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