NEXT
口腔粘膜溃疡类疾病
Oral Ulcerative diseases
BACK TO INDEX
Introduction
Beh?et’s disease
Traumatic Ulcer & Traumatic Bulla
Recurrent Aphthous Ulcer
Summary & Questions
BACK
Reiter’s Syndrome
I,Introduction
1,Ulcers are one of the most common
types of lesions seen in oral mucosa,
2,The difference between ulcer and
erosion,
NEXT
ulcer erosion
NEXT
ulcer erosion
continuity of
epithelium
broken
severe
superficial
basal cells involved free
border clear unclear
diseases RAU
Behcet’s disease
Syphilis
Pemphigus
Herpes simplex
BACK
Comparison
II.Recurrent Aphthous Ulcer
1.Preface
? Name
recurrent aphthous ulcer RAU
recurrent aphthous stomatitis RAS
recurrent oral ulcer ROU
NEXT
? Typing Lehner’s classification
minor aphthous ulcer （ MiAU）
major aphthous ulcer （ MjAU）
herpetiform ulcer （ HU）
? Characteristic
recidivity
self-healing
periodicity
NEXT
2,Etiology unknown
? immunity, cellular immunity,
humoral immunity,complement,
autoantibody
? heritage
? infection, HSV
? environment,psychology
NEXT
? denutrition, iron,copper,zinc,folic acid,
Vit B12
? hyperoxide dismutase
? microcirculation disturbance, lip,
nail,apex linguae
? systemic factor, ulceration of
stomach,hepatitis,colonitis,diarrhoea
NEXT
3,Clinical features
minor aphthous ulcer
major aphthous ulcer
herpetiform ulcer
NEXT
NEXT
MiAU MjAU HU
feature
yellow red concave
painful small (2-
4mm)
big (1-3cm)
deep scar multiple small
course 7-10 days 3-6 weeks 7-10 days
number 1-5 1 >10
position nonkeratinized oral mucosa soft palate tongue lip mouth floor
systemic
symptom —
lymph nodes
swelling
fever headache
lymph nodes
swelling
Minor aphthous ulcers
NEXT
NEXT
NEXT
MiAU MjAU HU
feature
yellow red concave
painful small (2-
4mm)
big (1-3cm)
deep scar multiple small
course 7-10 days 3-6 weeks 7-10 days
number 1-5 1 >10
position nonkeratinized oral mucosa soft palate tongue lip mouth floor
systemic
symptom —
lymph nodes
swelling
fever headache
lymph nodes
swelling
Major aphthous ulcers
NEXT
Periadenitis Mucosa Necrotica Recurrens
NEXT
Major aphthous ulcers
NEXT
MiAU MjAU HU
feature
yellow red concave
painful small (2-
4mm)
big (1-3cm)
deep scar multiple small
course 7-10 days 3-6 weeks 7-10 days
number 1-5 1 >10
position nonkeratinized oral mucosa soft palate tongue lip mouth floor
systemic
symptom —
lymph nodes
swelling
fever headache
lymph nodes
swelling
Herpetiform ulcers
NEXT
? disease-process
24h
10d-14d
outbreak
NEXT
intermission
healing
prodromal
stage
ulcerative
stage
5,Diagnosis
? history
? clinical feature
NEXT
4,Pathology,
nonspecific inflammation
6,Differential diagnosis
? benign ulcer & malignant ulcer
? Necrotizing sialadenometaplasia,
Beh?et’s disease,herpes simplex,
hand-foot-and-mouth disease
NEXT
benign ulcer malignant ulcer
age youth the aged
depth deep Deep or shallow
self-healing yes no
systemic
condition good cachexy
pathology chronic inflammation cancer
recurrence yes no
Comparison
NEXT
7,Treatment
? principle,symptomatic treatment
? Evaluation of curative effect
NEXT
? Topical 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 steroid
injection or systemic steroids in a low dose
(10-20 mg prednisone) for 5-10 days
reduce the pain dramatically,
BACK
III,Beh?et’s disease
1,Preface
Hulusi Beh?et (1937)
Beh?et’s disease is a chronic multisystemic
inflammatory disorder of uncertain cause and
prognosis,
2,Etiology
Unknown
NEXT
3,Clinical 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,urinary
NEXT
Beh?et’s disease
NEXT
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,
NEXT
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 Beh?et’s Disease,
recurrent oral ulceration plus any two of the other
