上海交通大学-口腔医学口腔粘膜病学课件溃疡类疾病
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superficial
free unclear Pemphigus Herpes simplex
5BACK
II.Recurrent Aphthous Ulcer
1.Preface
• Name
recurrent aphthous ulcer RAU recurrent aphthous stomatitis RAS recurrent oral ulcer ROU
32NEXT
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.
18NEXT
• disease-process
prodromal 24h ulcerative
stage
stage
outbreak
10d-14d
intermission
healing
19NEXT
4. Pathology ： nonspecific inflammation
5. Diagnosis
• 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.
stomach、hepatitis、colonitis、diarrhoea
9NEXT
3. Clinical features
minor aphthous ulcer major aphthous ulcer herpetiform ulcer
10NEXT
feature
MiAU
yellow red concave painful small (24mm)
8NEXT
• denutrition ：iron, copper, zinc, folic acid,
Vit B12
• hyperoxide dismutase • microcirculation disturbance ：lip,
nail, apex linguae
• systemic factor ：ulceration of
MjAU
big (1-3cm) deep scar
course
7-10 days
3-6 weeks
number position
1-5
nonkeratinized oral mucosa
1 soft palate
systemic symptom
—
lymph nodes swelling
HU
multiple small
BACK TO INDEX
口腔粘膜溃疡类疾病
Oral Ulcerative diseases
1NEXT
Introduction
Recurrent Aphthous Ulcer BehÇet’s disease Traumatic Ulcer & Traumatic Bulla Reiter’s Syndrome
1 soft palate
systemic symptom
—
lymph nodes swelling
HU
multiple small
7-10 days >10
tongue lip mouth floor fever headache lymph nodes swelling
17NEXT
Herpetiform ulcers
6NEXT
• Typing Lehner’s classification
minor aphthous ulcer （MiAU） major aphthous ulcer （MjAU） herpetiform ulcer （HU）
• Characteristic
recidivity self-healing periodicity
24BACK
III. BehÇet’s disease
1. Preface
Hulusi Behçet (1937) Behçet’s disease is a chronic multisystemic inflammatory disorder of uncertain cause and prognosis.
4) ocular lesions: conjunctivitis,
recurrent iritis
5) others systems: joint, digestive,
cardiovascular, nervous, respiratory, urinary
26NEXT
BehÇet’s disease
28NEXT
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.
• history • clinical feature
20NEXT
6. Differential diagnosis
• benign ulcer & malignant ulcer • Necrotizing sialadenometaplasia,
Behçet’s disease, herpes simplex, hand-foot-and-mouth disease
31BACK
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.
16NEXT
feature
MiAU
yellow red concave painful small (24mm)
MjAU
big (1-3cm) deep scar
course
7-10 days
3-6 weeks
number position
1-5
nonkeratinized oral mucosa
29NEXT
6. Differential diagnosis
RAU Herpetic atomatitis Crohn’s disease Reiter’s syndrome Stevens-Johnson syndrome
30NEXT
7. Treatment
Symptomatic in mild cases. Systemic steroids, immunosuppressive drugs, colchicines, thalidomide, and dapsone are administered in severe cases.
7NEXT
2. Etiology unknown
• immunity : cellular immunity, humoral immunity, complement, autoantibody • heritage • infection ：HSV • environment: psychology
7-10 days >10
tongue lip mouth floor fever headache lymph nodes swelling
11NEXT
Minor aphthous ulcers
12NEXT
13NEXT
feature
MiAU
yellow red concave painful small (24mm)
cachexy
chronic inflammation yes
cancer no
22NEXT
7. Treatment • principle：symptomatic treatment • Evaluation of curative effect
23NEXT
• Topical application of a steroid ointment reduces discomfort and decreases the duration of the lesions. Topical anesthetics, antibiotics, mouthwashes, etc., have been used.
Physical factors: thermal burns
Chemical factors: strong acid, strong base,
As2O3, Ag(NO)3, iodophenol
2. Etiology Unknown
25NEXT
3. Clinical features 1) oral mucosa: minor aphthous ulcer
2) genital lesion: ulcer 3) skin lesions: erythema nodosum,
epifolliculitis, pustule after needling
27NEXT
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.
MjAU
big (1-3cm) deep scar
course
7-10 days
3-6 weeks
number position
1-5
nonkeratinized oral mucosa
1 soft palate
systemic symptom
—
lymph nodes swelling
HU
multiple small
21NEXT
Comparison
age depth self-healing systemic condition pathology recurrence
benign ulcer youth deep yes
malignant ulcer the aged
Deep or shallow no
good
3NEXT
ulcer
ຫໍສະໝຸດ Baidu
erosion
4NEXT
Comparison
continuity of epithelium
basal cells border diseases
ulcer
broken severe involved clear RAU Behcet’s disease Syphilis
erosion
7-10 days >10
tongue lip mouth floor fever headache lymph nodes swelling
14NEXT
Major aphthous ulcers Periadenitis Mucosa Necrotica Recurrens
15NEXT
Major aphthous ulcers
Summary & Questions
2BACK
I. Introduction
1. Ulcers are one of the most common types of lesions seen in oral mucosa.
2. The difference between ulcer and erosion.
free unclear Pemphigus Herpes simplex
5BACK
II.Recurrent Aphthous Ulcer
1.Preface
• Name
recurrent aphthous ulcer RAU recurrent aphthous stomatitis RAS recurrent oral ulcer ROU
32NEXT
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.
