Oral ulceration

Oral Ulceration

By:
Dr. Ahmed Salih KhudhurBDS, MSc, PhD Newcastle University/ UK
دكتور احمد صالح خضر

UNIVERSITY OF MOSUL

COLLEGE OF DENTISTRY
2020-2021
Department of Oral and Maxillofacial Surgery
Department of:
HERE


Cyclic Neutropenia
• Clinical manifestations:The major signs and symptoms of cyclic neutropenia attributed to infections occurring during neutropenic episodes.
• The most common signs are:1. Fever2. Stomatitis (oral ulceration) and periodontal diseases3. Pharyngitis4. Skin abscessesThe severity of the infections is related to the severity of the neutropenia.
• Oral manifestations: Oral lesions are common in cyclic neutropenia and might be the major clinical manifestation of the disease.
• The two most common oral manifestations are oral ulcers and periodontal diseases.

Cyclic Neutropenia

Aggressive periodontitis in 10-year-old boy with cyclic neutropenia, Note the severe swelling and inflammation of the marginal and papillary gingiva. There is gross migration of teeth caused by a loss of bone support.
Panoramic radiograph demonstrating severe bone loss around all permanent teeth that have erupted.

Erythema Multiforme

• Erythema multiforme (EM)
In patients presenting to dentists, oral lesions may be the only sign.
EM is one of the few causes of recurrent oral ulceration and also produces blisters.
In general, EM is classified into: EM minor EM major
Other forms of EM known as Stevens–Johnson syndrome (SJS) and Toxic epidermal necrolysis (TEN) (Lyell disease).

Erythema Multiforme

Cutaneous target lesions (Iris, Bulls’ Eye)

Erythema Multiforme

Ulceration of the vermilion of the lip with bleeding, swelling and crusting is characteristic.

Erythema Multiforme

There is ulceration, erythema, sloughing of epithelium and a small vesicle centrally. The anterior part of the mouth and the lips are typically affected.




Erythema Multiforme
Intraoral erythema multiforme with coalescent aphthous-like ulcers and erythema of the buccal mucosa

Erythema Multiforme

Erythema multiforme with target lesions on the skin of the fingers and intraoral ulcers.

Stevens-Johnson Syndrome & Toxic Epidermal Necrolysis

•

Stevens-Johnson Syndrome

Lips and labial mucosa lesions in a 17-year-old male with Stevens–Johnson syndrome.

Toxic Epidermal Necrolysis

•

Miscellaneous oral ulcers

Other types of ulcers might present in the oral cavity associated with/or as the main manifestation of local (oral) or systemic diseases

Such as:

Pemphigus & Mucous Membrane Pemphigoid
Oral cancer
Ulcers associated with: Oral mucositis
Xerostomia & Sjögren’s syndrome
Diabetes Mellitus
Renal failure
Others

Miscellaneous oral ulcers

Non-painful, irregular, indurated exophytic and ulcerated buccal mass histolpathology revealed squamous cell carcinoma.

Miscellaneous oral ulcers

Advanced squamous carcinoma.
The classical ulcer with a rolled border and central necrosis is a late presentation.


Note the surrounding areas of keratosis and erythema which had been present for many years before the carcinoma developed.

Oral Ulceration

Conclusion:
The basic principles for the management of oral ulcers in general: 6 Stars

1.Early diagnosis

2.Relief pain
3.Remove cause
4.Isolate the ulcer
5.Reduce inflammation promote healing
6.Cure if Possible

THE END

UNIVERSITY OF MOSUL

COLLEGE OF DENTISTRY
2020-2021