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1、口腔黏膜课件第1页，此课件共59页哦IntroductionBehets diseaseTraumatic Ulcer&Traumatic BullaRecurrent Aphthous UlcerSummary&QuestionsBACKReiters Syndrome 第2页，此课件共59页哦I.Introduction1.Ulcers are one of the most common types of lesions seen in oral mucosa.2.The difference between ulcer and erosion.NEXT第3页，此课件共59页哦ulcer
2、erosionNEXT第4页，此课件共59页哦ulcererosioncontinuity of epitheliumbroken severesuperficial basal cellsinvolvedfreeborderclearuncleardiseasesRAUBehcets diseaseSyphilis PemphigusHerpes simplex BACKComparison第5页，此课件共59页哦II.Recurrent Aphthous Ulcer1.Preface Name recurrent aphthous ulcer RAU recurrent aphthous
3、stomatitis RAS recurrent oral ulcer ROUNEXT第6页，此课件共59页哦 Typing Lehners classification minor aphthous ulcer（MiAU）major aphthous ulcer（MjAU）herpetiform ulcer（HU）Characteristic recidivity self-healing periodicityNEXT第7页，此课件共59页哦2.Etiology unknown immunity:cellular immunity,humoral immunity,complement,a
4、utoantibody heritage infection：HSV environment:psychologyNEXT第8页，此课件共59页哦 denutrition：iron,copper,zinc,folic acid,Vit B12 hyperoxide dismutase microcirculation disturbance：lip,nail,apex linguae systemic factor：ulceration of stomach、hepatitis、colonitis、diarrhoeaNEXT第9页，此课件共59页哦3.Clinical features min
5、or aphthous ulcer major aphthous ulcer herpetiform ulcerNEXT第10页，此课件共59页哦NEXTMiAUMjAUHUfeatureyellow red concave painful small(2-4mm)big(1-3cm)deep scarmultiple smallcourse7-10 days3-6 weeks7-10 daysnumber 1-51 10positionnonkeratinized oral mucosa soft palatetongue lip mouth floorsystemic symptomlym
6、ph nodes swelling fever headache lymph nodes swelling 第11页，此课件共59页哦Minor aphthous ulcersNEXT第12页，此课件共59页哦NEXT第13页，此课件共59页哦NEXTMiAUMjAUHUfeatureyellow red concave painful small(2-4mm)big(1-3cm)deep scarmultiple smallcourse7-10 days3-6 weeks7-10 daysnumber 1-51 10positionnonkeratinized oral mucosa sof
7、t palatetongue lip mouth floorsystemic symptomlymph nodes swelling fever headache lymph nodes swelling 第14页，此课件共59页哦Major aphthous ulcers NEXT Periadenitis Mucosa Necrotica Recurrens 第15页，此课件共59页哦NEXTMajor aphthous ulcers 第16页，此课件共59页哦NEXTMiAUMjAUHUfeatureyellow red concave painful small(2-4mm)big(1
8、-3cm)deep scarmultiple smallcourse7-10 days3-6 weeks7-10 daysnumber 1-51 10positionnonkeratinized oral mucosa soft palatetongue lip mouth floorsystemic symptomlymph nodes swelling fever headache lymph nodes swelling 第17页，此课件共59页哦Herpetiform ulcers NEXT第18页，此课件共59页哦disease-process24h10d-14doutbreakNE
9、XTintermissionhealingprodromal stageulcerative stage第19页，此课件共59页哦5.Diagnosis history clinical featureNEXT4.Pathology：nonspecific inflammation第20页，此课件共59页哦6.Differential diagnosisbenign ulcer&malignant ulcerNecrotizing sialadenometaplasia,Behets disease,herpes simplex,hand-foot-and-mouth disease NEXT
10、第21页，此课件共59页哦benign ulcermalignant ulcerageyouththe ageddepthdeepDeep or shallowself-healingyesnosystemic conditiongoodcachexypathologychronic inflammationcancerrecurrenceyesnoComparison NEXT第22页，此课件共59页哦7.Treatmentprinciple：symptomatic treatmentEvaluation of curative effectNEXT第23页，此课件共59页哦Topical
11、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 dramatic
12、ally.BACK第24页，此课件共59页哦III.Behets disease1.Preface Hulusi Behet (1937)Behets disease is a chronic multisystemic inflammatory disorder of uncertain cause and prognosis.2.Etiology Unknown NEXT第25页，此课件共59页哦3.Clinical features 1)oral mucosa:minor aphthous ulcer 2)genital lesion:ulcer 3)skin lesions:eryth
13、ema nodosum,epifolliculitis,pustule after needling 4)ocular lesions:conjunctivitis,recurrent iritis 5)others systems:joint,digestive,cardiovascular,nervous,respiratory,urinaryNEXT第26页，此课件共59页哦Behets diseaseNEXT第27页，此课件共59页哦4.Pathology：Histopathologic changes consist of a perivascular mononuclear cel
14、lular infiltrate,endothelial cell swelling or necrosis,partial luminal obliteration and occasional fibrinoid necrosis of the vessels.NEXT第28页，此课件共59页哦5.Diagnosis 1)recurrent oral ulceration 2)recurrent genital ulceration 3)eye lesions 4)skin lesions 5)positive pathergy test To establish the diagnosi