four major clinical criteria must be present,
NEXT
6,Differential diagnosis
NEXT
RAU
Herpetic atomatitis
Crohn’s disease
Reiter’s syndrome
Stevens-Johnson syndrome
7,Treatment
Symptomatic in mild cases,
Systemic steroids,immunosuppressive
drugs,colchicines,thalidomide,and
dapsone are administered in severe cases,
BACK
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,
NEXT
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,
Physical factors,thermal burns
Chemical factors,strong acid,strong base,
As2O3,Ag(NO)3,iodophenol
NEXT
3,Clinical feature
1) Decubital ulcer
? mechanical irritating factors
? the ulcer conforms in area and linearity to the
source of the irritating factors
NEXT
NEXT
traumatic ulcer
traumatic ulcer
NEXT
? infants,hard palate
? improper feeding
NEXT
2) Bednar ulcer
3) Rida-Fede ulcer
? infants
? lingual frenum ulcer secondary to inferior
deciduous incisor
NEXT
4) 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
? tongue,lower lip,gingiva
? slow to heal due to perpetuation of the injury by
the patient
? local measures and psychiatric therapy
NEXT
5) Chemical burn
? the type of chemical utilized,its concentration,
and the duration
? whitish surface?desquamating?painful erosion
or ulcer?bone damage
? healing within 1-2 weeks
NEXT
NEXT
chemical burn
6) 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 week
NEXT
NEXT
thermal burn
7) Traumatic bulla & traumatic hematoma
? caused by biting or prosthetic appliances
? buccal mucosa,soft palate,lips,tongue
? self-healing in 4-6 days
NEXT
traumatic bulla
NEXT
4,Diagnosis
? history
? clinical features
NEXT
carcinoma,syphilis,tubercular ulcer,
major aphthous ulcer
thrombocytopenia,thrombasthenia
pemphigus,cicatricial pemphigoid
5,Differential diagnosis
malignant ulcer
NEXT
Traumatic
ulcer MjAU
malignant
ulcer
tubercular
ulcer
etiology
feature of
ulcer
morphology
of ulcer
pathology
5,Differential diagnosis
BACK
6,Treatment
? Removal of the traumatic factors
? Topical measures
NEXT
V,Reiter’s Syndrome
1,Preface
Reiter’s syndrome is a disease of
unknown cause that predominantly
affects young men,20-30 years of age,
NEXT
2,Etiology
unknown
3,Clinical feature
? Major symptoms,nongonococcal urethritis,
conjunctivitis,arthritis
? Other symptoms,oral ulcer,circinate
balanitis,keratoderma blennorrhagicum
NEXT
NEXT
oral lesion
4,Diagnosis
? history
? clinical criteria
NEXT
5,Differential diagnosis
The differential diagnosis the oral lesions
includes erythema multiforme,Stevens-
Johnson syndrome,psoriasis,Beh?et’s
Disease,geographic tongue,and stomatitis,
NEXT
6,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,
BACK
Summary
1,To compare the characteristics of major
Aphthous ulcer,traumatic ulcer,carcinoma
and tuberculous ulcer,(etiology,pathology,
clinical feature,treatment,prognosis),
2,To master the treatment principle of
ulcerative diseases by taking RAU for
example,
NEXT
3,To master the effect,usage,
contraindication and side-effect of
corticosteroid in treating ulcerative
diseases,
4,To establish the conception of oral
mucosal syndrome by means of learning
Beh?et’s disease,
NEXT
Questions
1,Which is the most common form of
Recurrent Aphthous Ulcer? What’s
the characteristic of its lesion?
2,What’s the effect of corticosteroid in
treating oral ulcerative diseases?
3,What’s the primary treatment to
traumatic ulcer?
NEXT
4,Taking major Aphthous ulcer and
carcinoma for example,try to tell the
difference between benign ulcer and
malignant ulcer,
5,What are the oral lesions of Beh?et’s
Disease and Reiter’s Syndrome?
What are their clinical systemic
features?
