also known as canker sores
recurrent aphthaous ulcerations
waht causes recurrent aphthaous ulcerations
-unknown pathogenesis, immune-mediated process
who is the most likely to get recurrent aphthalous ulcerations
-children and young adults
what are the possible triggers of recurrent aphthaous ulcerations
-stress, local trauma, menstrual cycle
what are the three clinical variations of recurrent aphthous ulcerations
most commone form of recurrent aphthous ulcerations
minor aphthous ulcerations
what is the duration of minor aphthous ulcerations?
fewest recurrences and shortest duration of lesions
where do minor aphthous ulcerations occur/
EXCLUSIVELY on nonkeratinized mucosa
-buccal and labial mucosa, ventral tongue, floor of mouth and soft palate
what is the clinical signs of minor aphthous ulcerations?
1-5 PAINFUL ulcers, preceeded by erytheatous macule
What is the healing process like for minor aphthous ulcerations?
heal WITHOUT scarring 7-10 days
what is the rate of recurrence for minor aphthous ulcerations?
larger than minor aphthous ulcers that are 1-3 cm in diameter that have 1-10 lesions per episode
major aphthous ulcerations
*NO RED HALO
what is the healing process like for major aphthous ulcerations?
longer duration per episode than minor, heal in 2-6 weeks often WITH scarring
what are the most common sites for major aphthous ulcerations?
- labial mucosa
- soft palate
- tonsillar fauces
what is unique about herpetiform aphthous ulcerations?
- greatest number of lesions and most frequent recurrences
- rarely have time period where pt does not have ulcers
- ANY oral mucosal surface
- individual lesions small (1-3mm) with many present per episode
what does herpetiform aphthous ulcerations resemble?
superficial resemblence to primary HSV
what is the healing process for herpetiform aphthous ulcerations?
heal in 7-10 days but recurrences tend to be closely spaced
what is the major difference between primary herpes and herpetiform aphthae?
primary herpes = systemic symptoms
herpetiform aphthae = no systemic symptoms
what is the tx for recurrent aphthous ulcerations?
respond well to TOPICAL high - potency corticosteroids
*applied early in course of disease; thin film, multiple times per day
MULTISYSTEM disorder with oral aphthous-like ulcerations that has its highest prevalence in Middle East and Japan (much less frequency in US)
what is the classic triad of Bechet’s syndrome
- oral ulcerations
- genital ulcerations
- ocular disease
oral involvement of Bechet’s disease
- first manifestation in 75% of cases
- occurs in 99% of cases
- commonly involves soft palate and oropharynx
- variable size, ragged borders, large zone erythema
genital ulcerations of Bechet’s disease
similar in appearance to oral ulcerations
-occur in 75% of cases
ocular disease of Bechet’s disease
- occur in 70-85% of cases
- posterior uveitis
how do you dx Bechet’s disease?
-clinical presentation and positive pathergy test
what is the tx for Bechet’s disease?
topical or systemic immunosuppressive or immunomodulatory therapy, early aggressive therapy for severe cases
what is the px for Bechet’s disease/
what causes orofacial granulomatosis?
unknown etiology, appears to represent an abnormal immune reaction
who is affected by orofacial granulomatosis the most?
what is the clinical presentation of orofacial granulomatosis?
non-necrotizing granulomatous infammation, presenting as persistent non-tender swelling
what is the location for orofacial granulomatosis?
lips most common site, may involve ANY oral mucosal or perioral location
type of orofacial granulomatosis taht is involvement of the lips alone?
type of orofacial granulomatosis that involves:
- non-tender lip swelling
- bell’s palsy
- fissured tongue
what is the tx for orofacial granulomatosis?
- thorough medical eval
- remove source of inflammation
- INTRALESIONAL CORTICOSTEROIDS work best
- multiple injections may be necessary
what is the px for orofacial granulomatosis?
granulomatosis that has polyangitis?
is wegner’s granulomatosis common?
no but it is well-recognized
where does wegner’s granulomatosis affect?
