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The oral or mucosal ulcerations are a break in
epithelial continuity that reach to connective tissue
and damage the damage the basement membrane ,
which frequently a feature of stomatitis.
While the mucosal laceration
just a sloughing of epithelial
layer above the basement
membrane.
Oral Ulcerations
1. Vesiculo-bullous diseasesA. InfectiveB. Non-infective
2. Ulcerations without preceding vesiculationA. InfectiveB. Non-infective
Infective• Primary herpetic stomatitis• Herpes labialis• Herpes zoster and chickenpox• Hand-foot-and-mouth disease
Non-infective• Pemphigus vulgaris• Mucous membrane pemphigoid• Linear IgA disease• Dermatitis herpetiformis• Bullous erythema multiforme
Infective• Cytomegalovirus-associated ulceration• Some acute specific fevers• Tuberculosis• Syphilis
Non-infective• Traumatic• Aphthous stomatitis• Behçet’s disease• HIV-associated mucosal ulcers• Lichen planus• Lupus erythematosus• Chronic ulcerative stomatitis• Eosinophilic ulceration• Wegener’s granulomatosis• Some mucosal drug reactions• Carcinoma
Traumatic ulcers are usually caused by a denture
and often seen in the buccal or lingual sulcus. They
are tender, have a yellowish floor, and red margins;
there is no induration.
The traumatic ulcers
(1)Physical trauma (sharp edge and thermal trauma)
(2) Factitious ulceration (self inflected ulcer)
(3) Chemical trauma
Recurrent aphthae constitute the most common oral mucosal disease and affect 10-25 % of the population, but many cases are mild and accepted with little complaint. The term is from from Greek: αφθα aphtha meaning "mouth ulcer".
RAS is a common condition, restricted to the mouth, that typically starts in childhood or teenager as recurrent small, round, or ovoid ulcers with circumscribed margins, erythematous haloes, and yellow or gray floors.
A positive family history of similar ulcers is common, and the natural history is typically of resolution in the third or fourth decade of life.
The etiology of recurrent aphthae is unclear. There
is no evidence that they are a form of auto-immune
disease in any accepted sense, and it is uncertain whether
many of the reported immunological abnormalities are
cause or effect.
However, in a minority of patients there is a clear
association with hematological deficiencies. The latter in
turn may be secondary to small-intestine disease or other
cause of malabsorption.
The old and recent theory that more accepted in the practice and foundation of this disease are ……….
The RAS is an allergy of oral mucosa to specitic allergen found in some 1…….food 2…….beverages3…….chewing gum4…….dentifrices (mainly hypersensitivity to sodium lauryl sulphate found in many brands of toothpaste).
Pathogenesis of RAS
The hypersensitivity start with Ag-Ab complex under
the oral mucosa which provoke the inflammatory reaction
that destroy the lining mucosa and form the ulcer. So the
patient felt with prodromal symptoms of pruritic
sensation and do friction to this site of redness before
ulcer to appear.
Types of recurrent aphthae ulcers
(clinically)1. Minor aphthae ulcers are most common type affects the non-
keratinised mucosa such as labial and buccal mucosa, floor of the
mouth, and lingual mucosa.
2. Major aphthae ulcer is uncommon type, frequently several
centimeter in diameter, and mimic a malignant ulcer, affected the
masticatory mucosa.
3. Herpetiform aphthae ulcers are uncommon type, affect the non-
keratinised mucosa.
Possible etiological factors for recurrent aphthae1- Genetic Factors2- Exaggerated response to trauma3- Infections4- Immunological abnormalities5- Gastrointestinal diseases6- Haematological deficiencies7- Hormonal factors8- Stress9- HIV infection10- Non-smoking
Diagnosis and treatment of RAU