口腔粘膜病诊断和治疗措施课件整理.ppt

1、IntroductionBehets 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 erosion.NEXTulcererosionNEXTulcererosioncontinuity of epithel

2、iumbroken severesuperficial basal cellsinvolvedfreeborderclearuncleardiseasesRAUBehcets diseaseSyphilis PemphigusHerpes simplex BACKComparison Recurrent Aphthous Ulcer1.Preface Name recurrent aphthous ulcer RAU recurrent aphthous stomatitis RAS recurrent oral ulcer ROUNEXT Typing Lehners classificat

3、ion 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：HSV environment:psychologyNEXT denutrition：iron,copper,zinc,fol

4、ic 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 herpetiform ulcerNEXTNEXTMiAUMjAUHUfeatureyellow red concave painful small(2-4m

5、m)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 swelling Minor aphthous ulcersNEXTNEXTNEXTMiAUMjAUHUfeatureyellow red concave painful

6、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 swelling Major aphthous ulcers NEXT Periadenitis Mucosa Necrotica Recurrens

7、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 palatetongue lip mouth floorsystemic symptomlymph nodes swelling fever headache lymph nodes sw

8、elling Herpetiform ulcers NEXTdisease-process24h10d-14doutbreakNEXTintermissionhealingprodromal stageulcerative stage5.Diagnosis history clinical featureNEXT4.Pathology：nonspecific inflammation6.Differential diagnosis benign ulcer&malignant ulcer Necrotizing sialadenometaplasia,Behets disease,herpes

9、 simplex,hand-foot-and-mouth disease NEXTbenign ulcermalignant ulcerageyouththe ageddepthdeepDeep or shallowself-healingyesnosystemic conditiongoodcachexypathologychronic inflammationcancerrecurrenceyesnoComparison NEXT7.Treatmentprinciple：symptomatic treatmentEvaluation of curative effectNEXTTopica

10、l 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 dramat

11、ically.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 features 1)oral mucosa:minor aphthous ulcer 2)genital lesion:ulcer 3)skin lesions:erythema nodosum,epifolliculi

12、tis,pustule after needling 4)ocular lesions:conjunctivitis,recurrent iritis 5)others systems:joint,digestive,cardiovascular,nervous,respiratory,urinaryNEXTBehets diseaseNEXT4.Pathology：Histopathologic changes consist of a perivascular mononuclear cellular infiltrate,endothelial cell swelling or necr

13、osis,partial luminal obliteration and occasional fibrinoid necrosis of the vessels.NEXT5.Diagnosis 1)recurrent oral ulceration 2)recurrent genital ulceration 3)eye lesions 4)skin lesions 5)positive pathergy test To establish the diagnosis of Behets Disease,recurrent oral ulceration plus any two of t

14、he other four major clinical criteria must be present.NEXT6.Differential diagnosisNEXTRAU Herpetic atomatitis Crohns diseaseReiters syndromeStevens-Johnson syndrome7.Treatment Symptomatic in mild cases.Systemic steroids,immunosuppressive drugs,colchicines,thalidomide,and dapsone are administered in

15、severe cases.BACKIV.Traumatic Ulcer Traumatic Bulla1.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.NEXT2.Etiology Mechanical factors:a sharp or broken tooth,rough fillings,clumsy

16、 use of cutting dental instruments,hard foodstuffs,sharp foreign bodies,biting of the mucosa,and denture irritation etc.Physical factors:thermal burnsChemical factors:strong acid,strong base,As2O3,Ag(NO)3,iodophenolNEXT3.Clinical feature1)Decubital ulcer mechanical irritating factors the ulcer confo

17、rms in area and linearity to the source of the irritating factorsNEXTNEXTtraumatic ulcertraumatic ulcerNEXT infants,hard palate improper feedingNEXT2)Bednar ulcer3)Rida-Fede ulcer infants lingual frenum ulcer secondary to inferior deciduous incisorNEXT4)Factitious ulcer mentally handicapped patients

18、 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 NEXT5)Chemical burn the type of chemical utilized,it

19、s concentration,and the duration whitish surfacedesquamatingpainful erosion or ulcerbone damage healing within 1-2 weeksNEXTNEXTchemical 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

20、 treatment;self-healing in about a weekNEXTNEXTthermal burn7)Traumatic bulla&traumatic hematoma caused by biting or prosthetic appliances buccal mucosa,soft palate,lips,tongue self-healing in 4-6 days NEXTtraumatic bullaNEXT4.Diagnosis historyclinical featuresNEXTcarcinoma,syphilis,tubercular ulcer,

21、major aphthous ulcerthrombocytopenia,thrombastheniapemphigus,cicatricial pemphigoid 5.Differential diagnosis malignant ulcerNEXTTraumatic ulcerMjAUmalignant ulcertubercular ulceretiologyfeature of ulcermorphology of ulcerpathology5.Differential diagnosisBACK6.Treatment Removal of the traumatic facto

22、rsTopical measures NEXTV.Reiters Syndrome1.PrefaceReiters syndrome is a disease of unknown 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 balani

23、tis,keratoderma blennorrhagicumNEXTNEXToral lesion4.Diagnosis history clinical criteriaNEXT5.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 nonspe

24、cific 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.(eti

25、ology,pathology,clinical feature,treatment,prognosis).n To master the treatment principle of ulcerative diseases by taking RAU for example.NEXTn To master the effect,usage,contraindication and side-effect of corticosteroid in treating ulcerative diseases.n To establish the conception of oral mucosal

26、 syndrome by means of learning Behets disease.NEXTQuestionsn Which is the most common form of Recurrent Aphthous Ulcer?Whats the characteristic of its lesion?n Whats the effect of corticosteroid in treating oral ulcerative diseases?n Whats the primary treatment to traumatic ulcer?NEXTn Taking major Aphthous ulcer and carcinoma for example,try to tell the difference between benign ulcer and malignant ulcer.n What are the oral lesions of Behets Disease and Reiters Syndrome?What are their clinical systemic features?BACK59谢谢！谢谢！60