aphthous ulcer

PRESENTED BY – DR.ManjulaMuthurajmanju

SYNONYMS -

RECURRENT APHTHOUS STOMATITIS

APHTHAECANKER SORES

manju

The term "aphthous"

Greek word "aphtha"

ulceration.

manju

CANKER

LATIN WORD

CANCER

BUT NOT A TYPE OF CANCER

DEFINITION

It is a most common disease charecterized by the development of painful,recurring ,solitary or multiple ulcerations of the oral mucosa.

manju

ETIOLOGYBACTERIAL INFECTION- a pleomorphic transitional L-form of an α-hemolytic streptococci,streptococcus

sanguis play a significant role.

IMMUNOLOGIC ABNORMALITIES

Iron, vitamin B12, folic acid deficiency

TRAUMA- due to self –inflicted bites,oral surgical procedures,tooth brushing,dental procedures,needle

injections,dental trauma

ENDOCRINE CONDITION-during premenstrual period and at postovulation period.

ALLERGIC FACTORS-hay fever,asthma,drug/food allergy.

manju

SURBHI

PATHOGENESIS

PRIMARY IMMUNO

DYSRETIONGULA

REDDUCTION OF CD4 + T LYMPHOCYT

E

DECREASE IN MUCOSAL BARRIER

TRAUMA

NUTRITIONAL DEFICIENCY

INCREASE IN ANTIGENIC EXPOSURE

↑ CYTOTOXIC DESTRUCTIO

N OF MUCOSA

TYPES

manju

SURBHI

CLINICAL FEATURESRECURRENT APHTHOUS MINOR

AGE-10-30yr GENDER-women>men SITE-common on non-keratinized mucosa e.g –buccal

&labial mucosa,buccal & lingual sulci,tongue,soft palate,pharynx,gingiva.

APPEARANCE-begins as a single or multiple superficial erosions covered by greyish – white removable fibrinopurulent membrane encircled by erythematous halo.

SIZE-2-3 mm to 10 mm in diameter. Persist for 7-14 days & heal without scarring.

MINOR APHTHOUS ULCER

Area of ulceration with surrounding erythema present on movable mucosa of left maxillary muco-buccal fold.

manju

MINOR APHHOUS ULCER.

manju

RECURRRNT APHTHOUS MAJOR

Previously it represent a separate disease entity k/n as periadenitis mucosa necrotica recurrens (mikulicz’s scarring aphthae or sutton’s disease)

It is now regarded as severe expression of aphthous stomatitis.

COMMON SITE- lips,cheeks,tongue,soft palate,fauces,cause severe pain & dysphagia.

Also involve keratinized mucosa INCIDENCE – common in HIV patient. SIZE – Larger than the minor apthous ulcer diameter more

than 10mm.manju

Continued......

NO.-1-10 in no.Takes 4-6 weeks to heal.Heal with scarringRecurrs in less than a month time.APPEARANCE- extend deeper and may present

as crater-like ulcers with rolled margins which are indurated on palpation because of underlying fibrosis.

manju

manju

MAJOR APHTHOUS ULCER

MAJOR APHTHOUS ULCER

manju

RECURRENT HERPETIFORM ULCERS

manju

Clinical features

SITE- any intra oral siteSIZE-1-3 mm in diameterAPPEARANCE – charecterized by crop of

small,shallow ulcers ,that may be joined together and form large ulcer.

No. – 10 – 100Healing occur in 1 to 2 weeks.Heal with scarring.Lesions persist for 1 to 3 year,with short remissions

manju

RECURRENT HERPETIFORM ULCERATIONS

manju

CONTRASTING FEATURES

MINOR MAJOR HERPETIFORM

SIZE <0.5 cm >0.5 cm <0.5 cm

SHAPE Oval Ragged oval,crateriform

oval

NUMBER 1-5 1-10 10-100

LOCATION Non-keratinized mucosa

Non-keratinized mucosa

Any intra oral site

TREATMENT Topical corticosteroids,tetracycline mouthrinse

Topical/systemic/intralesionalcorticosteroids, immunosuppressives

Topical/systemiccorticosteroids, tetracyclinemouthrinse

manju

HISTOPATHOLOGY

Central zone of ulceration.

Fibrinopurulent membrane covers the

ulcer.

Inflammatory cells –

neutrophils and lymphocytes seen in C.T

CYTOLOGICAL SMEAR• Anitschkow

cells.

manju

manju

ANITSCHKOW CELL

SURBHI