1. Oral Ulcerative Diseases

2.  Ulcers are the most common oral soft
tissue lesions.
 Traumatic ulcers
 Aphthous stomatitis
 Behcet’s disease
 Viral infections of oral mucosa: Herpes
simplex, herpangina, herpes zoster
 Erosive lichen planus
 Bacterial infections: T.B ulcer, syphilitic
ulcerations
 Vesiculo-bullous diseases
 Malignant ulcers

3.  Caused by local trauma
 Either by ill fitted dentures
 Sharp edges of brocken tooth
 Lip or tongue biting after heavy
anesthesia
 Cheek biting

9.  Most common oral mucosal lesion
 Possible etiological factors:
 Allergy: food
 Genetic predisposition: HLA family
 Nutritional deficiency:B12,folate,Iron
 Hematological abnormalities
 Hormonal influences: Female, menstrual period
 Infectious agents: AIDS,HSV,VZV
 Trauma
 Stress

10.  Of all the types of nontraumatic
ulceration that affect oral
mucosa, aphthous ulcers (canker sores)
are probably the most common.
 incidence ranges from 20% to 60%.
 Prevalence tends to be higher in
professional persons, in those in upper
socioeconomic groups, and in those
who do not smoke.

11.  Onset frequently in childhood but
peak in adolescence or early adult
life
 Attacks at variable but sometimes
relatively regular intervals
 Most patients are non-smokers
 Usually self-limiting eventually

12.  Three forms of aphthous ulcers have
been recognized:
 minor, major, and herpetiform
 All are believed to be part of the same
disease spectrum, and all are believed
to have a common etiology.
Differences are essentially clinical and
correspond to the degree of severity.

13. Minor Aphthous stomatitis
The most common type
Non-keratinized mucosa affected
Ulcers are shallow, rounded, 5-7mm with
erythematous margins and yellowish
floor
One or several ulcers may be present

14.  Clinical Features
 Minor aphthous ulcers usually appears as a
single, painful, oval ulcer that is less than 0.5 cm
in diameter, covered by a yellow fibrinous
membrane and surrounded by an erythematous
halo. Multiple oral aphthae may be seen.
 Minor aphthous ulcers generally last 7 to 10 days
and heal without scar formation. Recurrences vary
from one individual to another. Periods of
freedom from disease may range from a matter of
weeks to as long as years.

21.  Uncommon
 Ulcers frequently several cms mimic
malignant ulcers
 Ulcers persist for several months
 Masticatory mucosa, dorsum of tongue
or gingiva may be involved
 Scar follow healing

22.  Clinical Features
 painful recurrent ulcers.
 prodromal symptoms of tingling or burning before
the appearance of lesions.
 The ulcers are not preceded by vesicles and
characteristically appear on the vestibular and
buccal mucosa, tongue, soft palate, fauces, and floor
of mouth.
 Only rarely do these lesions occur on the attached
gingiva and hard palate, thus providing an
important clinical sign for the separation of
aphthous ulcers from secondary herpetic ulcers.

27.  discomfort, systemic health may be
compromised because of difficulty
in eating and psychological stress.
The predilection for movable oral
mucosa is as typical for major
aphthous ulcers as it is for minor
aphthae.
 HIV-positive patients may have
aphthous lesions at any intraoral
site.

28.  Uncommon
 Non-keratinized mucosa affected
 Ulcers are 1-2 cm
 Dozens or hundreds may be present
 May coalesce to form irrigular ulcers
 Widespread bright erythemous
round ulcers

29.  Herpetiform Aphthous Ulcers.
 Clinically
 recurrent crops of small ulcers.
 movable mucosa is predominantly affected,
 palatal and gingival mucosa may also be
involved. Pain may be considerable,
 healing generally occurs in 1 to 2 weeks.
 Unlike herpes infection, herpetiform
aphthous ulcers are not preceded by vesicles
and exhibit no virus-infected cells.

33.  the diagnosis of these ulcers is usually
evident clinically, biopsies usually are
unnecessary and therefore are rarely
performed.
 Aphthous ulcers have nonspecific
microscopic findings, and no histologic
features are diagnostic.
 Studies have shown that mononuclear cells
are found in submucosa and perivascular
tissues in the preulcerative stage. These cells
are predominantly CD4 lymphocytes,

35.  Differential Diagnosis.
 Diagnosis of aphthous ulcers is generally based
on the history and clinical appearance.
 Lesions of secondary (recurrent) oral herpes are
often confused with ulcers.
 A history of vesicles preceding ulcers, location on
the attached gingiva and hard palate, and crops of
lesions indicate herpetic rather than aphthous
ulcers.
 Other painful oral ulcerative conditions include
trauma, pemphigus vulgaris, mucous membrane
pemphigoid, and neutropenia.

36.  Treatment.
 occasional or few minor aphthous
ulcers, usually no treatment is
needed apart from a bland mouth
rinse such as sodium bicarbonate in
warm water to keep the mouth
clean.
 patients more severely
affected, some forms of treatment
can provide significant control (but
not necessarily a cure) of this

37.  Behçet’s syndrome is a rare multisystem
inflammatory disease
(gastrointestinal, cardiovascular, ocular, CNS, a
rticular, pulmonary, dermal) in which
recurrent oral aphthae are a consistent feature.
 Although the oral manifestations are usually
relatively minor, involvement of other
sites, especially the eyes and CNS, can be
serious.

38.  Disease comprised oral aphthae, genital
ulcerations and ocular diseases and
other lesions
 Major and minor criteria
 Affect mostly young adult males
between 20-40y
 Strong genetic component

39.  Recurrent oral aphthae
 Genital ulceration
 Eye lesions
 Skin lesions

40.  Arthralgia or arthritis
 Gastrointestinal lesions
 Vascular lesions
 C.N.S involvement

44.  Clinical features:
 - Rare disease of middle age
 - Initial presentation:
sinusitis, rhinorrhea, nasal stuffiness &
epistaxis.
 - Majority of cases, nasal & maxillary sinus
ulceration.
 - Necrosis & perforation of the nasal septum
or palate are occasionally seen.
 - Intra-oral lesions consist of
red, hyperplastic, granular lesion on attached
Gingiva.
 - Classical triad : upper respiratory

47.  Allergic contact stomatitis: many agents cause
reactions in the oral cavity as: numerous
food, chewing gums, food additives, mouth
washes dental materials, oral anasthesia.
 Acute or chronic, female predominance
 Appearance, mild redness- bright erythematous
lesions or vesicls rapture to form areas of
erosions

49.  Anaphylactic stomatitis either alone or in
conjunction with urticarial skin lesions.
 The affected mucosa show multiple zones of
erythema or many aphthous-like ulceration.
 Mucosal fixed drug eruptions develop into
vesiculo-erosive lesions mostly on the labial
mucosa
 Most common drugs penicillin, barbiturates
and sulfa drugs

50.  Erythema Multiforme
 Anaphylactic stomatitis
 Lichenoid drug reactions
 Pemphigus-like drug reactions
 Non-specific vesiculo-ulcerative
lesions