ALLERGY

Aphthous stomatitis
 disease

solitary or multiple ulcerations

IIIR - herpes simplex infection - no etiologic relationship

L-form of β- hemolytic streptococcus, Streptococcus sanguis

Autoimmune response - oral epithelium

IgG and IgM - spinous layer of oral mucosa
Elevated gamma globulin levels against Streptococcus 2Aand M5
No major one.

Self-inflicted bites, oral surgical procedures, tooth brushing.

Dental- procedures, needle injections and dental trauma."

Premenstrual period/postovulation period/bloodlevelofprogesterone

Menarche/menopause

. Acute psychologic problems

. Asthma, hay fever or food or drug allergies.

 ,

most common 'canker' sore.

more severe form of recurrent aphthous

Age: 10 and 30 years
Sex: women
Frequency of outbreaks – varies between patients

One or more small

Generalized of the oral cavity / tongue

Single or multiple superficial

Paresthesia, malaise, low-grade fever
Lesions – - one to over 100

Size -

Sites –

Buccal and labial mucosa, buccal and lingual sulci,

tongue, soft palate, pharynx and gingiva, all locations of

labile mucosa not bound to periosteum

Ulcers - without scarring.

Large painful ulcers
Occur at frequent intervals

1-10 in

: lips, cheeks, tongue, soft palate and fauces

–
vagina or penis, rectum and larynx, with associated rheumatoid
arthritis or conjunctivitis.
Crops of multiple small, shallow ulcers –

Site: any site in the oral cavity

 on oral mucosa

Small pin head size erosions - gradually enlarge/coalase

Lesions are painful

Lesion – present -1-3 yrs, with short remissions.

Immediate but temporary relief - 2% tetracycline

mouthwash.
 HSV - cannot be by electron
microscopy
Cytologic smears -

microscopic findings identical with recurrent aphthous

ulcer.
Immunofluorescent and serologic techniques -
as well as to oral
epithelium.
Ulcer - fibrinopurulent membrane - superficial colonies of
microorganisms
Epithelial proliferation - at the margins

intense inflammatory cell infiltration –

neutrophils / lymphocytes
necrosis of tissue near the surface of the lesion
Granulation tissue - base of the lesion.

focal periductal and perialveolar fibrosis

ductal ectasia and mild chronic inflammation.
Immune enhancement - Levamisole Vaccine
Immunosuppression, inflammatory suppression
Prednisone, Triamcinaione acetonide, Betamethasone-17-benzoate, Antihistamine
(Tetracycline?)
Antibiotics
Tetracycline suspension, topical Chloramphenicol Broad-spectrum antibiotics
Antiseptic
Silver nitrate, Coagulating agent, negatol Gentian violet (Lactobacillus?)
Diet supplementation
Vitamin B12, folic acid Iron , Zinc sulfate
Symptomatic treatment
Xylocaine/lidocaine
Silver nitrate
Benadryl, topical
Camphor-phenol
uncertain etiology

resemble -
pleuro-pneumonia-like organisms (PPLO) / virus
– autoantibodies against oral mucosa
microorganism cross-reaching the mucosa (antigen)
stimulate
humoral antibody and cell-mediated immune responses
Age:10 and 45 years of age, with a mean age of 30 years,
Sex: males

S/S:
–
painful / IIIr recurrent aphthous ulcers.
crops at any intraoral site
consist of ulcers - size - millimeters to centimeter
Ulcers –
erythematous border - covered by a gray oryellow exudate.
 – photophobia, irritation, conjunctivitis – uveitis
→hypophyon
: various forms of pyoderma
erythema nodosum and erythema multiforme
rthralgia, thrombophlebitis, central
nervous system, cardiac or pulmonary involvement -
Behcet's syndrome, at least two of the classic triad must be
present
ulcers and occuIar inflammation.
similar to recurrent aphthous ulcers
Endothelial proliferation / Vasculitis + Behcet's disease

hypergammaglobulinemia,
leukocytosis with eosinophilia and ↑ESR

. no specific treatment
symptomatic or supportive measures
progress to serious complications and even result in Death.
unknown etiology

Currently - immunodysregulated condition,

disease may be trigered by infectious agents in genetically
susceptible patients
Seen in HIV patients
most common complication - nonspecific urethritis (gonorrhea)
Age: young adult men 20 and 30 years
Sex: male

S/s: :
Non-gonococcal urethritis, Arthritis, conjunctivitis and
mucocutaneous lesions.
– first sign / Urethral discharge - itching, burning sensation
–bilateral, symmetrical, polyarticular
- mild
– keratoderma blennorrhagica
red or yellow keratotic macules / papules -
desquamate
5 to about 50 per cent of patients
Painless, red, slightly
circinate border
- buccal mucosa, lips, gingiva
Palate- small, bright red which darken
and coalase
Tongue - resemble "
Glans penis - circinate balanitis.
not diagnostic.
parakeratosis, acanthosis and polymorphonuclear infiltration
of the epithelium with microabscess (psoriasis)

mild leukocytosis,
an elevated sedimentation rate / pyuria.

