粘膜总论变态反应性疾病

1、 ContentsDefinitionStructureBasic lesionGeneral featuresDiagnosis and treatmentOral mucosa: mucous membrane epithelium of the mouth Oral mucosal diseases: all sorts of diseases happened on oral mucosa and soft oral facial tissuesOral Medicine: Oral Medicine is a special discipline in dentistry, whic

2、h concerns oral mucosal diseases and their management with systemic and topical medicines.Section 1 DefinitionOral Medicine and PathologyUsually, discipline of oral medicine is very much depended on oral pathology, and these two disciplines are one family now abroad, which means you cannot be a spec

3、ialist of oral medicine without a degree of oral pathology. Oral Medicine: We bring medicine to dentistry-The American Academy of Oral Medicine Section 2 structurestructureepitheliumConnective tissueBasal membranekeratinocyteBasal layerprickle cell layer granular layer keratin layer Non-keratinocyte

4、melanocyte Langerhance cellMerkel cell lamina propia submucous layer Orthokeratosis and Parakeratosis the most apical layers (exterior) of cells are dead and lose their nucleus and cytoplasm, instead contain a tough, resistant protein called keratin. If all the nucleus disappear,we call it Orthokera

5、tosis. If not,we call it Parakeratosisthe basal membrane zone All epithelial cells rest on a basement membrane, which acts as a scaffolding on which epithelium can grow and regenerate after. The basement membrane acts as a selectively permeable membrane that determines which substances will be able

6、to enter the epithelium. Oral MucosaThree recognizable histological typesMasticatory (tough) mucosa in the gingivae and hard palate; Lining (flexible) mucosa in the lips, cheeks, vestibule, alveolar mucosa, soft palate, floor of mouth, and inferior surface of the tongue; Specialized (mix of masticat

7、ory and lining) mucosa on the dorsum of the tongue.Section 3Basic lesionsMaculesmall, circular, flat spot 2 cm can be seen but not feltvariety of shapesdifferent color from nearby skin (usually brown, red, or black)Patch a large macule 2cm in diameter 1.Macule & Patch2 papule and plaquePapulea circu

8、mscribed, solid elevation of mucosa with no visible fluidvarying in size from a pinhead to 1cmcan be either white, pink or red Plaquea broad papule, or confluence of papules 1cm3 vesicle ,bulla and pustule Vesicle: a circumscribed, fluid-containing, epidermal elevation.1-10mm in sizeBulla : a rounde

9、d or irregularly shaped blister containing serous or seropurulent fluid. 1cmPustule: a small elevation of the skin containing purulent material usually consisting of necrotic inflammatory cells . rarely in oral cavity.Section 4 General FeaturesAetiologyIn general, the aetiology of oral mucosal disea

10、ses is complicated (like OLP, RAU), and the host immunities are usually involved in most cases although in some cases, the causes are quite simple (like oral mucosal trauma). And females might be more susceptible to oral mucosal diseases. (2) age (3) location: risk zone lesion:Alteration; location d

11、iversity; compossibility (1) sex Clinical character Section 4 General FeaturesSection 5Diagnosis and treatment Clinical diagnosisHistorical diagnosisLaboratory diagnosisMicroscopical diagnosis (histopathology &Microbiology)History Takingphysical examinationauxiliary examinationhematologicalexaminati

12、on biopsyimmunologictestexaminationofpathogenicmicroorganismconfirmed diagnosis differential diagnosisDiagnosis ProceduresClinical Examination ProceduresOral mucosal diseases- treatment Different treatment for same diseases Same treatment for different diseasesSystemic treatment for local lesionsCom

13、bination of chinese and western medicineOral mucosal diseases- Prognosis Fine prognosis Recurrent and chronicPremalignatMalignancyAllergic Diseases of Oral MucosaAllergic Reaction - ReviewAlso called “hypersensitivity”Undesirable reactions produced by the normal immune systemOccur to normally harmle