18NEXT
• disease-process
prodromal 24h ulcerative
stage
stage
outbreak
10d-14d
intermission
healing
19NEXT
4. Pathology ： nonspecific inflammation
5. Diagnosis
• 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.
stomach、hepatitis、colonitis、diarrhoea
9NEXT
3. Clinical features
minor aphthous ulcer major aphthous ulcer herpetiform ulcer
10NEXT
feature
MiAU
yellow red concave painful small (24mm)
8NEXT
• denutrition ：iron, copper, zinc, folic acid,
Vit B12
• hyperoxide dismutase • microcirculation disturbance ：lip,
nail, apex linguae
• systemic factor ：ulceration of
MjAU
big (1-3cm) deep scar
course
7-10 days
3-6 weeks
number position
1-5
nonkeratinized oral mucosa
1 soft palate
systemic symptom
—
lymph nodes swelling
HU
multiple small
BACK TO INDEX
口腔粘膜溃疡类疾病
Oral Ulcerative diseases
1NEXT
Introduction
Recurrent Aphthous Ulcer BehÇet’s disease Traumatic Ulcer & Traumatic Bulla Reiter’s Syndrome
1 soft palate
systemic symptom
—
lymph nodes swelling
HU
multiple small
7-10 days >10
tongue lip mouth floor fever headache lymph nodes swelling
17NEXT
Herpetiform ulcers
6NEXT
• Typing Lehner’s classification
minor aphthous ulcer （MiAU） major aphthous ulcer （MjAU） herpetiform ulcer （HU）
• Characteristic
recidivity self-healing periodicity
24BACK
III. BehÇet’s disease
1. Preface
Hulusi Behçet (1937) Behçet’s disease is a chronic multisystemic inflammatory disorder of uncertain cause and prognosis.
4) ocular lesions: conjunctivitis,
recurrent iritis
5) others systems: joint, digestive,
cardiovascular, nervous, respiratory, urinary
26NEXT
BehÇet’s disease
28NEXT
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.
• history • clinical feature
20NEXT
6. Differential diagnosis
• benign ulcer & malignant ulcer • Necrotizing sialadenometaplasia,
Behçet’s disease, herpes simplex, hand-foot-and-mouth disease
31BACK
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.
16NEXT
feature
MiAU
yellow red concave painful small (24mm)
MjAU
big (1-3cm) deep scar
course
7-10 days
3-6 weeks
number position
1-5
nonkeratinized oral mucosa
29NEXT
6. Differential diagnosis
RAU Herpetic atomatitis Crohn’s disease Reiter’s syndrome Stevens-Johnson syndrome
30NEXT
7. Treatment
Symptomatic in mild cases. Systemic steroids, immunosuppressive drugs, colchicines, thalidomide, and dapsone are administered in severe cases.
7NEXT
2. Etiology unknown
• immunity : cellular immunity, humoral immunity, complement, autoantibody • heritage • infection ：HSV • environment: psychology
7-10 days >10
tongue lip mouth floor fever headache lymph nodes swelling
11NEXT
Minor aphthous ulcers
12NEXT
13NEXT
feature
MiAU
yellow red concave painful small (24mm)
cachexy
chronic inflammation yes
cancer no
22NEXT
7. Treatment • principle：symptomatic treatment • Evaluation of curative effect
23NEXT
• Topical application of a steroid ointment reduces discomfort and decreases the duration of the lesions. Topical anesthetics, antibiotics, mouthwashes, etc., have been used.
Physical factors: thermal burns
Chemical factors: strong acid, strong base,
As2O3, Ag(NO)3, iodophenol
2. Etiology Unknown
25NEXT
3. Clinical features 1) oral mucosa: minor aphthous ulcer
2) genital lesion: ulcer 3) skin lesions: erythema nodosum,
epifolliculitis, pustule after needling
27NEXT
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.
MjAU
big (1-3cm) deep scar
course
7-10 days
3-6 weeks
number position
1-5
nonkeratinized oral mucosa
1 soft palate
systemic symptom
—
lymph nodes swelling
HU
multiple small
21NEXT
Comparison
age depth self-healing systemic condition pathology recurrence
benign ulcer youth deep yes
malignant ulcer the aged
Deep or shallow no
good
3NEXT
ulcer
ຫໍສະໝຸດ Baidu
erosion
4NEXT
Comparison
continuity of epithelium
basal cells border diseases
ulcer
broken severe involved clear RAU Behcet’s disease Syphilis
erosion
7-10 days >10
tongue lip mouth floor fever headache lymph nodes swelling
14NEXT
Major aphthous ulcers Periadenitis Mucosa Necrotica Recurrens
15NEXT
Major aphthous ulcers
Summary & Questions
2BACK
I. Introduction
1. Ulcers are one of the most common types of lesions seen in oral mucosa.
2. The difference between ulcer and erosion.