口腔黏膜ppt课件

1、NEXT口腔粘膜溃疡类疾病Oral Ulcerative diseasesBACK TO INDEXIntroductionBehets diseaseTraumatic Ulcer & Traumatic BullaRecurrent Aphthous UlcerSummary & QuestionsBACKReiters Syndrome I. IntroductionUlcers are one of the most common types of lesions seen in oral mucosa. 2. The difference between ulcer and eros

2、ion. NEXTulcererosionNEXTulcererosioncontinuity of epitheliumbroken severesuperficial basal cellsinvolvedfreeborderclearuncleardiseasesRAUBehcets diseaseSyphilis PemphigusHerpes simplex BACKComparison Recurrent Aphthous Ulcer1.Preface Name recurrent aphthous ulcer RAU recurrent aphthous stomatitis R

3、AS recurrent oral ulcer ROUNEXT Typing Lehners classification minor aphthous ulcer MiAU major aphthous ulcer MjAU herpetiform ulcer HU Characteristic recidivity self-healing periodicityNEXT2. Etiology unknown immunity : cellular immunity, humoral immunity, complement, autoantibody heritage infection

4、 ：HSV environment: psychologyNEXT denutrition ：iron, copper, zinc, folic acid, Vit B12 hyperoxide dismutase microcirculation disturbance ：lip, nail, apex linguae systemic factor ：ulceration of stomach、hepatitis、colonitis、diarrhoeaNEXT3. Clinical features minor aphthous ulcer major aphthous ulcer her

5、petiform ulcerNEXTNEXTMiAUMjAUHUfeatureyellow red concave painful small (2-4mm)big (1-3cm) deep scarmultiple smallcourse7-10 days3-6 weeks7-10 daysnumber 1-51 10positionnonkeratinized oral mucosa soft palatetongue lip mouth floorsystemic symptomlymph nodes swelling fever headache lymph nodes swellin

6、g Minor aphthous ulcersNEXTNEXTNEXTMiAUMjAUHUfeatureyellow red concave painful small (2-4mm)big (1-3cm) deep scarmultiple smallcourse7-10 days3-6 weeks7-10 daysnumber 1-51 10positionnonkeratinized oral mucosa soft palatetongue lip mouth floorsystemic symptomlymph nodes swelling fever headache lymph

7、nodes swelling Major aphthous ulcers NEXT Periadenitis Mucosa Necrotica Recurrens NEXTMajor aphthous ulcers NEXTMiAUMjAUHUfeatureyellow red concave painful small (2-4mm)big (1-3cm) deep scarmultiple smallcourse7-10 days3-6 weeks7-10 daysnumber 1-51 10positionnonkeratinized oral mucosa soft palateton

8、gue lip mouth floorsystemic symptomlymph nodes swelling fever headache lymph nodes swelling Herpetiform ulcers NEXTdisease-process24h10d-14doutbreakNEXTintermissionhealingprodromal stageulcerative stage5. Diagnosis history clinical featureNEXT4. Pathology ： nonspecific inflammation6. Differential di

9、agnosis benign ulcer & malignant ulcer Necrotizing sialadenometaplasia, Behets disease, herpes simplex, hand-foot-and-mouth disease NEXTbenign ulcermalignant ulcerageyouththe ageddepthdeepDeep or shallowself-healingyesnosystemic conditiongoodcachexypathologychronic inflammationcancerrecurrenceyesnoC

10、omparison NEXT7. Treatmentprinciple：symptomatic treatmentEvaluation of curative effectNEXTTopical application of a steroid ointment reduces discomfort and decreases the duration of the lesions. Topical anesthetics, antibiotics, mouthwashes, etc., have been used. In severe cases, intralesional steroi

11、d injection or systemic steroids in a low dose (10-20 mg prednisone) for 5-10 days reduce the pain dramatically. BACKIII. Behets disease1. Preface Hulusi Behet (1937) Behets disease is a chronic multisystemic inflammatory disorder of uncertain cause and prognosis. 2. Etiology Unknown NEXT3. Clinical