14、ss environmental substances known as allergens (antigent, hapten)Reactions are rapid, reversible, predictable, and specificAllergic StomatitisAllergic medicamentosus stomatitisAllergens - medicineAllergic contacted stomatitisAllergens Dental materials (amalgam, liquid denture acrylic, mouthwash, etc

15、.) Cosmetics (Lipsticks, etc.)Clinical PresentationsMedical history drug usage and allergen contactSymptoms - latent period: a few hours to several days- prodromal stage: none or fever, sore throat- topical symptom: burning, sore, hard to swallowSigns - Oral lesion: vesicle, erosion, ulcer- Skin les

16、ion: red macula, papula, vesicle Allergic medicamentosus stomatitis is a postponed reaction of hypersensitivity where cutaneous or mucosal lesion occurs due to a recurrent contact with the same pharmacologic agents by systemic or local administration. Recurrent allergic medicamentosus lesion occurri

17、ng at the same place is called fixed drug eruption.Allergic medicamentosus stomatitis Oral cavity always on the lips , buccal mucosa, tongue burning, tingling, erythema, vesicle, erosion, ulceration, yellow or white pesudomembrane cheilitis, lip and facial swelling Lyell syndrome is an extensive,ext

18、reme, systemic allergic reaction. skin and various mucosal surfaces (oral, nose, eye,vagina, genitalia, anus, et al)Allergic medicamentosus stomatitisContact stomatitis is inflammation or pain of the oral mucosa due to both irritant and allergic substances. Irritants include heat, frictional trauma,

19、 and chemicals. Oral flavorings, preservatives, and dental materials are common allergens. Allergic contact stomatitis may be difficult to distinguish from irritant stomatitis. Allergic contact stomatitisAllergic contact stomatitis may mimic the oral changes of a vitamin deficiency, certain anemias,

20、 uremic stomatitis, and even candidiasis. burning, tingling, erythema, vesicle, erosion, ulceration, yellow or white pesudomembrane Allergic contact stomatitisPatch testing to a broad series of antigens may be required to identify specific causes of allergic contact stomatitis. Skin patch testing ma

21、y be indicated. There is no need to test the oral mucosa directly because the oral mucosa and skin are sensitized at the same time.Allergic contact stomatitisDIAGONOSISMedical history. AllergenClinical manifestation. Acute inflammation . Remove suspicious allergen. Lesions would improve.Allergic sto

22、matitisTHERAPYRemoving of suspicious allergen or avoidance of contactants is the primary mode of therapy Corticosteroid and antihistamine treatmentSupportive therapy.Nutritional supplement.Therapies according to clinical signs and symptoms. Topical and systemic medicaments.Allergic stomatitisAngione

23、urotic edemaRecurring periods of noninflammatory swelling involving the skin, intestinal organs, brain and mucous membranesIn severe cases, respiratory swelling can result in compromised breathingType I hypersensitivityAllergen: uncertain, probably foods, drugs, mental / physical conditions Clinical

24、 FeaturesJoint pain Purpura Fever Skin swelling Mucous membrane swelling Brain swelling Visceral swelling Abdominal pain Voice box swelling various sources for Angioneurotic Edema includes the 9 symptoms listed below:THERAPYRemoving of suspicious allergen is the primary mode of therapy Corticosteroi

25、d , adrenaline, antihistamine treatmentSupportive therapy.Nutritional supplement.Therapies according to clinical signs and symptoms. Topical and systemic medicaments.Angioneurotic edemaErythema MultiformeA mucocutaneous condition of unknown cause, possibly mediated by deposition of immune complex (m

26、ostly IgM) in the superficial microvasculature of the skin and oral mucosaAcute eruption, self-limiting and recurrentClinical PresentationsSymptoms - prodromal stage: tired, fever, headache, sore throat, sneeze, coughSigns -lesions usually appear symmetrically- Oral lesion: extensive erosion, exudation, pseudomembrane, crust (especially on lips) - Skin lesion: Central sore surrounded by pale red rings, also called a t