15、s of Behets Disease,recurrent oral ulceration plus any two of the other four major clinical criteria must be present.NEXT第29页，此课件共59页哦6.Differential diagnosisNEXTRAU Herpetic atomatitis Crohns diseaseReiters syndromeStevens-Johnson syndrome第30页，此课件共59页哦7.Treatment Symptomatic in mild cases.Systemic
16、steroids,immunosuppressive drugs,colchicines,thalidomide,and dapsone are administered in severe cases.BACK第31页，此课件共59页哦IV.Traumatic Ulcer Traumatic Bulla1.Preface Because of the constant motion of the masticatory mucosa over the teeth and the introduction of hard objects into the oral cavity,traumat
17、ic ulcers are frequent.NEXT第32页，此课件共59页哦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
18、 base,As2O3,Ag(NO)3,iodophenolNEXT第33页，此课件共59页哦3.Clinical feature1)Decubital ulcer mechanical irritating factors the ulcer conforms in area and linearity to the source of the irritating factorsNEXT第34页，此课件共59页哦NEXTtraumatic ulcer第35页，此课件共59页哦traumatic ulcerNEXT第36页，此课件共59页哦 infants,hard palate impro
19、per feedingNEXT2)Bednar ulcer第37页，此课件共59页哦3)Rida-Fede ulcer infants lingual frenum ulcer secondary to inferior deciduous incisorNEXT第38页，此课件共59页哦4)Factitious ulcer mentally handicapped patients or those with serous emotional problems oral self-inflicted trauma by biting,fingernails,or by the use of
20、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第39页，此课件共59页哦5)Chemical burn the type of chemical utilized,its concentration,and the duration whitish surfacedesquamatingpainful erosion or ulcerbone damag
21、e healing within 1-2 weeksNEXT第40页，此课件共59页哦NEXTchemical burn第41页，此课件共59页哦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 weekNEXT第42页，此课件共59页哦NEXTthermal
22、burn第43页，此课件共59页哦7)Traumatic bulla&traumatic hematoma caused by biting or prosthetic appliances buccal mucosa,soft palate,lips,tongue self-healing in 4-6 days NEXT第44页，此课件共59页哦traumatic bullaNEXT第45页，此课件共59页哦4.Diagnosis historyclinical featuresNEXTcarcinoma,syphilis,tubercular ulcer,major aphthous u
23、lcerthrombocytopenia,thrombastheniapemphigus,cicatricial pemphigoid 5.Differential diagnosis 第46页，此课件共59页哦malignant ulcerNEXT第47页，此课件共59页哦Traumatic ulcerMjAUmalignant ulcertubercular ulceretiologyfeature of ulcermorphology of ulcerpathology5.Differential diagnosisBACK第48页，此课件共59页哦6.Treatment Removal
24、 of the traumatic factorsTopical measures NEXT第49页，此课件共59页哦V.Reiters Syndrome1.PrefaceReiters syndrome is a disease of unknown cause that predominantly affects young men,20-30 years of age.NEXT2.Etiologyunknown第50页，此课件共59页哦3.Clinical feature Major symptoms:nongonococcal urethritis,conjunctivitis,art
25、hritis Other symptoms:oral ulcer,circinate balanitis,keratoderma blennorrhagicumNEXT第51页，此课件共59页哦NEXToral lesion第52页，此课件共59页哦4.Diagnosis history clinical criteriaNEXT第53页，此课件共59页哦5.Differential diagnosis The differential diagnosis the oral lesions includes erythema multiforme,Stevens-Johnson syndrom
26、e,psoriasis,Behets Disease,geographic tongue,and stomatitis.NEXT第54页，此课件共59页哦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第55页，此课件共59页哦Sum
27、mary 1.To compare the characteristics of major Aphthous ulcer,traumatic ulcer,carcinoma and tuberculous ulcer.(etiology,pathology,clinical feature,treatment,prognosis).2.To master the treatment principle of ulcerative diseases by taking RAU for example.NEXT第56页，此课件共59页哦3.To master the effect,usage,c
28、ontraindication and side-effect of corticosteroid in treating ulcerative diseases.4.To establish the conception of oral mucosal syndrome by means of learning Behets disease.NEXT第57页，此课件共59页哦Questions1.Which is the most common form of Recurrent Aphthous Ulcer?Whats the characteristic of its lesion?2.
29、Whats the effect of corticosteroid in treating oral ulcerative diseases?3.Whats the primary treatment to traumatic ulcer?NEXT第58页，此课件共59页哦4.Taking major Aphthous ulcer and carcinoma for example,try to tell the difference between benign ulcer and malignant ulcer.5.What are the oral lesions of Behets Disease and Reiters Syndrome?What are their clinical systemic features?BACK第59页，此课件共59页哦