口腔黏膜

1、Introduction,BehÇet’s disease,Traumatic Ulcer & Traumatic Bulla,Recurrent Aphthous Ulcer,Summary & Questions,BACK,Reiter’s Syndrome,I. Introduction,Ulcers are one of the most common types of lesions seen in

2、oral mucosa. 2. The difference between ulcer and erosion.,NEXT,ulcer,erosion,NEXT,BACK,Comparison,Recurrent Aphthous Ulcer,1.Preface ? Name recurrent aphthous ulcer RAU recurrent aphthous

3、 stomatitis RAS recurrent oral ulcer ROU,NEXT,? Typing Lehner’s classification minor aphthous ulcer （MiAU） major aphthous ulcer （MjAU） herpetiform ulcer （HU）? Characterist

4、ic recidivity self-healing periodicity,NEXT,2. Etiology unknown ? immunity : cellular immunity, humoral immunity, complement, autoantibody ? heritage ? infection ：HSV ? environm

5、ent: psychology,NEXT,? denutrition ：iron, copper, zinc, folic acid, Vit B12? hyperoxide dismutase? microcirculation disturbance ：lip, nail, apex linguae? systemic factor ：ulceration of stomach、hepatitis、colonitis、diar

6、rhoea,NEXT,3. Clinical features minor aphthous ulcer major aphthous ulcer herpetiform ulcer,NEXT,NEXT,Minor aphthous ulcers,NEXT,NEXT,NEXT,Major aphthous ulcers,NEXT,Periadenitis Mu

7、cosa Necrotica Recurrens,NEXT,Major aphthous ulcers,NEXT,Herpetiform ulcers,NEXT,disease-process,24h,,10d-14d,,,outbreak,NEXT,intermission,healing,prodromal stage,ulcerative stage,5. Diagnosis,history clinical feature,

8、NEXT,4. Pathology ： nonspecific inflammation,6. Differential diagnosis,benign ulcer & malignant ulcerNecrotizing sialadenometaplasia, Behçet’s disease, herpes simplex, hand-foot-and-mouth disease,NEXT,Comp

9、arison,NEXT,7. Treatment,principle：symptomatic treatmentEvaluation of curative effect,NEXT,Topical application of a steroid ointment reduces discomfort and decreases the duration of the lesions. Topical anesthetics, an

10、tibiotics, 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.,BACK,III. BehÇet’s

11、 disease,1. Preface Hulusi Behçet (1937) Behçet’s disease is a chronic multisystemic inflammatory disorder of uncertain cause and prognosis. 2. Etiology Unknown,NEXT,3. Clinical features

12、 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 s

13、ystems: joint, digestive, cardiovascular, nervous, respiratory, urinary,NEXT,BehÇet’s disease,NEXT,4. Pathology ： Histopathologic changes consist of a perivascular mononuclear cellular infiltrate, endothelial

14、 cell swelling or necrosis, partial luminal obliteration and occasional fibrinoid necrosis of the vessels.,NEXT,5. Diagnosis 1) recurrent oral ulceration 2) recurrent genital ulceration 3) eye lesions

15、 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.,NEXT,6.

16、Differential diagnosis,NEXT,RAU Herpetic atomatitis Crohn’s diseaseReiter’s syndromeStevens-Johnson syndrome,7. Treatment Symptomatic in mild cases. Systemic steroids, immunosuppressive drugs, colchi

17、cines, thalidomide, and dapsone are administered in severe cases.,BACK,IV. Traumatic Ulcer Traumatic Bulla,1. Preface,Because of the constant motion of the masticatory mucosa over the teeth and the introduction o

18、f hard objects into the oral cavity, traumatic ulcers are frequent.,NEXT,2. Etiology,Mechanical factors: a sharp or broken tooth, rough fillings, clumsy use of cutting dental instruments, hard foodstuffs, sharp foreign

19、bodies, biting of the mucosa, and denture irritation etc.Physical factors: thermal burnsChemical factors: strong acid, strong base, As2O3, Ag(NO)3, iodophenol,NEXT,3. Clinical feature,1) Decubital ulcer,mechanical irri

20、tating factors the ulcer conforms in area and linearity to the source of the irritating factors,NEXT,NEXT,traumatic ulcer,traumatic ulcer,NEXT,infants, hard palate improper feeding,NEXT,2) Bednar ulcer,3) Rida-Fede ul

21、cer,infants lingual frenum ulcer secondary to inferior deciduous incisor,NEXT,4) Factitious ulcer,mentally handicapped patients or those with serous emotional problems oral self-inflicted trauma by biting, fingernail

22、s, or by the use of a sharp object tongue, lower lip, gingiva slow to heal due to perpetuation of the injury by the patient local measures and psychiatric therapy,NEXT,5) Chemical burn,the type of chemical utilized, i

23、ts concentration, and the duration whitish surface?desquamating?painful erosion or ulcer?bone damage healing within 1-2 weeks,NEXT,NEXT,chemical burn,6) Thermal burn,very hot foods, liquid, or hot metal objects palat

24、e, lips, floor of the mouth, tongue painful, red, undergoing desquamation, leaving erosions supportive treatment; self-healing in about a week,NEXT,NEXT,thermal burn,7) Traumatic bulla & traumatic hematoma,caused

25、by biting or prosthetic appliances buccal mucosa, soft palate, lips, tongue self-healing in 4-6 days,NEXT,traumatic bulla,NEXT,4. Diagnosis,historyclinical features,NEXT,carcinoma, syphilis, tubercular ulcer, major a

26、phthous ulcerthrombocytopenia, thrombastheniapemphigus, cicatricial pemphigoid,5. Differential diagnosis,malignant ulcer,NEXT,5. Differential diagnosis,BACK,6. Treatment,Removal of the traumatic factorsTopical measur

27、es,NEXT,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.,NEXT,2. Etiology,unknown,3. Clinical feature,Major symptoms: nongonococcal

28、 urethritis, conjunctivitis, arthritis Other symptoms: oral ulcer, circinate balanitis, keratoderma blennorrhagicum,NEXT,NEXT,oral lesion,4. Diagnosis,history clinical criteria,NEXT,5. Differential diagnosis,The differ

29、ential diagnosis the oral lesions includes erythema multiforme, Stevens-Johnson syndrome, psoriasis, Behçet’s Disease, geographic tongue, and stomatitis.,NEXT,6. Treatment,It is nonspecific and symptomatic. Non-ster

30、oidal anti-inflammatory drugs, salicylates, and tetracyclines may be helpful, cyclosporin, azathioprine, methotrexate, and systemic steroid in severe case.,BACK,Summary,To compare the characteristics of major Aphthous ul

31、cer, traumatic ulcer, carcinoma and tuberculous ulcer. (etiology, pathology, clinical feature, treatment, prognosis) .To master the treatment principle of ulcerative diseases by taking RAU for example.,NEXT,To master th

32、e effect, usage, contraindication and side-effect of corticosteroid in treating ulcerative diseases. To establish the conception of oral mucosal syndrome by means of learning Behçet’s disease.,NEXT,Questions,Which

33、is the most common form of Recurrent Aphthous Ulcer? What’s the characteristic of its lesion? What’s the effect of corticosteroid in treating oral ulcerative diseases? What’s the primary treatment to traumatic ulcer?,N

34、EXT,Taking major Aphthous ulcer and carcinoma for example, try to tell the difference between benign ulcer and malignant ulcer. What are the oral lesions of Behçet’s Disease and Reiter’s Syndrome ? What are their c