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Traumatic Ulcers
Very common
Supportive history usually present
Varying degrees of pain
Acute or chronic
Usually short term (10-14 days)
A non-healing ulcer must be biopsied
Aphthous Ulcers
Reportedly affect 50% of population
Often found at sites of trauma
Usually acutely painful
Freely-movable mucosa
Often 0.5 -1.0 cm in diameter
Usually 1-3 ulcers
Respond to topical steroids
Aphthous Ulcers
Acutely painful
Supportive history (may be chronic)
Yellow-gray-tan pseudomembrane
Inflammatory halo
Aphthous Ulcers
No single causative factor identified
T-cell mediated immune reaction
Biopsies indicate pre-dominance of T
lymphocytes
Suggests antibody-dependent cellular
cytotoxicity
Aphthous Ulcers
Allergies
Trauma
Stress
Familial (genetic predisposition)
Nutritional deficiencies
Hematologic disorders
Infectious agents (HIV)
Aphthous Ulcers
Minor variant
Major variant
Herpetiform aphthous stomatitis
Pseudo-Aphthous Ulcers
Often require medical consultation
Inflammatory or autoimmune bowel
disorders
Cyclic neutropenia
Nutritional deficiencies
IgA deficiency
Immunocompromised/suppressed
MAGIC and PFAPA syndromes
Rx Decadron (dexamethasone)
elixir 0.5 mg/5 ml
Disp: 8 oz
Sig: Rinse and expectorate with 1
tblspoon exilir 3-4 times per day
Rx Kenalog in orabase
(triamcinalone 0.1% in oral paste)
Disp: 15 gram tube
Sig: apply sparingly to oral ulcer 2-3
times per day
Rx Temovate (clobetosol
propionate) ointment 0.05%
Disp: 15 gram tube
Sig: apply sparingly to oral ulcer 2 x
per day for no more than 2 weeks
Herpes Viruses
HSV1
HSV2
Varicella-zoster virus (HHV-3)
Epstein-Barr virus (HHV-4)
Cytomegalovirus (HHV-5)
HHV 6 and 7
HSV8 (HHV8, HSKS)
Signs
Herpes labialis
Recurrent Intraoral
Herpes Simplex
(RIOHS)
Recurrent Intraoral
Herpes Simplex (RIOHS)
can be caused by
HSV1 or HSV2
RIOHS
Appears on tightly-bound, highly
keratinized tissues
Initial lesion is a vesicle
Multiple shallow, punctate ulcers
May coalesce to form larger lesions
NOT treated with steroids
vs.
CASE 1
A.
B.
C.
D.
C. Cicatricial pemphigoid
D. Lichen planus (erosive)
CASE 2
Case 3