a. What is perio-endo lesion?

According to American Academy of Periodontology (2000) perio-endo lesions are

localized, circumscribed areas of bacterial infection originating from either dental

pulp, periodontal tissues surrounding the involved tooth or teeth or both. Perio-

endo lesions take the form of abscesses and can originate from either or both of

two distinct locations and may be informally sub-classified as follows:

1. Endo-Perio: infection from the pulp tissue within a tooth may spread into the

bone immediately surrounding the tip, or apex, or the tooth root, forming

a periapical abscess. This infection may then proliferate coronally to

communicate with the margin of the alveolar bone and the oral cavity by

spreading through the periodontal ligament.

2. Perio-Endo: infection from a periodontal pocket may proliferate

via accessory canals into the root canal of the affected tooth, leading to

pulpal inflammation. Accessory canals may not be big enough to allow

bacterial penetration; periodontal disease must reach the apex to induce an

endodontic lesion.

Treatment includes conventional endodontic therapy followed by convectional

periodontal therapy. If the lesion is deemed too severe for treatment, the involved

tooth may require extraction.

1
 b. Write on the various causes of mouth ulcers.

Mouth ulcers (also known as canker sores) are normally small, painful lesions that

develop in the mouth or at the base of the gums. They can make eating, drinking,

and talking uncomfortable. Women, adolescents, and people with a family history

of mouth ulcers are at higher risk for developing mouth ulcers. Mouth ulcers are

common and are usually due to trauma such as from ill fitting dentures, fractured

teeth, or fillings.

Mouth ulcers are not contagious and usually go away within one to two weeks.

However, patients with an ulcer of over three weeks’ duration should be referred

for biopsy or other investigations to exclude malignancy or other serious

conditions such as chronic infections. Ulcers related to trauma usually resolve in

about a week after removal of the cause and use of benzydamine hydrochloride

0.15% mouthwash or spray (Difflam) to provide symptomatic relief and

chlorhexidine 0.2% aqueous mouthwash to maintain good oral hygiene

Causes of Mouth Ulcers

There is no definite cause behind mouth ulcers. However, certain factors and

triggers have been identified. These include:

2
  minor mouth injury from dental work, hard brushing, sports injury, or

accidental bite

 toothpastes and mouth rinses that contain sodium lauryl sulfate

 food sensitivities to acidic foods like strawberries, citrus, and pineapples,

and other trigger foods like chocolate and coffee

 lack of essential vitamins, especially B-12, zinc, folate, and iron

 allergic response to mouth bacteria

 dental braces

 hormonal changes during menstruation

 emotional stress or lack of sleep

 bacterial, viral, or fungal infections

Mouth ulcers also can be a sign of conditions that are more serious and require

medical treatment, such as:

 celiac disease (a condition in which the body is unable to tolerate gluten)

 inflammatory bowel disease

 diabetes mellitus

3
  Behcet’s disease (a condition that causes inflammation throughout the body)

 a malfunctioning immune system that causes your body to attack the healthy

mouth cells instead of viruses and bacteria

 HIV/AIDs

Recurrent aphthous stomatitis (aphthae, canker sores): Recurrent aphthous

stomatitis typically starts in childhood or adolescence with recurrent small, round,

or ovoid ulcers with circumscribed margins, erythematous haloes, and yellow or

grey floors. It affects at least 20% of the population, and its natural course is one of

eventual remission. There are three main clinical types:

 Minor aphthous ulcers (80% of all aphthae) are less than 5 mm in diameter

and heal in 7-14 days.

 Major aphthous ulcers are large ulcers that heal slowly over weeks or

months with scarring.

 Herpetiform ulcers are multiple pinpoint ulcers that heal within about a

month.

Some cases have a familial and genetic basis, but most patients seem to be

otherwise well. However, a minority have etiological factors that can be identified,

including stress, trauma, stopping smoking, menstruation, and food allergy.

4
As earlier stated, aphthae are also seen in haematinic deficiency (iron, folate, or

vitamin B-12); coeliac disease; Crohn’s disease; HIV infection, neutropenia, and

other immunodeficiencies; Neumann’s bipolar aphthosis, where genital ulcers may

also be present; and Behcet’s syndrome, where there may be genital, cutaneous,

ocular, and other lesions. The mouth ulcers in Behcet’s syndrome are often major

aphthae with frequent episodes and long duration to healing.

In children, aphthae also occur in periodic fever, aphthous stomatitis, pharyngitis,

and cervical adenitis syndrome. This syndrome resolves spontaneously, and long

term sequelae are rare. Corticosteroids are highly effective symptomatically;

tonsillectomy and cimetidine treatment have been effective in some patients.

Malignant ulcers: Oral carcinoma may present as a solitary chronic ulceration.

Mouth ulcers in systemic disease: Ulcers may be manifestations of disorders of

skin, connective tissue, blood, or gastrointestinal tract. The main skin disorders are

lichen planus, pemphigus, pemphigoid, erythema multiforme, epidermolysis

bullosa, and angina bullosa haemorrhagica (blood filled blisters that leave

ulcerated areas after rupture).

Drug induced mouth ulcers: Among the drugs that may be responsible for mouth

ulcers are cytotoxic agents, antithyroid drugs, and nicorandil.

5
 REFERENCES

American Academy of Periodontology. (2000). Parameter on acute periodontal

diseases. J. Periodontol., 71 (5), 863 – 866. 
Scully, C. & Shotts, R. (2014). Mouth ulcers and other causes of orofacial
soreness and pain. British Medical Journal, 321(1), 162 – 165.