Immunologic diseases of

oral cavity
-by Saurabh Ahuja
Recurrent Aphthous stomatitis
 Aphthous ulcer; canker
sore
 It is a common disease
 Characterized by
o Development of painful
recurring ulceration
Of the oral cavity
 May be single or multiple
 It is usually confused with
herpes simplex infection
Etiology
Exact etiology : unknown
 The contributing factors are
a. Physical trauma ( abrasive braces)
b. Stress
c. Lack of sleep
d. Immune response
e. Deficiencies( vitamin B12 iron folic acid)
f. Sudden weight loss
g. Food allergies
Clinical factors
 Painful oral ulcers
 Occurs in the mouth or oropharynx region
 Non contagious
 Reoccurs regularly
 10% population affected
 Women are more commonly affected
 30-40% chances of genetic inheritence
 classification

minor major herpeform

Recurrent aphthous ulcer minor

Lesion size – 3-10mm

Erythamatous halo
around it yellow to grey
in color
Pain is severe
Lip swelling present
Usually subsides in 2
weeks
Recurrent aphthous major

Lesion size greater than 10

mm
Extremely painful
Takes up to 30 days to heal
Leaves a scar
 usually Seen after puberty
Movable non keratinized
oral surface
Caused by herpes simplex
virus
Recurrent herpetiform ulcer
Most severe form
Most common in adult females
Lesion size is small ( 1-3mm)
Numerous in number
Heals in under a month without scarring
Differential diagnosis
No herpes simplex virus is found from the lesion
This helps in differentiating it from the herpes
infection
Treatment
Tetracycline mouth wash ( 250mg/5ml) QD for 7 days
Prednisolone ointment
Removal of offending substance( trauma)
Immunosuppressant's in autoimmune cases
Anti inflammatories
Becchet’s syndrome
Becchet’s syndrome
Autoimmune disorder
Auto antibodies are formed against the oral mucosa
It is usually cell mediated
Clinical features
Average age of initiation is 10 - 45 years
Males are more commonly affected ( 5 – 10 %)
Oral or genital or ocular ulcers or skin lesions are found
Oral:
a. Painful ulcers similar to reoccurring aphthous stomatitis
b. Ulcers have Erythematous border with grey exudate
 Genital:
1. Small ulcers found on scrotum and labia majora
 Occular:
I. Begins as photophobia and proceeds to range between a conjuctivitis to
a uveitis and finally hypopyon
 Skin:
i. Small postules and papules are found on the trunk of limbs
Histopathologic features
The features are non specific
No endothelial proliferations are seen
Laboratory findings
Hypergmmaglobulinema
Leucocytosis
Elevated ESR
Treatment
Symptomatic
It regresses itself in few weeks to months
The infection may reoccur after few weeks or months
or years
May also progress to severe form and cause death
Reiter’s syndrome
Reiter’s syndrome
Most common complication of non specific uretheritis
Seen frequently in HIV positive patients
Considered to be an immuno dysregulated condition
Clinical features
Young adult men more commonly affected
Male: female= 9:1
Associated with non gonorrheal uretheritis and
arthritis
conjunctivitis and Mucocutaneos lesion are found
together
Uretheritis is the first sign ( discharge is associated
with a burning / itching feeling)
Arthritis is bilaterally symmetrical and polyarticular
Conjunctivitis is mild
Oral manifestations
Oral lesions: in 5 – 50% cases
Painless red slightly elevated areas
May be granular or vascular
May have a white circinate border on buccal mucosa lips or
gingiva

Palatal lesions : small bright red purpuric spots which

darken and coalesce

Tongue lesions: resemble geographic tongue ( benign

migratory glossitis
Histological features
The findings are not diagnostic
parakeratosis akanthosis and polymorphonuclear
leukocyte infiltration of epithelium is found
Micro abscess formation is seen
Treatment and Prognosis
May undergo spontanneous remission
Treatment plan includes ANTIBIOTICS
CORTICOSTEROIDS
Sarcoidosis
Sarcoidosis
Also called as boeck’s sarcoid
It is a multisystem granulomatous disease
 Characterized: by-
1. Formation of uniform discrete compact and non caseating
epitheloid granuloma
 Blacks are more commonly affected
 Found mainly in young adults
 Presents with:
a) Hilar lymphadenopathy
b) Pulmonary infiltration
c) Skin and eye lesions
Most affected sites
The most affected sites are
1. Lungs
2. Skin
3. Lymph nodes
4. Salivary glands
5. Spleen
6. Bone
 There is a depression of delayed type of
hypersensitivity that Indicates Impaired cell
mediated immunity
Clinical features
Symptoms are not severe so usually go unnoticed
Mild malaise and cough may be present
Involvement of an individual organ leads to its
dysfunction
Cutaneous lesions:
I. Found in 25 -35% cases
II. These are multiple raised red patches occuring in groups
III. These grow slowly
IV. Do not ulcerate
V. Erythema nodosum is found in 15% cases

 Hepatospleenomegaly may be found

Oral manifestations
Lip:
1. Small papular nodules/plaques
2. Also called as fever blissters
 Palate;
I. Diffuse destruction of bone
II. Lesions are : Bleblike containing a clear yellow fluid
present/Solid nodule like structures
Histologic features
Resemble proliferative non caseating nodules of
tuberculosis
No acid fast micro organisms are found in the tissue of
epitheloid cells with multinucleated giant cell are
found
T and B cells may be found
Caseation necrosis absent
Granuloma; solid amorphous eosinophilic hyaline
mass
Angioedema
Angioedema
Also called as ; Angioneurototic oedema
It is diffuse oedematous swelling of soft tissue
( submuonnective taneous and submucosal tissue)
It may be fatal
Pathogenesis
Most common causes are:
a. Allergic angioedema ( mant cell granuloma)
b. Use of angiotensin converting enzyme inhibitors
c. Activation of complement system
 Hereditary
 acquired
Clinical features
Soft and non tender Diffused edematous swelling
Has a very rapid onset
May be solitary or multiple
Found on:
i. Lips
ii. Chin
iii. Larynx
iv. Hands
v. Arms
vi. Eyes
vii. Tongue
viii. Pharynx
 Watery diarrhea present
 Involvement of respiratory system
Clinical features
Lips: puffy
Eyes : swollen
Skin: normal
Periodontium:
periodontal oedema
present
The enlargement usually
resolves within 24 – 72
hours
Treatment
Eliminate causative agent
Use of EPINEPHRINE is indicated
Angioedema is treated by IV injection of corticosteroids
Corticosteroids are also indicated for lesions caused due to
auto antibodies
Disease is dangerous only if oedema of glossitis takes place
Hereditary angioedema are dangerous and at times life
threatening