BACK
口腔粘膜溃疡类疾病
Oral Ulcerative diseases
BACK TO INDEX
Introduction
Beh?et’s disease
Traumatic Ulcer & Traumatic Bulla
Recurrent Aphthous Ulcer
Summary & Questions
BACK
Reiter’s Syndrome
I,Introduction
1,Ulcers are one of the most common
types of lesions seen in oral mucosa,
2,The difference between ulcer and
erosion,
NEXT
ulcer erosion
NEXT
ulcer erosion
continuity of
epithelium
broken
severe
superficial
basal cells involved free
border clear unclear
diseases RAU
Behcet’s disease
Syphilis
Pemphigus
Herpes simplex
BACK
Comparison
II.Recurrent Aphthous Ulcer
1.Preface
? Name
recurrent aphthous ulcer RAU
recurrent aphthous stomatitis RAS
recurrent oral ulcer ROU
NEXT
? Typing Lehner’s classification
minor aphthous ulcer （ MiAU）
major aphthous ulcer （ MjAU）
herpetiform ulcer （ HU）
? Characteristic
recidivity
self-healing
periodicity
NEXT
2,Etiology unknown
? immunity, cellular immunity,
humoral immunity,complement,
autoantibody
? heritage
? infection, HSV
? environment,psychology
NEXT
? denutrition, iron,copper,zinc,folic acid,
Vit B12
? hyperoxide dismutase
? microcirculation disturbance, lip,
nail,apex linguae
? systemic factor, ulceration of
stomach,hepatitis,colonitis,diarrhoea
NEXT
3,Clinical features
minor aphthous ulcer
major aphthous ulcer
herpetiform ulcer
NEXT
NEXT
MiAU MjAU HU
feature
yellow red concave
painful small (2-
4mm)
big (1-3cm)
deep scar multiple small
course 7-10 days 3-6 weeks 7-10 days
number 1-5 1 >10
position nonkeratinized oral mucosa soft palate tongue lip mouth floor
systemic
symptom —
lymph nodes
swelling
fever headache
lymph nodes
swelling
Minor aphthous ulcers
NEXT
NEXT
NEXT
MiAU MjAU HU
feature
yellow red concave
painful small (2-
4mm)
big (1-3cm)
deep scar multiple small
course 7-10 days 3-6 weeks 7-10 days
number 1-5 1 >10
position nonkeratinized oral mucosa soft palate tongue lip mouth floor
systemic
symptom —
lymph nodes
swelling
fever headache
lymph nodes
swelling
Major aphthous ulcers
NEXT
Periadenitis Mucosa Necrotica Recurrens
NEXT
Major aphthous ulcers
NEXT
MiAU MjAU HU
feature
yellow red concave
painful small (2-
4mm)
big (1-3cm)
deep scar multiple small
course 7-10 days 3-6 weeks 7-10 days
number 1-5 1 >10
position nonkeratinized oral mucosa soft palate tongue lip mouth floor
systemic
symptom —
lymph nodes
swelling
fever headache
lymph nodes
swelling
Herpetiform ulcers
NEXT
? disease-process
24h
10d-14d
outbreak
NEXT
intermission
healing
prodromal
stage
ulcerative
stage
5,Diagnosis
? history
? clinical feature
NEXT
4,Pathology,
nonspecific inflammation
6,Differential diagnosis
? benign ulcer & malignant ulcer
? Necrotizing sialadenometaplasia,
Beh?et’s disease,herpes simplex,
hand-foot-and-mouth disease
NEXT
benign ulcer malignant ulcer
age youth the aged
depth deep Deep or shallow
self-healing yes no
systemic
condition good cachexy
pathology chronic inflammation cancer
recurrence yes no
Comparison
NEXT
7,Treatment
? principle,symptomatic treatment
? Evaluation of curative effect
NEXT
? Topical 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 steroid
injection or systemic steroids in a low dose
(10-20 mg prednisone) for 5-10 days
reduce the pain dramatically,
BACK
III,Beh?et’s disease
1,Preface
Hulusi Beh?et (1937)
Beh?et’s disease is a chronic multisystemic
inflammatory disorder of uncertain cause and
prognosis,
2,Etiology
Unknown
NEXT
3,Clinical 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,urinary
NEXT
Beh?et’s disease
NEXT
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,
NEXT
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 Beh?et’s Disease,
recurrent oral ulceration plus any two of the other
