Chapter 1

Today, we’ll study oral mucosal diseases.Chapter 1, I’ll introduce the

most common oral mucosal disease, that is recurrent aphthous ulcer (it’s
shortened form is RAU).What is RAU?it’s a self-confined , ulcerative
lesion of oral mucosa with the characteristic of periodic recurrence ,
occured in the sites of lower- level keratosis.
The incidence of RAU is 20%. RAU was divided into three types. MiAU
is the most commom type.some 80% patients have lesion of this type.
The cause of this disease is not know with certainty, but it is possibly
(likely to)related to immunity, heredity, systematic diseases(especially
gastro-intestinal disease and incretion diseases), infection by virus and
bacteria. some scholar consider RAU is a autoimmune diseases, but it is
controversial at present.and the mechanism that immunological disorder
resulting the disease has been established.
Clinical manifestations:
Gingiva and hard palate are rarely observed. the pseudomembrane is
gray-yellow(fibrous exudates),red margin(inflammation) 、 concave.This
picture shows a typical ulcer.it occurred on the lower lip, it is yellowish,
surrounded by a red margin，with painful feelings.
There are some cases in our clinical .This lesions is located on the top of
tongue, there are three ulcer, they are individual ,not confluent.
In MiAU, healing occurs without scar formation. Following the healing
of the ulcers, there is an ulcer-free internal, which is widely variable. 3-4
weeks is most common, but in a few patients, the reccurence of ulcer
appears to random and in some cases there not be an ulcer-free period
between attacks. the ulcerative episodes overlap in time.
Treatment principles:
Because the etiology is poorly understand ,the treatment is largely
symptomatic and may give considerable relief by shortening the duration
or by reducing the pain. Approaches to the therapy of MiRAU can be
outlined as follows:
1. The maintenance of strict oral hygiene;
2. The use of covering agents. There are many pastes and gels and
creams can be used to form a protective barrier against further second
infection and mechanical irritation.
3. The use of topical antibiotics, to avoid secondary infection.
4. The use of steroids.
5. The use of anaesthetics. it may be used as a last resort, usually be
used before eating a meal.

Chapter 2:
OLP is a common chronic inflammatory diseases of the oral mucosa,
the incidence of the disease is about 0.51%. The buccal、glossal mucosa,
and oral vestibule are the most common locations, however, lesions can
also be found in the hard palate, gingiva and lip.Middle-aged female
people always suffer from this disease.But nowadays,more and more
young people also suffer from this disease.
The etiology of OLP is very complex but there are indications that it
may be assoatied with stress, some systemic diseases, drug and
immunological disorders. In some patients the lesions may disappear
spontaneously.
Typical histological findings as follows:
All tissue specimens showed similar abnormalities. (The epithelium of
the oral mucosa was hyperplastic with acanthotic projections,hyperplasia
was seen in the spinous layer),the epithelium was covered by a
parakeratatic layer. vascular ( 血 管 的 )degeneration of basal cells was
observed and accompanied by typical lymphocyte infiltrate at the
connective tissue.
 OLP has a variety of clinical appearances, reticular, plaque like,
erosive, ulcerative, bullous and atrophic. the reticular form is the most
common and is generally asymptomatic, while the ulcerative and bullous
forms are frequently associated with pain. The dentritic lesions consist of
greyish white, linear, lacelike elevations composed of individual papules
which are usually the size of pinhead. The lesions frequently present
erosion at the sites of frictional trauma .these areas are brightened, and
apt to cause symptoms such as dryness and pain.
( 图解)
 Differential Diagnosis:
(1) Leukoplakia: usually asymmetrical and asymptomatic . A local cause
such as tobacco play a significant role.
(2) White sponge nevus: the disease may be present at birth or appear
during childhood. The oral mucosa is white, thickened and in minute
folds with papillary projections.
(3) P.V: should be differenciated from chronic bullous OLP. but the
lesions tend to heal and reccur, diagnosis is conformed by biopsy.
Treatment
Some articles reported that there is no cure for OLP, but treatment often
relieve pain ,improve the appearance .Topical corticosteroid creams are
effective. In more severe and wide spread cases, lesions respond well to
systemic corticosteroids or intralesional steroid injections.

Chapter 3: white patches(leukoplakia)

 According to WHO,the definition of leukoplakia is that a white patch on
the oral mucosa that can not be wiped away and is not susceptible to any
other clinical diagnosis.some leukoplakia can transfer to cancer. 3 %-5%
of OLK has the potential to become cancer.Clinically, it is one of the
most common oral potentially malignant diseases.
It is clearly established that there are a number of clinically significant
etiological factors which may contribute to the production of oral
leukoplakia. the most important of these is smoking.
A second important etiological factor in the production of leukoplakia is
candidal infection. It has been shown that such lesions are associated with
an increased incidence of malignant transformation (the precise
relationship between the candidal and production of the leukoplakia is not
known).
The histopathologic findings mainly represent the hyperplasia of the
epithelium, accompanied by excessive orthokeratosis and parakerotosis.
Clinical features:
Oral leukoplakia can be divided into homogenous lesions: such as
plaquelike W.P, winkle-like W.P. unhomogenous lesions: verruciform
W.P, granular W.P and ulcerative W.P .we’ll introduce one by one.
These three pictures shows plaquelike white patch, it is homogenous,
grey-white, had a soft-texture and usually painless. winkle-like white
patch has a rough surface, clear boundary line, mucosa around it is
normal. It is grey white or chalk. verruciform white patch is milk white,
thick and protrusive, roughand hard. It usually appears in the alveolar
ridge, lip, palate and floor of mouth. Granular W.P ,that is
erythroleukoplakia. The patches of erythroleukoplakia is interspersed
with leukoplakic lesions. It is most often seen on the buccal mucosa near
the mouth corner. The picture is of ulcerative form, infact, it has been
transform to cancer.
This is a typical hairy leukoplakia of AIDS patients.
Diagnosis:
According to clinical feature and biopsy,easy to give a diagnosis.W.P is
belong to precancerous lesion, the following may suggest cancerous
transformation.
Treatment principles:Remove the stimulating factor, such as smoking.
Remove keratinization:Smear Vit paste in the local area or take Vit orally
(VitE and VitA);improve the resistance of epithelial mucosa
;Use antifungal agent topically;Close follow-up, preventing cancer
Operation
手 术 ： is not preferred. because after the operation, recurrence is not
completely avoided.

