Transcript Introduction - Waxbarashada.com

Introduction
Ulceration of the oral mucosa is a common reason for
patients to seek medical or dental advice. Patients
may report recurrent episodes of oral ulceration,
single episodes of ulceration, or persistent oral
ulceration. Causes of oral ulceration (Table 5.1)
include trauma, recurrent aphthous stomatitis (RAS),
microbial infections (Chapter 4), mucocutaneous
diseases (Chapter 11), drug therapy (Chapter 14),
and squamous cell carcinoma (Chapter 10).
Ulceration due to trauma, RAS, and Behçet's
disease will be discussed in this chapter.
Principal causes of oral ulceration
• Trauma
Recurrent aphthous stomatitis (RAS)
Microbial infections
Mucocutaneous diseases
Systemic disorders
Drug therapy
Squamous cell carcinoma
Traumatic ulceration
Aetiology
• Traumatic ulcers can be due to physical
(mechanical, thermal, electrical) or chemical
trauma. Common causes of mechanical trauma
are sharp, broken down teeth, orthodontic and
prosthetic appliances, and numb lips or tongue
being bitten after a local anaesthetic injection.
• Chemical trauma can be caused by aspirin or
‘toothache’ remedies being placed
directly on the oral mucosa
Clinical features
• Traumatic ulcers are sore, painful to touch,
and tend to have an irregular border with
erythematous margins and a yellow base.
During the healing phase they frequently
develop a ‘keratotic halo’.
Management
• Management involves the elimination of
the suspected cause and use of an
antiseptic mouthwash (for example, 0.2
per cent chlorhexidine) or a simple
covering agent such as OrabaseÂ
• If a putative traumatic ulcer persists for
more than 10–14 days after elimination
of the aetiological factor, then the patient
should be referred for a specialist opinion
and possible biopsy to exclude the
possibility of an oral carcinoma.
Recurrent aphthous stomatitis
• Recurrent aphthous stomatitis (RAS) is the
most common oral mucosal disease
affecting humans and has been reported
as affecting 20–25 per cent of the
general population at any time. A higher
prevalence has been reported in North
American students, particularly at
examination times, and in upper socioeconomic groups. Interestingly, RAS is
infrequently found in Bedouin Arabs
Clinical features
• The clinical features of RAS consist of recurrent
bouts of one or several, shallow, ovoid, painful
ulcers, occurring at intervals of a few days or up
to 2–3 months. Three clinical presentations of
RAS are recognized: minor recurrent aphthous
stomatitis (MiRAS), major recurrent aphthous
stomatitis (MjRAS); and herpetiform ulceration
(HU). The clinical presentation of these types of
RAS are shown in Table 5.2. Patients may
sometimes present with a mixed pattern of RAS
but this is relatively uncommon
Minor recurrent aphthous stomatitis
(MiRAS)
• This is the most common form of RAS and
approximately 80 per cent of patients have
lesions of this type. It is reported that 56 per
cent of the patients are females and that the
peak age of onset of the ulcers is in the
second decade (10–19 years). However,
many patients experience their first ulcers at
an age well outside these limits. Indeed, it is
by no means uncommon to find this form of
ulceration in much younger children
Aetiology of RAS
• The causative factors of RAS are unknown
but are probably multifactorial, with
precipitating systemic, local, microbial, and
genetic factors all being implicated (Table
5.3). ‘Aphthous-like’ ulcers can be
associated with a number of systemic
conditions, but these may not exhibit the
classical behaviour or pattern of RAS
Possible aetiological associations
with RAS
• Trauma
Smoking cessation
Microbial agents
Genetic factors
Stress
Menstruation
Food hypersensitivity
Systemic conditions and
‘aphthous-like’ lesions
• Behçet's disease
Nutritional deficiencies
Gastrointestinal disorders
Cyclical neutropenia
HIV infection
MAGIC syndrome
FAPA syndrome
Drug reactions
Nutritional deficiencies
• Haematinic (iron, folic acid, or vitamin B12)
deficiencies have been reported to be twice as
common in RAS patients as in controls and up to
20 per cent of RAS patients may have a
haematinic deficiency. B-complex deficiency
(B1, B2, and B6) has been reported in a Scottish
cohort of RAS patients and zinc deficiency has
been implicated in a few patients. Replacement
therapy in RAS patients with nutritional
deficiencies has not, however, met with uniform
success
Gastrointestinal disorders
• The association of RAS with coeliac
disease and Crohn's disease is fully
discussed in Chapter 12. The prevalence
of coeliac disease in patients who present
with RAS is now thought to be less than 5
per cent. Patients with established Crohn's
disease frequently report oral ulceration
that is ‘aphthous-likeâ
Neutropenia
• A large percentage of patients with cyclical
neutropenia present with ‘aphthous-like’
ulceration that occurs at intervals (often monthly),
reflecting their neutropenic status. Other
manifestations of neutropenia include fever, malaise,
and susceptibility to bacterial and fungal infections.
Patients who are functionally neutropenic (for
example, those with chronic granulomatous disease
or benign familial neutropenia) are also susceptible
to ‘aphthous-type’ ulceration.
HIV-associated aphthous stomatitis
• These ulcers tend to occur in crops of five
or fewer ulcers, on non-keratinized
mucosa and may resemble minor or major
aphthae. They are frequently very painful
and last for several months. This type of
ulceration can be extremely debilitating in
these patients and can cause problems
with eating. Care must be taken to exclude
cytomegalovirus infection in HIV-infected
patients. In addition, some of the drugs
used to
Other systemic conditions and
factors
• Other systemic conditions associated with
‘RAS-like’ ulceration include MAGIC
(mouth and genital ulcers with inflamed
cartilage) syndrome, FAPA (periodic fever,
aphthous ulcers, pharyngitis, and cervical
adenitis) syndrome, and relative IgA deficiency.
Drugs such as nonsteroidal anti-inflammatory
drugs (NSAIDs), nicorandil, a potassium-channel
activator, and methotrexate have been
implicated in ‘RAS-like’ ulceration
important points in the history
• Age of onset
Family history
Frequency of ulceration
Duration of ulceration
Number of ulcers
Site of ulcers (non-keratinized or keratinized)
Size and shape of ulcers
Associated medical condition(s)
Genital ulceration
Skin problems
Gastrointestinal disturbances
Drug history
Oral ulceration—important
features to be noted
• Number of ulcers
Size and shape of ulcer(s)
Site of ulceration
Edge of ulcer
Base of ulcer
Surrounding tissue
Scarring
Consistency
Investigations for patients with
persistent RAS
• Haemoglobin and full blood count
ESR/CRP
Serum B12
Serum/red cell folate
Anti-gliadin and anti-endomysial
autoantibodies
Layli 1aad
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1-Give A list Of Oral Anatomy
2-What Are the Functions Of Oral Cavity
3-Define Oral Physiology
4-Enamurate Muscles of Mastication and
write Short note Each of them
• 5- Sheeg Gobolka Ugu dagmooyinka
badan uguna Dadka badan Somalia??