Oral ulcers

Dr Vadish Bhat
Professor, ENT
KSHEMA
 Causes of oral ulcers
• Infectious
• Immune mediated
• Traumatic
• Neoplastic
• Dermatologic disorders
• Blood disorders
• Drug allergy
• Vitamin deficiency
• Miscellaneous
 Infections
• Viral infections:
– Herpangina- Coxsackie viral infection, Children
– Herpetic gingivostomatitis- Herpes simplex virus
– Hand foot mouth disease
 Bacterial infections
Vincents infection (Acute
necrotizing gingivostomatitis)
– fusiform bacillus and spirochete-
Borreia vincentii
– Young adults and elderly
– Starts in interdental papillae-
spreads to free margin- gingival
necrosis
– Tonsils- Vincents angina
– Diagnosis- smear examination
– Treatment: Systemic antibiotics-
Penicillin/ Erythromycin
– Mouth wash
• Fungal
– Candidiasis(Moniliasis)-
candida albicans
1) Oral thrush
- grey white patches ;
leaves an
erythematous area
when wiped off
-
Immunocompromised/
imunocompetent
- Topical antfungal
2) Chronic hypertrophic
candidiasis- candidial
leukoplakia
-white patch which cannot
be wiped off
Treatment-excision
 Immune disorders
Aphthous ulcer:
Recurrent, superficial ulcers- tongue, buccal mucosa,
FOM, soft palate
(hard palate and gingiva are generally spared)
Minor form: small 2-10 mm ulcers, multiple with central
necrosis and red halo- heals in about 2 weeks, without
scarring
Major form: big 2-4 cm ulcers, heals with scar
Etiology: unknown
autoimmune process, nutritional deficiency, food
allergy, stress and hormonal alterations
No constitutional symptoms
Treatment: Topical steroid (triamcinolone)
Topical anesthetic agents- lignocaine
Minor
Major
 Behcet syndrome
• Oculo-oro-genital syndrome
– Aphthous like oral ulcers- punched out edges
– Genital ulcers
– Uveitis
 Trauma
• Dental ulcers
– Lateral border of tongue
– Presence of sharp tooth
• Sharp foreign object
• Accidental ingestion of acids/alkali
• Aspirin burn
 Neoplastic
• Carcinoma, Lymphoma
 Dermatological conditions
• Erythema multiforme
• Pemphigus vulgaris
• Benign mucous membrane pemphigoid
• Lichen planus- Reticular/erosive
• Chronic discoid lupus erythematosis
 Blood disorders
• Leukemia
• Agranulocytosis
• Pancytopenia
 Miscellaneous lesions of tongue
• Median rhomboid glossitis
• Geographical tongue
• Hairy tongue
• Fissured tongue
• Ankyloglossia (Tongue tie)
• Fordyce’s spots- Ectopic sebaceous glands
• Nicotine stomatitis
Median rhomboid glossitis Geographical tongue
Fissured tongue Hairy tongue
Tongue tie
 Submucous fibrosis
• Chronic insidious condition characterized by
juxta-epithelial inflammatory reaction and
progressive fibrosis of the submucosal tissues
• As the disease progresses, the jaws become rigid
to the point that the patient is unable to open his
mouth- trismus
• S G Joshi coined the term Submucous fibrosis in
1953
• Etiology: Tobacco, Arecanut, Alcohol, Nutritional
deficiency of Vitamin A, Zinc, antioxidants
Pathogenessis
 Clinical Presentation
• Oral submucous fibrosis is clinically divided into
three stages:
• Stage 1: Stomatitis
• Stage 2: Fibrosis
– a- Early lesions, blanching of the oral mucosa
– b- Older lesions, vertical and circular palpable fibrous
bands in and around the mouth or lips, resulting in a
mottled, marble-like appearance of the buccal mucosa
• Stage 3: Sequelae of oral submucous fibrosis
– a- Leukplakia
– b- Speech and hearing deficits
 Treatment
• Steroids- Submucosal injection-
dexamethasone, triamsinolone
– Combined with hylase
– Repeated injection for 8-10 weeks
• Avoid irritant factors
• Nutritional supplments
• Jaw opening exercises
 Surgical treatment
• Simple release of fibrosis with skin graft
• Bilateral tongue flap
• Nasolabial flaps
• Palatal flaps
• Bilateral Radial forearm free flap
• Surgical excision with buccal fat pad graft
• Coronoidectomy and temporalis muscle
myotomy
 surgeries
Injection Release of fibrotic band
 surgeries
Nasolabial flap Buccal fat
 Trismus
• Lock jaw
• Reduced mouth opening
• Variety of causes
– Temporary- spasm of muscles
– Permanent- pathology in the oral cavity/TM joint
 Causes
• Temporaomandibular joint ankylosis
• Dental causes
• Ulcers
• OSMF
• Malignancy of oral cavity, with infiltration of
muscles of mastication
• Radiotherapy
• Infections-Quinsy
 Grades

• Normal mouth opening: 35 mm- 45 mm (4

finger)
• Mild (grade 1): 20-30 (2-3 finger)
• Moderate(grade 2): 10-20 (1-2 finger)
• Severe(grade 3): <10 (<1 finger)
 Ranula
• Cystic transluscent lesion
seen in the floor of mouth
• Seen on one side of
frenulum, pushing the
tongue up
• Arises from sublingual
salivary gland- ductal
obstruction
• Plunging ranula- extends to
neck
• Treatment: Complete surgical excision/
Marsupialisation, if large
THANK YOU