3. .Cont
:Etiology
:The main cause is unknown, however
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•
•
•
•
•
•
focal immune dysfunction .
endogenous or exogenous antigen .
non specific factor, such as trauma .
neuropeptide could mediate lymphocytes
epithelial necrosis .
Focal release of cytokines .
B12 , folic acid and iron deficiency .
Hormonal alteration , stress and allergy .
infiltration and
4. Clinical features :
Minor aphthae
Major aphthae
Herpetiform
aphthae
Size
<0.5 cm
>0.5 cm
<0.5 cm
Pain
painful
Sever pain
Considerable
pain
location
Nonkeratinized
mucosa
Nonkeratinized
mucosa
Any intraoral site
Topical / systemic
corticosteroids,
immuno suppresive
Topical/systimic
corticosteroids ,
tetracycline
mouth rinse
treatment Topical
corticosteroids ,
tetracycline
mouth rinse
5. Histopathology :
• biopsy is usually unnecessary .
• Non specific microscopic findings .
Differential diagnosis :
• Other painful ulcerative conditions .
6. 2- behcet`s syndrome :
Etiology : unknown , yet: immunodysfunction.
Clinical features : it affect : -nonkeratenized oral mucosa.
-eyes.
-joints.
-CNS , as headache .
Histopathology : - T lymphocytes are prominent .
- neutrophilic within the vessel wall
( vasiculitis).
Treatment : systemic steroids and immunosuppressive drugs .
7. 3- reiter`s syndrome :
Etiology : it’s a triad of nonspecific urethritis , conjuctivitis ,and
arthritis that follow bacterial dysentry or sexually transimmible
disease.
An abnormal immune response to microbial antigen(s) is likely to be
the mechanism for this syndrom
.
Clinical features : painless aphthous ulcer , its occurrence
predominantly in white men in their third decayed .
Treatment: NSAID .
8. 4- erythema multiform : it’s a hypersensitivity reaction that
target skin lesion and/or ulcerative oral lesion .
Etiology : minor form – HSV trigger.
major form – triggered by certain drugs.
hypersensitivity reaction.
antigen antibody complex.
Clinical features : most common in young adult .
sites: buccal, tongue, lips, and palat.
9. .Cont
Histopathology :
Epithelial hyperplasia.
Basal and parabasal apoptotic keratinocytes.
Vesicle at epithelium-connective tissue interface.
Infiltration of lymphocytes and macrophages.
Differential diagnosis: for the oral expression of the disease:
HSV infection , aphthous ulcers and pemphigus
valgaris.
Treatment : minor- symptomatic treatment.
major- topical corticosteroids with antifungal.
10. 5- drug reaction:
Etiology:
1-immunologic response (allergy), related to drug
immunogenicity, frequency, rout of adminstration.
2-nonimmunologic response , realated to over dose,
toxicity, side effect.
Clinical features: urticaria, maculopopular rash,erythema,vesicle ulcers.
angioedema appears as soft diffuse painless with
swelling.
Histopathology: nonspecific ulcer.
Treatment: antihistamine and occasionally corticosteroids.
11. Contact allergy:
It occurs directly adjacent to the causative agent
(erythematous,vesicular, ulcerative lesion).
Clinical features :mainly skin but when its in the oral cavity its due to
mouth paste, mouth wash and chewing gum .
Histopathology: nonspecific ulcer.
Treatment : eleminate the causative agent.
topical steroids may hasten the healing.
12. 6-Wegner`s granuloma:
A systemic inflammatory condition of unknown etiology.
Clinical features:upper respiratory tract,lung and kidney involvement
Intraoral lesion consists of red, hyperplastic,
granular lesion the attached gingiva.
Histopathology: granulomatous lesion , necrosis and multinucleated
giant cells.
Treatment: cytotoxic agent cyclophsphamide combined with
corticosteroids.
13. 7- midline granuloma :
Etiology: occult T-cell lymphomas.
Clinical features: a unifocal destructive process, generally in the
midline of the oronasal region.
Aggressive necrotic ulcer that is nonhealing.
Proflation can be seen.
Histopathology:acute and chronic inflammatory in partially necrotic
tissue.
Treatment: local radiation.
14. 8- chronic granulmatous:
It’s a rare systemic disease caused by defect of (NADPH) oxidate
complex that result in altered neutrophil and macrophages function .
Manifistation appear during childhood, it affect the lymph nodes, lung,
liver, spleen, bone and skin.
15. 9-Cyclic neutropenia:
Its presented as sever cyclic depletions of neutrophils from the blood
and marrow with periodicity of 21 days.
Fever , malaise, oral ulcer and cervical lymphadenopathy can be seen.
