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Recurrent Aphthous Ulcer Introduction Recurrent Aphthous Ulcer BehÇet’s disease Traumatic Ulcer & Traumatic Bulla Reiter’s Syndrome Summary & Questions BACK
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口腔粘膜溃疡类疾病Oral Ulcerative diseases
BACK TO INDEX
Introduction
BehÇet’s disease
Traumatic Ulcer & Traumatic Bulla
Recurrent Aphthous Ulcer
Summary & Questions
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Reiter’s Syndrome
I. Introduction
1. Ulcers are one of the most common types of lesions seen in oral mucosa.
2. The difference between ulcer and erosion.
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ulcer erosion
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ulcer erosioncontinuity of epithelium
broken severe
superficial
basal cells involved freeborder clear uncleardiseases RAU
Behcet’s diseaseSyphilis
PemphigusHerpes simplex
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Comparison
II.Recurrent Aphthous Ulcer
1.Preface • Name recurrent aphthous ulcer RAU recurrent aphthous stomatitis RAS recurrent oral ulcer ROU
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• Typing Lehner’s classification minor aphthous ulcer (MiAU) major aphthous ulcer (MjAU) herpetiform ulcer ( HU)• Characteristic recidivity self-healing periodicity
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2. Etiology unknown • immunity : cellular immunity, humor
al immunity, complement, autoantibody
• heritage • infection : HSV
• environment: psychology
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• denutrition : iron, copper, zinc, folic acid, Vit B12
• hyperoxide dismutase• microcirculation disturbance : lip,
nail, apex linguae
• systemic factor : ulceration of stomach、 hepatitis、 colonitis、 diarrhoea
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3. Clinical features
minor aphthous ulcer major aphthous ulcer herpetiform ulcer
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MiAU MjAU HU
featureyellow red concave painful small (2-4mm)
big (1-3cm) deep scar multiple small
course 7-10 days 3-6 weeks 7-10 days
number 1-5 1 >10
position nonkeratinized oral mucosa soft palate tongue lip
mouth floor
systemic symptom — lymph nodes
swelling
fever headache lymph nodes swelling
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Minor aphthous ulcers
Major aphthous ulcers
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Periadenitis Mucosa Necrotica Recurrens
Herpetiform ulcers
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•disease-process
24h
10d-14doutbreak
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intermissionhealing
prodromal stage
ulcerative stage
5. Diagnosis• history
• clinical feature
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4. Pathology : nonspecific inflammation
6. Differential diagnosis
• benign ulcer & malignant ulcer• Necrotizing sialadenometaplasia, Be
hçet’s disease, herpes simplex, hand-foot-and-mouth disease
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benign ulcer malignant ulcerage youth the ageddepth deep Deep or shallowself-healing yes nosystemic condition good cachexy
pathology chronic inflammation cancerrecurrence yes no
Comparison
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7. Treatment
• principle: symptomatic treatment
• Evaluation of curative effect
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• Topical 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 prednisone) for 5-10 days reduce the pain dramatically.
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III. BehÇet’s disease
1. Preface Hulusi Behçet (1937) Behçet’s disease is a chronic multisystemic inflammatory disorder of uncertain cause and prognosis. 2. Etiology Unknown
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3. Clinical features 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, urinary
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4. 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.
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5. Diagnosis 1) recurrent oral ulceration
2) recurrent genital ulceration
3) eye lesions
4) skin lesions
5) positive pathergy test
To establish the diagnosis of Behçet’s Disease, recurrent oral ulceration plus any two of the other four major clinical criteria must be present.
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6. Differential diagnosis
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RAU Herpetic atomatitis Crohn’s diseaseReiter’s syndromeStevens-Johnson syndrome
7. Treatment
Symptomatic in mild cases. Systemic steroids, immunosuppressive drugs, colchicines, thalidomide, and dapsone are administered in severe cases.
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IV. Traumatic Ulcer Traumatic Bulla
1. 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.
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2. 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: thermal burns
Chemical factors: strong acid, strong base, As2O3, Ag(NO)3, iodophenol
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3. Clinical feature
1) Decubital ulcer
mechanical irritating factors
the ulcer conforms in area and linearity to the s
ource of the irritating factors
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traumatic ulcer
infants, hard palate
improper feeding
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2) Bednar ulcer
3) Rida-Fede ulcer
infants
lingual frenum ulcer secondary to inferior decidu
ous incisor
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4) Factitious ulcer mentally handicapped patients or those with ser
ous emotional problems
oral self-inflicted trauma by biting, fingernails, o
r by the use of a sharp object
tongue, lower lip, gingiva
slow to heal due to perpetuation of the injury by t
he patient
local measures and psychiatric therapy NEXT
5) Chemical burn
the type of chemical utilized, its concentration,
and the duration
whitish surfacedesquamatingpainful erosion
or ulcerbone damage
healing within 1-2 weeks
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6) Thermal burn
very hot foods, liquid, or hot metal objects
palate, lips, floor of the mouth, tongue
painful, red, undergoing desquamation, leaving er
osions
supportive treatment; self-healing in about a week
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7) Traumatic bulla & traumatic hematoma
caused by biting or prosthetic appliances buccal mucosa, soft palate, lips, tongue self-healing in 4-6 days
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traumatic bulla
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4. Diagnosis • history• clinical features
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carcinoma, syphilis, tubercular ulcer, major aphthous ulcerthrombocytopenia, thrombastheniapemphigus, cicatricial pemphigoid
5. Differential diagnosis
malignant ulcer
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Traumatic ulcer MjAU malignant
ulcertubercular
ulcer
etiology
feature of ulcermorphology of ulcer
pathology
5. Differential diagnosis
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6. Treatment
• Removal of the traumatic factors• Topical measures
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V. Reiter’s Syndrome
1. Preface
Reiter’s syndrome is a disease of unknown cause that predominantly affects young men, 20-30 years of age.
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2. Etiology
unknown
3. Clinical feature
Major symptoms: nongonococcal urethritis,
conjunctivitis, arthritis
Other symptoms: oral ulcer, circinate balan
itis, keratoderma blennorrhagicum
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4. Diagnosis
• history • clinical criteria
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5. Differential diagnosis
The differential diagnosis the oral lesions includes erythema multiforme, Stevens-Johnson syndrome, psoriasis, Behçet’s Disease, geographic tongue, and stomatitis.
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6. Treatment
It is nonspecific and symptomatic. Non-steroidal anti-inflammatory drugs, salicylates, and tetracyclines may be helpful, cyclosporin, azathioprine, methotrexate, and systemic steroid in severe case.
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Summary
1. To compare the characteristics of major Aphthous ulcer, traumatic ulcer, carcinoma and tuberculous ulcer. (etiology, pathology, clinical feature, treatment, prognosis) .
2. To master the treatment principle of ulcerative diseases by taking RAU for example.
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3. 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 Behçet’s disease.
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Questions
1. Which is the most common form of Recurrent Aphthous Ulcer? What’s the characteristic of its lesion?
2. What’s the effect of corticosteroid in treating oral ulcerative diseases?
3. What’s the primary treatment to traumatic ulcer?
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4. 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 Behçet’s Disease and Reiter’s Syndrome ? What are their clinical systemic features?
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