- upper airway
how serious is wegner’s granulomatosis?
condition was uniformly fatal prior to development of current tx modalities
type of wegner’s granulomatosis that involves the upper and lower respiratory tracts and kidneys
generalized wegner’s (classic wegner’s)
type of wegner’s granulomatosis that affects the upper and lower respiratory tract only
type of wegner’s granulomatosis that affects the lesions of primarily skin and mucosa
what is wegner’s granulomatosis characterized by?
what are the two lab studies that can be used for wegner’s granulomatosis?
c-ANCA (cytoplasmic) = most useful
p-ANCA (perinuclear) = also seen in systemic vasculitidies
what could happen to limited and superficial forms of wegner’s granulomatosis?
progress to classic wegner’s granulomatosis
what is the clinical appearance of an allergic reaction to systemic drug/
oral mucosa ulceration and erosion with variable erythema and white stripes
what re the most common sites for allergic reaction to systemic drugs
- buccal mucosa
- labial mucosa
- ventro-lateral tongue
inflammatory alterations that recur at the same site after the administration of a medication
fixed drug eruption
medication induced mucosal alterations which mimic appearance of lichen planus
lichenoid drug reaction
how do you dx an allergic rx to systemic drugs
- biopsy (non-specific)
- detailed medicinal and clinical history
- serial elimination of the medications
- mucoal alterations resolve after discontinue meds (recur on reintroduction)
what is the tx for allergic reaction to systemic drugs
discontinue responsible meds in conjunction with pt physician +/- topical corticosteroids
mild/barley visible erythema to extensive erythema, edema, erosions, ulcerations, and exfoliations
allergic contact stomatosis
*may be asymptomatic (burning, itching, stinging)
how do you dx allergic contact stomatosis?
- ID of temporal relationship between contact with agent and oral changes
- patch testing (insert antigens under skin)
what are the three aspects of allergic contact stomatosis?
- dentrifice-realated sloughing
- oral mucosal cinnamon reaction
- lichenoid amalgam reaction
what is dentrifice-related sloughing that is associated with allergic contact stomatosis?
- toothpaste can cause widespread desquamation of the superficial layers of epithelium
- minimal/mild erythema
- associated with sodium lauryl sulfate
what is the tx to dentrifice-related sloughing
no tx necessary, harmless process
-switching to a bland toothpaste will result in resolution
what is oral mucosal cinnamon reaciton associated with allergic contact stomatosis?
- contact reaction to artificial cinnamon flavoring
- clinical distribution varies by medium of delivery
- -toothpaste: diffuse, gingiva
- -chewing gum/candy: localized
what are the cliinical signs of oral mucosal cinnamon reaction
- erythema with overlying shaggy hyperkeratosis
- pain and burning are common symptoms
what is the tx of oral mucosal cinnamon rxs
resolution within one week following discontinuation of the cinnamon product
what is a lichenoid amalgam reaction associated with allergic contact stomatosis?
associated with old amalga resotrations undergoing corrosion and release of metallic ions
where does lichenoid amalgam reactions occur?
limited to mucosal surfaces directly in contact with the resotration
what does the clinical presentation of lichenoid amalgam reactions look like?
may be white or erythematous, +/- peripheral striae
what is the tx of lichenoid amalgam reations?
- smooth, polish, recontour old amalgam
- replace amalgam with non-metallic resotration
diffuse edematous swelling of soft tissue
what three things cause angioedema?
- IgE mediated hypersensitivity reaciton (most common)
- angiotension-converting enzyme (ACE) inhibitors
- C1 esterase inhibitor deficiency
what are the clinical features of angioedema?
- relatively rapid onset of soft tissue swelling
- non-painful, pruitus and erythema may be seen
- solitary or multiple sites of involvement
- commonly affects head and neck region
- resolution in 24-72 hrs
how do you dx angioedema?
- clinical presentation (trigger)
- eval of C1-INH
what is the tx of angioedema?
- oral antihistamine, IV corticosteroids
- ACE inhibitor related and C1-INH deficiency non-responsive to standard tx