spontaneous remission
antibiotics and corticosteroids.
Multisystem granulomatous disease
Unknown origin
Uniform, discrete, compact, non-caseating epitheloid
granulomas
Atypical tuberculosis
 - impaired cell-mediated

immunity

– lymphoproliferation

, circulating immune complexes and serum

inhibitors - contribute to the granulomatous disorder

- granulomatous

inflammation
Common in blacks

Young adults

Lungs, Skin, Lymph Nodes, Salivary Glands, Spleen,

And Bones

S/S - not severe enough to cause alarm

Mild
Involvement of a specific organ / dysfunction of that
organ.
Cutaneous lesions - 25-35 %
Multiple, raised - do not tend to ulcerate or
crust - Erythema nodosum
Lymph nodes or salivary glands -
Hepatomegaly and splenomegaly
 -small, papular nodules / plaques or resembled

herpetic lesions or ‘

mucosa – - clear yellowish

fluid / solid nodules.

diffuse
Resemble proliferative

Nests of epithelioid cells, with multinucleated giant cells

T and B cells
ultimately transforms into a solid, amorphous, eosinophilic,
hyaline mass as it ages

:
Intracutaneous test - Kveim-Siltzbach test
form of sarcoidosis

cranial nerve involvement

Submaxillary /sublingual/lacrimal glands – involved

low-grade fever / lassitude / malaise / GI disturbances / nausea

and vomiting
Xerostomia is common.
 – uveitis / conjunctivitis/ keratitis / corneal

herpes permanent visual impairment

Unilateral or bilateral

Signs and symptoms - disappear in time

Swelling of the parotid glands and visual disturbance

may persist.
unusual condition,
Resembles a serious infection

Wegener’s disease Vs Midline lethal granuloma

arthus phenomenon or periarteritis nodosa

hyperimmune tissues – necrotic

Superficial - palate or nasal septum
Feel of in the nose – preceeds / resemble - carcinoma.
from the palate ↔ nose ↔ outside
Palatal, nasal, and malar bones – -
destruction - prominent feature -
from the eyes and nose
tracts may develop
Nasopharynx ↔ oralcavity - soft tissue sloughaway leaving a directopening.
Death due to exhaustion or of hemorrhage if a large blood vessel
becomes eroded.
Extensive necrosis with inflammatory infiltration

Occasional new capillaries formation

Repeat biopsies - to find neoplastic tissue.

Fatal

Corticosteroid therapy coupled with antibiotics

Best treated by high- dose radiation therapy.

Unknown etiology
Involves - vascular, renal and respiratory systems
nose, paranasal air sinuses, lower respiratory tract, gut,
Joints, nervous system, and kidneys.

Abnormal immune reaction secondary to a nonspecific infection

Hypersensitivity reaction to an unknown antigen.
Hereditary predisposition
Age: any age / fourth and fifth decades of life
Sex: males
multisystem disease
First - development of rhinitis, sinusitis, and otitis or ocular
symptoms.
cough and hemoptysis / fever and joint pains
Hemorrhagic or vesicular skin lesions
Granulomatous lesions of the lungs
Glomerulonephritis → uremia and terminal renal failure.
 .
Rare
Gingiva – strawberry gingiva
Ulcerations, friable granular lesions
Enlargement of gingiva
Starts at interdental papilla – spreads to PDL – bone loss –
tooth mobility
Ulceration of palate - destructive
- resemble aphthae
Diffuse ulceration – exfoliation of teeth – failure of healing of
extraction socket
Anemia
Leukocytosis ESR↑
Hyperglobulinemia Hematuria

Mixed inflammation around blood vessels

Lungs/upper respiratory tract – giant cell necrotizing granulomatous
lesion / vasculitis
Oral tissue – pseudoepitheliomatous hyperplasia
Subepithelial abscess / Scattered giant cells

fatal / cytotoxic agents

uncommon hereditary disease with an X-linked mode of transmission
autosomal recessive characteristic
males
infants and children /young adults

↓ oxidative metabolism
defect of intracellular leukocyte enzymatic function

chemotactic and phagocytic functions of the leukocytes are generally

unimpaired.
lymph nodes, lung, liver, spleen, bone and skin,
eczematous lesions of face → tissue necrosis/granuloma formation.
Abscesses, septicemia, pneumonia, pericarditis, meningitis, and
osteomyelitis

diffuse with or without solitary or multiple .

of permanent teeth - severe early infection.

ulcerated lesions - consisting of small granulomas + mononuclear
histiocytes + multinucleated giant cells.
Central necrosis + polymorphonuclear leukocytes

neutrophil function tests

impairment of in vitro microbicidal activity
failure of reduction of nitroblue tetrazolium (NBT test).

vigorous treatment of the infection.

Angioedema is a diffuse edematous swelling of the soft tissues
commonly involving the subcutaneons and submucosal connective
tissues.
Death occurs – GI / RI involved.

Mast cell degranulation

Associated with use of angiotensin converting enzyme
Activation of the complement pathway
presence of high levels of antigen-antibody complexes
elevated peripheral blood eosinophil counts
manifests as a soft, non-tender, diffuse edematous swelling
rapid onset
solitary or multiple – face, lips, chin, eyes, lips, tongue, pharynx,
larynx
Hands, arms, legs, genitals and buttocks
skin and mucous membrane
Eyes: swollen, shut,
Lips: puffy
Symptoms appear as soon as the patient wakes up in the
morning
Feel tense, itchy/prickly → utricarial swelling
 Skin – normal to pink
Perioral/orbital edema
Enlargement resolves in 24-72 hrs/ few days
Both genders
Children not affected
Hereditary form – dangerous

Elimination of the etiology

Antihistaminics
Drug allergy

Contact stomatitis
Cinnamon
Dental amalgam

Perioral dermatitis