12、 features 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 systems: joint, digestive, cardiovascular, nervous, respiratory, urinaryNEXTBehets diseaseN

13、EXT4. 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. NEXT5. Diagnosis 1) recurrent oral ulceration 2) recurrent genital ulceration 3)

14、eye lesions 4) skin lesions 5) positive pathergy test To establish the diagnosis of Behets Disease, recurrent oral ulceration plus any two of the other four major clinical criteria must be present. NEXT6. Differential diagnosisNEXTRAU Herpetic atomatitis Crohns diseaseReiters syndromeStevens-Johnson

15、 syndrome7. Treatment Symptomatic in mild cases. Systemic steroids, immunosuppressive drugs, colchicines, thalidomide, and dapsone are administered in severe cases. BACKIV. Traumatic Ulcer Traumatic Bulla1. Preface Because of the constant motion of the masticatory mucosa over the teeth and the intro

16、duction of hard objects into the oral cavity, traumatic ulcers are frequent.NEXT2. 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.Physical factors:

17、 thermal burnsChemical factors: strong acid, strong base, As2O3, Ag(NO)3, iodophenolNEXT3. Clinical feature1) Decubital ulcer mechanical irritating factors the ulcer conforms in area and linearity to the source of the irritating factorsNEXTNEXTtraumatic ulcertraumatic ulcerNEXT infants, hard palate

18、improper feedingNEXT2) Bednar ulcer3) Rida-Fede ulcer infants lingual frenum ulcer secondary to inferior deciduous incisorNEXT4) Factitious ulcer mentally handicapped patients or those with serous emotional problems oral self-inflicted trauma by biting, fingernails, or by the use of a sharp object t

19、ongue, lower lip, gingiva slow to heal due to perpetuation of the injury by the patient local measures and psychiatric therapy NEXT5) Chemical burn the type of chemical utilized, its concentration, and the duration whitish surfacedesquamatingpainful erosion or ulcerbone damage healing within 1-2 wee

20、ksNEXTNEXTchemical burn6) Thermal burn very hot foods, liquid, or hot metal objects palate, lips, floor of the mouth, tongue painful, red, undergoing desquamation, leaving erosions supportive treatment; self-healing in about a weekNEXTNEXTthermal burn7) Traumatic bulla & traumatic hematoma caused by

21、 biting or prosthetic appliances buccal mucosa, soft palate, lips, tongue self-healing in 4-6 days NEXTtraumatic bullaNEXT4. Diagnosis historyclinical featuresNEXTcarcinoma, syphilis, tubercular ulcer, major aphthous ulcerthrombocytopenia, thrombastheniapemphigus, cicatricial pemphigoid 5. Different

22、ial diagnosis malignant ulcerNEXTTraumatic ulcerMjAUmalignant ulcertubercular ulceretiologyfeature of ulcermorphology of ulcerpathology5. Differential diagnosisBACK6. Treatment Removal of the traumatic factorsTopical measures NEXTV. Reiters Syndrome1. PrefaceReiters syndrome is a disease of unknown

23、cause that predominantly affects young men, 20-30 years of age. NEXT2. Etiologyunknown3. Clinical feature Major symptoms: nongonococcal urethritis, conjunctivitis, arthritis Other symptoms: oral ulcer, circinate balanitis, keratoderma blennorrhagicumNEXTNEXToral lesion4. Diagnosis history clinical c

24、riteriaNEXT5. Differential diagnosis The differential diagnosis the oral lesions includes erythema multiforme, Stevens-Johnson syndrome, psoriasis, Behets Disease, geographic tongue, and stomatitis. NEXT6. Treatment It is nonspecific and symptomatic. Non-steroidal anti-inflammatory drugs, salicylates, and tetracyclines may be helpful, cyclosporin, azathioprine, methotrexate, and systemic steroid in severe case. BACKSummary n To compare the characteristics of major Aphthous ulcer, traumatic ulcer, carcinoma and tuberculous ulcer. (etiolog