口腔粘膜病诊断和治疗措施课件.ppt

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 erosion.NEX

2、TulcererosionNEXTulcererosioncontinuity of epitheliumbroken severesuperficial basal cellsinvolvedfreeborderclearuncleardiseasesRAUBehcets diseaseSyphilis PemphigusHerpes simplex BACKComparison Recurrent Aphthous Ulcer1.Preface Name recurrent aphthous ulcer RAU recurrent aphthous stomatitis RAS recur

3、rent 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：HSV environme

4、nt: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 herpetiform ulcerNEXTNEXTMiAU

5、MjAUHUfeatureyellow 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 swelling Minor aphthous ulcersNEXTNE

6、XTNEXTMiAUMjAUHUfeatureyellow 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 swelling Major aphthous ul

7、cers 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 palatetongue lip mouth floorsystemic symptom

8、lymph nodes swelling fever headache lymph nodes swelling Herpetiform ulcers NEXTdisease-process24h10d-14doutbreakNEXTintermissionhealingprodromal stageulcerative stage5.Diagnosis history clinical featureNEXT4.Pathology：nonspecific inflammation6.Differential diagnosis benign ulcer&malignant ulcer Nec

9、rotizing sialadenometaplasia,Behets disease,herpes simplex,hand-foot-and-mouth disease NEXTbenign ulcermalignant ulcerageyouththe ageddepthdeepDeep or shallowself-healingyesnosystemic conditiongoodcachexypathologychronic inflammationcancerrecurrenceyesnoComparison NEXT7.Treatmentprinciple：symptomati

10、c 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 steroid injection or systemic steroids in a low dose(10-20

11、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 features 1)oral mucosa:minor aphthous ulcer 2)genital lesion:

12、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 diseaseNEXT4.Pathology：Histopathologic changes consist of a perivascular mononuclear cel

13、lular 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)eye lesions 4)skin lesions 5)positive pathergy test To establish the diagnosis of Behets D

14、isease,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 syndrome7.Treatment Symptomatic in mild cases.Systemic steroids,immunosuppressive drugs,colchi

15、cines,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 introduction of hard objects into the oral cavity,traumatic ulcers are frequent.NEXT2.Etiology Mechanical fac

16、tors: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 burnsChemical factors:strong acid,strong base,As2O3,Ag(NO)3,iodophenolNEXT3.Clinical feature1)Decubital u

17、lcer mechanical irritating factors the ulcer conforms 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 incisorNE

18、XT4)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 NE

19、XT5)Chemical burn the type of chemical utilized,its 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,u

20、ndergoing desquamation,leaving erosions supportive 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 historyclinica

21、l featuresNEXTcarcinoma,syphilis,tubercular ulcer,major aphthous ulcerthrombocytopenia,thrombastheniapemphigus,cicatricial pemphigoid 5.Differential diagnosis malignant ulcerNEXTTraumatic ulcerMjAUmalignant ulcertubercular ulceretiologyfeature of ulcermorphology of ulcerpathology5.Differential diagn

22、osisBACK6.Treatment Removal of the traumatic factorsTopical 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,ar

23、thritis Other symptoms:oral ulcer,circinate balanitis,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

24、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,tr

25、aumatic ulcer,carcinoma and tuberculous ulcer.(etiology,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 dise

26、ases.n To establish the conception of oral mucosal 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?BACK