four major clinical criteria must be present,
NEXT
6,Differential diagnosis
NEXT
RAU
Herpetic atomatitis
Crohn’s disease
Reiter’s syndrome
Stevens-Johnson syndrome
7,Treatment
Symptomatic in mild cases,
Systemic steroids,immunosuppressive
drugs,colchicines,thalidomide,and
dapsone are administered in severe cases,
BACK
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,
NEXT
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,
Physical factors,thermal burns
Chemical factors,strong acid,strong base,
As2O3,Ag(NO)3,iodophenol
NEXT
3,Clinical feature
1) Decubital ulcer
? mechanical irritating factors
? the ulcer conforms in area and linearity to the
source of the irritating factors
NEXT
NEXT
traumatic ulcer
traumatic ulcer
NEXT
? infants,hard palate
? improper feeding
NEXT
2) Bednar ulcer
3) Rida-Fede ulcer
? infants
? lingual frenum ulcer secondary to inferior
deciduous incisor
NEXT
4) 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
? tongue,lower lip,gingiva
? slow to heal due to perpetuation of the injury by
the patient
? local measures and psychiatric therapy
NEXT
5) Chemical burn
? the type of chemical utilized,its concentration,
and the duration
? whitish surface?desquamating?painful erosion
or ulcer?bone damage
? healing within 1-2 weeks
NEXT
NEXT
chemical burn
6) 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 week
NEXT
NEXT
thermal burn
7) Traumatic bulla & traumatic hematoma
? caused by biting or prosthetic appliances
? buccal mucosa,soft palate,lips,tongue
? self-healing in 4-6 days
NEXT
traumatic bulla
NEXT
4,Diagnosis
? history
? clinical features
NEXT
carcinoma,syphilis,tubercular ulcer,
major aphthous ulcer
thrombocytopenia,thrombasthenia
pemphigus,cicatricial pemphigoid
5,Differential diagnosis
malignant ulcer
NEXT
Traumatic
ulcer MjAU
malignant
ulcer
tubercular
ulcer
etiology
feature of
ulcer
morphology
of ulcer
pathology
5,Differential diagnosis
BACK
6,Treatment
? Removal of the traumatic factors
? Topical measures
NEXT
V,Reiter’s Syndrome
1,Preface
Reiter’s syndrome is a disease of
unknown cause that predominantly
affects young men,20-30 years of age,
NEXT
2,Etiology
unknown
3,Clinical feature
? Major symptoms,nongonococcal urethritis,
conjunctivitis,arthritis
? Other symptoms,oral ulcer,circinate
balanitis,keratoderma blennorrhagicum
NEXT
NEXT
oral lesion
4,Diagnosis
? history
? clinical criteria
NEXT
5,Differential diagnosis
The differential diagnosis the oral lesions
includes erythema multiforme,Stevens-
Johnson syndrome,psoriasis,Beh?et’s
Disease,geographic tongue,and stomatitis,
NEXT
6,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,
BACK
Summary
1,To compare the characteristics of major
Aphthous ulcer,traumatic ulcer,carcinoma
and tuberculous ulcer,(etiology,pathology,
clinical feature,treatment,prognosis),
2,To master the treatment principle of
ulcerative diseases by taking RAU for
example,
NEXT
3,To master the effect,usage,
contraindication and side-effect of
corticosteroid in treating ulcerative
diseases,
4,To establish the conception of oral
mucosal syndrome by means of learning
Beh?et’s disease,
NEXT
Questions
1,Which is the most common form of
Recurrent Aphthous Ulcer? What’s
the characteristic of its lesion?
2,What’s the effect of corticosteroid in
treating oral ulcerative diseases?
3,What’s the primary treatment to
traumatic ulcer?
NEXT
4,Taking major Aphthous ulcer and
carcinoma for example,try to tell the
difference between benign ulcer and
malignant ulcer,
5,What are the oral lesions of Beh?et’s
Disease and Reiter’s Syndrome?
What are their clinical systemic
features?
BACK