Chapter4:
These disease is infected by fungus, a majority of the fungus is candida
albicans. Many microorganisms live in the mouth, thrush occurs when
the normal balance of the organisms is upset (of disorder). this allows an
overgrowth of candia to occur.
It is sometimes seen in children and also in adults with poor fitting
dentures, taking excessive broad-spectrum antibiotics or oral steroid or
suffering from diabetes or from depressed immune system.This picture
represent the pseudohyphae and true hyphae of the candia albicans.
The clinical features of thrush can be described in a word: white,
creamy patches appear on red spots when forcibly srcaped off.
From this picture .we can see the clinical features of thrush. creamy-
white can be observed on the lip and tougue.the creamy-white patches
on the soft palate and uvala.
This two HIV patient presented with a secondary opportunistic oral
candidiosis infection.
Diagnosis of thrush according as follows:
(1) history
(2) typical clinical appearance easy to give a diagnosis
(3) microscopic study of smears from lesions
(4) direct candia culture.
But sometimes the lesions is not typical ,3,4can help us to give a
diagosis.
Treatment Principles:
1. eliminate the predisposing factors
2. the use of topical and antifungal agents: such as 2%-4%NaHCO3;
Nystatin, fluconazole
3. Enhance immunity( This diagram give a suggest for treating oral
candidiasis in developing countries. the crucial step(measure) is
prevention and education, including three aspects,1,2,3

Chapter 5:
We’ll introduce another infective disease—herpetic stomatitis. herpetic
stomatitis is caused by the herpes simplex virus.
A developed herpetic stomatitis mainly affects patients in two main age
group: young child and young adults.the developed of the disease will
come through four stage:1,2,3,4. In the prodromal , the initial-stage
symptoms are of malaise with tiredness, generalized muscle aches, and
sometimes a sore throat. This prodromal phase may be lasted a day or
two. In the vesicle stage , groups of vesicles appear on the oral mucosa
and sometimes circumoral skin.but the vesicle breaddown rapidly to
produce shallow ulcers.with the progress of the disease,the individual
ulcer may shape a large areas of ulceration.. the whole period of the
disease may be expected to last 7-10dayds.
( 图 解 ) this picture shows a typical herpetic stomatitis. we can see oral
and circumoral lesions. on the circum skin, we can see some vesicles.but
at this location, this ulceration has been confluent and be coverd with
scrab.this lesions is in the condition of vesicle stage and we can see the
red and swelling gingiva.
The lesions at the lower lip, the corner of the mouth and the dorsum of
the tougue.
This lesion is located on the soft palate, the multiple vesicles has
ruptured and left behind redding shallow ulcerations and there is a
secondary candidal infection.
This is a patient who has lesions involing the mouth and lips.
This picture shows a recurrent herpes. the disease usually be located at
the labium and circum-labial skin.Catching a cold is the most common
inducement(predisposing factor).
The marked erythema and enlargement of the gingiva is typically seen in
the primary herpes in this picrure.this must be distinguished from
necrotizing ulcerative gingivitis. Generally this can be distinguished by
noting the absence of necrosis of the interdental papillae.
Treatment:
1. antivirus: acyclovir
2. topical agent
3. Chinese medicine
4. improve immunity:To those patient who suffer from periodic recurrent
herpes or to the severe cases.

Chapter 6: PV
Pemphigus is an severe acute or chronic skin-mucosa disease , of the
several types of the condition, pemphigus vulgaris is the most common.
At present, it has been suggested that P.V is an autoimmune disease.
before the use of the steroid,t here has a high death rate.
Characteristic pathologic findings: 见幻灯
Acantolysis, intraepithelial vesicles are the pathognomotic changes, the
basal layer remain attached to be connective tissue. The characteristic
feature is of primary bullous lesions in the mucosal membrane. this is a
typical bullous lesions, but the thin-walled bullae has been ruptured. the
wall of the bullae can be easily wiped off and leaving a raw red
ulcerations. the boundary is clear. this a primary ruptured bullae on
gingiva, wiped off the wall of the bullae, we can see red spot. this lesion
is on the dorsum of the tongue/on the palate, the ulceration is covered
with pseudomembrance.
In clinical work, before giving a diagonosis,we must do a special work-
N.S The positive (Nikolsky’s sign) show the loss of epithelium by
rubbing of the normal epithelium in appearance. In the condition of P.V
.there is a positive N.S.
Treatment and prognosis:
The livability for ten years is 95% or so.