous ulcer s
Major apthous ulcer
Her ptifor m ulcer s.
Contd«./
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Oral ulceration/cont««dOral ulceration/cont««dtraumatic ulcerstraumatic ulcers
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Oral ulceration/cont««dOral ulceration/cont««d
CAUSES/cont«..d
4. ASSOCIATED WITH SYSTEMIC DISEASE
Haematological diseases
Gastr ointestinal tract diseasesBehcet syndr ome
HIV infection
Other diseases
5. ASSOCIATED WITH DERMATOLOGICAL DISEASES
Lichen planus
Chr onic discoid lupus erythematosis
Vesiculobullous diseases
6. NEOPLASTIC
Squamous cell carcinoma
Other malignant neoplasms
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RECURRENT APTHOUSRECURRENT APTHOUS
STOMATITISSTOMATITIS
TYPES
Minor apthous ulcer s
Major apthous ulcer s
Her petifor m ulcer s
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Recurr ent apthous stomatitis/cont«dRecurr ent apthous stomatitis/cont«d
ETIOLOGY
The etiology is not basically under stood but incr easing evidence of damaging immune r esponse is being given.How ever some of the f actor s ar e consider ed to be the
cause.1.Immunological f actor s
2.her editary f actor s
3.Micr obiological f actor s
4.Emotional str ess
5.Nutr itional deficiencies
6.Allergic disor der s.
7.Hematalogical f actor s.
8.Gastr ointestinal f actor s
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Recurr ent apthous stomatitis/cont«dRecurr ent apthous stomatitis/cont«d
CLINICAL FEATURESMinor apthous ulcers
Pr odomal signs begin to appear hour befor e with burning and tingling.
Mor e than 80% May be shallow and r ound effecting the nonkeratinized
par t of the oral epithelium
Diameter of the ulcer s is less than 10mm with r ed
margins. Heal without scarr ing within 7-10 days.
Tend to r ecur at an inter val of 1-4 months
Site is usually the tongue ,buccal mucosa soft palatef loor of the tongue
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Recurr ent apthous stomatitis/cont«dRecurr ent apthous stomatitis/cont«dminor apthous ulcersminor apthous ulcers
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Recurr ent apthous stomatitis/cont«dRecurr ent apthous stomatitis/cont«d
MAJOR APTHOUS ULCERS
Larger than the minor apthous ulcer diameter mor e than
10mm.
Site similar to that of the minor apthous ulcer s. Also involve the keratinzed par t of the epithelium.
They vary in number f r om 1-10.
Take 4-6 weeks to heal.
Heal with scarr ing.
Recur s in less than a months time.
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Recurr ent apthous stomatitis/cont«dRecurr ent apthous stomatitis/cont«d
major apthous ulcersmajor apthous ulcers
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Recurr ent apthous stomatitis/cont«dRecurr ent apthous stomatitis/cont«d
HERPETIFORM ULCERATION
Multiple small pinhead size .Each ulcer 1-2 mm in size.
Can occur at any par t of the oral cavity and as many as
hundr eds of small ulcer s may be pr esent. The ulcer s ar e pr esent in the for m of cluster s or cor ps
and sometime these ar e joined together to for m a very
large ulcer .
They also heal with scarr ing. Recur in less than a month time.
Associated with extr eme pain and discomfor t.
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Recurr ent apthous stomatitis/cont«dRecurr ent apthous stomatitis/cont«dherptiform ulcer herptiform ulcer
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Recurr ent apthous stomatitis/cont«dRecurr ent apthous stomatitis/cont«d
HISTOPATHOLOGY(minor ,major, herptiform)
Mononuclear cells ar e found in the submucously in the pr e
ulcerative stage
These mononuclear cells ar e the T-4 lymphocytes and ar e
soon out number ed to T-8 lymphocytes as the ulcerative
stage develops.
Macr ophages and the mast cells ar e also pr esent at thebase of the ulcer .
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Recurr ent apthous stomatitis/cont«dRecurr ent apthous stomatitis/cont«d
TREATMENT(Minor ,Major ,her ptifor m)
Minor apthous ulcer s r equir e no tr eatment only topical gels ar e used to minimize the pain ,as the ulcer is self limiting and heals with in7-10 days
Anti inf lammatory gels and mouth washes ar e also usedto pr event any fur ther infection and to contr ol theinf lammation caused by the ulcer
For major apthous ulcer topical cor ticoster iods may be
used In extr eme sever e cases systemic ster oids such as
pr ednisilone in doses of 20-40mg daily have shown pr omise