Oral Ulceration and Vb Disease(3)

8/3/2019 Oral Ulceration and Vb Disease(3)

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ORAL ULCERATIONORAL ULCERATIONANDAND

VESICULLOBULLOUSVESICULLOBULLOUSDISEASEDISEASE

BY : DR.KHURRAM ZAFFARBY : DR.KHURRAM ZAFFAR



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)



Oral eptitheliumOral eptithelium



Oral ulcerationsOral ulcerations

DefinitionDefinition

ClassificationClassification

CausesCauses



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.



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 ).




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«./



Oral ulceration/cont««dOral ulceration/cont««dtraumatic ulcerstraumatic ulcers




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



RECURRENT APTHOUSRECURRENT APTHOUS

STOMATITISSTOMATITIS

TYPES

Minor apthous ulcer s

Major apthous ulcer s

Her petifor m ulcer s



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




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



Recurr ent apthous stomatitis/cont«dRecurr ent apthous stomatitis/cont«dminor apthous ulcersminor apthous ulcers




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.




major apthous ulcersmajor apthous ulcers




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.



Recurr ent apthous stomatitis/cont«dRecurr ent apthous stomatitis/cont«dherptiform ulcer herptiform ulcer




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 .




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

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Oral Ulceration and Vb Disease(3)