1	ORAL ULCERATION AND VESICULLOBULLOUS DISEASE BY : DR.KHURRAM ZAFFAR
2	Oral eptithelium It is stratified sqamous Can be keratinized,para or orthokeratinized even non keratinized. LAYERS: Stratum basale (sinosidal cuboidal cells) Stratum spinosum (irregularly polyhedral cells) Stratum granulosum (flatter and wider cells) Stratum cornium (keratinized squames)
3	Oral eptithelium
4	Oral ulcerations Definition Classification Causes
5	Oral ulceration DEFINITION: Injury to the oral mucosa may result in a localized defect of the surface in which the covering epithelium is destroyed leaving an inflamed area of exposed connective tissue . Such defects or erosions are called ULCERS.
6	Oral ulceration/cont……d CLASSIFICATION Traumatic ulcers Recurrent apthous stomatitis (RAS) Ulcers associated with systemic diseases and vesiculobullous diseases ( Pemphigus ,pemphgoid ,erythema multiforme) (Dermatitis herpetiformis Epidermolysis bullosa ).
7	Oral ulceration/cont……d CAUSES OF ORAL ULCERATION 1. INFECTIVE viral , bacterial , fungal 2. TRAUMATIC Mechanical, chemical, thermal Factitious injury Radiation Eosinophillic ulcer or traumatic granuloma 3. IDIOPATHIC Recurrent aphthous stomatitis Minor aphthous ulcers Major apthous ulcer Herptiform ulcers. Contd…./
8	Oral ulceration/cont……d traumatic ulcers
9	Oral ulceration/cont……d CAUSES/cont…..d
10	RECURRENT APTHOUS STOMATITIS TYPES Minor apthous ulcers Major apthous ulcers Herpetiform ulcers
11	Recurrent apthous stomatitis/cont…d ETIOLOGY The etiology is not basically understood but increasing evidence of damaging immune response is being given. How ever some of the factors are considered to be the cause. 1.Immunological factors 2.hereditary factors 3.Microbiological factors 4.Emotional stress 5.Nutritional deficiencies 6.Allergic disorders. 7.Hematalogical factors. 8.Gastrointestinal factors
12	Recurrent apthous stomatitis/cont…d CLINICAL FEATURES Minor apthous ulcers Prodomal signs begin to appear hour before with burning and tingling. More than 80% May be shallow and round effecting the nonkeratinized part of the oral epithelium Diameter of the ulcers is less than 10mm with red margins. Heal without scarring within 7-10 days. Tend to recur at an interval of 1-4 months Site is usually the tongue ,buccal mucosa soft palate floor of the tongue
13	Recurrent apthous stomatitis/cont…d minor apthous ulcers
14	Recurrent apthous stomatitis/cont…d MAJOR APTHOUS ULCERS Larger than the minor apthous ulcer diameter more than 10mm. Site similar to that of the minor apthous ulcers. Also involve the keratinzed part of the epithelium. They vary in number from 1-10. Take 4-6 weeks to heal. Heal with scarring. Recurs in less than a months time.
15	Recurrent apthous stomatitis/cont…d major apthous ulcers
16	Recurrent apthous stomatitis/cont…d HERPETIFORM ULCERATION Multiple small pinhead size .Each ulcer1-2 mm in size. Can occur at any part of the oral cavity and as many as hundreds of small ulcers may be present. The ulcers are present in the form of clusters or corps and sometime these are joined together to form a very large ulcer. They also heal with scarring. Recur in less than a month time. Associated with extreme pain and discomfort.
17	Recurrent apthous stomatitis/cont…d herptiform ulcer
18	Recurrent apthous stomatitis/cont…d HISTOPATHOLOGY(minor ,major, herptiform) Mononuclear cells are found in the submucously in the pre ulcerative stage These mononuclear cells are the T-4 lymphocytes and are soon out numbered to T-8 lymphocytes as the ulcerative stage develops. Macrophages and the mast cells are also present at the base of the ulcer.
19	Recurrent apthous stomatitis/cont…d TREATMENT(Minor,Major,herptiform) Minor apthous ulcers require no treatment only topical gels are used to minimize the pain ,as the ulcer is self limiting and heals with in7-10 days Anti inflammatory gels and mouth washes are also used to prevent any further infection and to control the inflammation caused by the ulcer For major apthous ulcer topical corticosteriods may be used In extreme severe cases systemic steroids such as prednisilone in doses of 20-40mg daily have shown promise