ORAL ULCERATION

Dr Sabeen Fazal
BDS, FCPS(OMFS)
• Definition:
• A breach in the continuity of epithelium
• Injury to oral mucosa may result in a localized defect of the
surface in which covering epithelium is destroyed leaving an
inflammed area of exposed connective tissue
• Parts of an ulcer:
a. margin: regular/irregular, rounded/oval
point where ulcer joins normal epi tissue
b. edge: connects floor to margin
c. floor: one which is seen.
may contain discharge, slough
d. base: the one on which ulcer rests.
bone or soft tissue
• Causes:
• Infective (bacterial, viral, fungal)
• Traumatic (physical, chemical, factitious, radiation)
• Idiopathic (RAS)
• Associated with systemic diseases
Haematological diseases
Gastrointestinal diseases
Behcet syndrome
HIV infections
Other diseases
• Associated with dermatological conditions
Lichen planus
 Vesiculobullous diseases
Chronic discoid lupus erythematosus
• Neoplastic
Squamous cell carcinoma
Other malignant tumors
TRAUMATIC ULCERATION
• Common
• Due to physical trauma
Acute or chronic trauma
sharp objects
accidental or intentional biting
overzealous brushing
• Or chemical trauma
aspirin
• Usually solitary
• Size >1mm to <1cm
• Tender
• Irregular borders, erythematous margins,
yellow base
• Factitious ulcers:
• Due to stress, anxiety, emotional disturbances
• Causes are lip, cheek and tongue biting

• Treatment:
• Elimination of underlying cause
• Antiseptic mouthwash (0.2% chlorhexidine)
• Covering agent (orabase)
• Psychiatric consultation (for factitious ulcers)
RECURRENT APHTHOUS STOMATITIS
• Idiopathic ulcers characterized by frequent reccurances
• Term aphthous is derived from Greek word aphtha which
means ulceration
• Most commonly affects young adults
• Sex: females>males
• High prevalence in students (60%)
ETIOLOGY
CLINICAL FEATURES
• Minor RAS
round/oval ulcers
may be shallow
grey/yellow base, erythematous borders
recur 1-4 months
• Major Ras:
may be associated with severe discomfort
difficulty in eating and speaking
extension is deeper and present as crater like ulcers with rolled
margins
indurated due to fibrosis
recur < 1 month
• Herpetiform:
multiple, small, pinhead ulcers
may form clusters
may cause severe pain and discomfort
recur < 1 month
IMMUNOPATHOGENESIS
• Management:
• History
• Examination
• Investigations
• Treatment
• Minor RAS: no treatment, self limiting
for pain … topical analgesics
• Major RAS: topical steroids
• Severe cases: systemic steroids
• To prevent infection: topical antiseptics
topical antibiotic
BEHCET’S DISEASE