口腔粘膜病诊断和治疗措施 上海第二医科大学附属 第九人民医院口腔内科精选文档.ppt

Introduction,Behets disease,Traumatic Ulcer&Traumatic Bulla,Recurrent Aphthous Ulcer,Summary&Questions,BACK,Reiters Syndrome,I.Introduction,Ulcers are one of the most common types of lesions seen in oral mucosa.2.The difference between ulcer and erosion.,NEXT,ulcer,erosion,NEXT,BACK,Comparison,Recurrent Aphthous Ulcer,1.Preface Name recurrent aphthous ulcer RAU recurrent aphthous stomatitis RAS recurrent oral ulcer ROU,NEXT,Typing Lehners classification minor aphthous ulcer（MiAU）major aphthous ulcer（MjAU）herpetiform ulcer（HU）Characteristic recidivity self-healing periodicity,NEXT,2.Etiology unknown immunity:cellular immunity,humoral immunity,complement,autoantibody heritage infection：HSV environment:psychology,NEXT,denutrition：iron,copper,zinc,folic acid,Vit B12 hyperoxide dismutase microcirculation disturbance：lip,nail,apex linguae systemic factor：ulceration of stomach、hepatitis、colonitis、diarrhoea,NEXT,3.Clinical features minor aphthous ulcer major aphthous ulcer herpetiform ulcer,NEXT,NEXT,Minor aphthous ulcers,NEXT,NEXT,NEXT,Major aphthous ulcers,NEXT,Periadenitis Mucosa Necrotica Recurrens,NEXT,Major aphthous ulcers,NEXT,Herpetiform ulcers,NEXT,disease-process,24h,10d-14d,outbreak,NEXT,intermission,healing,prodromal stage,ulcerative stage,5.Diagnosis,history clinical feature,NEXT,4.Pathology：nonspecific inflammation,6.Differential diagnosis,benign ulcer&malignant ulcerNecrotizing sialadenometaplasia,Behets disease,herpes simplex,hand-foot-and-mouth disease,NEXT,Comparison,NEXT,7.Treatment,principle：symptomatic treatmentEvaluation of curative effect,NEXT,Topical 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 dramatically.,BACK,III.Behets disease,1.Preface Hulusi Behet(1937)Behets disease is a chronic multisystemic inflammatory disorder of uncertain cause and prognosis.2.Etiology Unknown,NEXT,3.Clinical features 1)oral mucosa:minor aphthous ulcer 2)genital lesion:ulcer 3)skin lesions:erythema nodosum,epifolliculitis,pustule after needling 4)ocular lesions:conjunctivitis,recurrent iritis 5)others systems:joint,digestive,cardiovascular,nervous,respiratory,urinary,NEXT,Behets disease,NEXT,4.Pathology：Histopathologic changes consist of a perivascular mononuclear cellular infiltrate,endothelial cell swelling or necrosis,partial luminal obliteration and occasional fibrinoid necrosis of the vessels.,NEXT,5.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 the other four major clinical criteria must be present.,NEXT,6.Differential diagnosis,NEXT,RAU Herpetic atomatitis Crohns diseaseReiters syndromeStevens-Johnson syndrome,7.Treatment Symptomatic in mild cases.Systemic steroids,immunosuppressive drugs,colchicines,thalidomide,and dapsone are administered in severe cases.,BACK,IV.Traumatic Ulcer Traumatic Bulla,1.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.,NEXT,2.Etiology,Mechanical factors: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,iodophenol,NEXT,3.Clinical feature,1)Decubital ulcer,mechanical irritating factors the ulcer conforms in area and linearity to the source of the irritating factors,NEXT,NEXT,traumatic ulcer,traumatic ulcer,NEXT,infants,hard palate improper feeding,NEXT,2)Bednar ulcer,3)Rida-Fede ulcer,infants lingual frenum ulcer secondary to inferior deciduous incisor,NEXT,4)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,NEXT,5)Chemical burn,the type of chemical utilized,its concentration,and the duration whitish surfacedesquamatingpainful erosion or ulcerbone damage healing within 1-2 weeks,NEXT,NEXT,chemical burn,6)Thermal burn,very hot foods,liquid,or hot metal objects palate,lips,floor of the mouth,tongue painful,red,undergoing desquamation,leaving erosions supportive treatment;self-healing in about a week,NEXT,NEXT,thermal burn,7)Traumatic bulla&traumatic hematoma,caused by biting or prosthetic appliances buccal mucosa,soft palate,lips,tongue self-healing in 4-6 days,NEXT,traumatic bulla,NEXT,4.Diagnosis,historyclinical features,NEXT,carcinoma,syphilis,tubercular ulcer,major aphthous ulcerthrombocytopenia,thrombastheniapemphigus,cicatricial pemphigoid,5.Differential diagnosis,malignant ulcer,NEXT,5.Differential diagnosis,BACK,6.Treatment,Removal of the traumatic factorsTopical measures,NEXT,V.Reiters Syndrome,1.Preface,Reiters syndrome is a disease of unknown cause that predominantly affects young men,20-30 years of age.,NEXT,2.Etiology,unknown,3.Clinical feature,Major symptoms:nongonococcal urethritis,conjunctivitis,arthritis Other symptoms:oral ulcer,circinate balanitis,keratoderma blennorrhagicum,NEXT,NEXT,oral lesion,4.Diagnosis,history clinical criteria,NEXT,5.Differential diagnosis,The differential diagnosis the oral lesions includes erythema multiforme,Stevens-Johnson syndrome,psoriasis,Behets Disease,geographic tongue,and stomatitis.,NEXT,6.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.,BACK,Summary,To compare the characteristics of major Aphthous ulcer,traumatic ulcer,carcinoma and tuberculous ulcer.(etiology,pathology,clinical feature,treatment,prognosis).To master the treatment principle of ulcerative diseases by taking RAU for example.,NEXT,To master the effect,usage,contraindication and side-effect of corticosteroid in treating ulcerative diseases.To establish the conception of oral mucosal syndrome by means of learning Behets disease.,NEXT,Questions,Which is the most common form of Recurrent Aphthous Ulcer?Whats the characteristic of its lesion?Whats the effect of corticosteroid in treating oral ulcerative diseases?Whats the primary treatment to traumatic ulcer?,NEXT,Taking major Aphthous ulcer and carcinoma for example,try to tell the difference between benign ulcer and malignant ulcer.What are the oral lesions of Behets Disease and Reiters Syndrome?What are their clinical systemic features?,BACK,