V Ulceration of the oral mucous membrane is a common

occurance
V The word ulcer is a greek word meaning Wound or Sore
V It has a focus of necrotic tissue on surface & a destroyed
overlying epithelium
V It consists of margin, edges , floor & base
Margin: junction between normal epithelium & ulcer: boundary of
the ulcer
Edge: junction between margins & floor of ulcer.: activity is max. at
margins & edges of the ulcer
jloor : exposed surface of ulcer: composed of
connective tissue fibrin with polymorphonuclear
leukocyte infiltration
Differences between base & floor : base better felt than
seen : floor exposed surface within the ulcer.
jormation of
an ulcer
ife cycle of an ulcer
V Differentiating between many diseases of
similar clinical appearance.
V Characteristic oral environment
3 Thin oral mucosa-causes vesciculae & bullae
to rapidly break into ulcers ± ulcers get easily
traumatized from teeth as well as food and
become secondarily infected
3 This caused the lesions having characteristic
appearance on skin to have non-specific
appearance on oral mucosa
V Detailed history:
3 
I
ength of time lesions have been present: ACUTE/C IC
The past history of similar lesions :
IMA/ECUET
o. f lesions present: SIE /MUTI
E.
3 Complete review of systems
presence of skin, eye, genital & rectal lesions
Symptoms of diseases associated with oral lesions; i.e. about
symptoms like joint pain, muscle weakness, dyspnea, diplopia and
chest pain
V Clinical examination:
3 Thorough inspection of exposed skin surfaces
3 Knowledge of basic dermatology is essential as disorders
occurring on oral mucosa may also affect the skin
According to their clinical appearance
V Macules
V
apules
V
laques
V odules
V Vesicles
V Bullae
V Erosions
V
ustules
V Ulcers
V
urpura
V Solid raised lesions >1cm
diameter
V arge papules
V
laque ± like lichen
planus
V Well-circumscribed, flat
lesions noticeable due to
their change from normal
skin or mucosa colour
V ed-increased
vascularity/inflammation
V
igmented due to
3 presence of
melanin,hemosiderin &
foreign material
3 Ingestion ofmedication
V Example in oral cavity :
melanotic macule
V Solid lesions raised above
skin / mucosal surface smaller
than 1cm in diameter
V Seen in wide variety of
diseases: erythema
multiforme, rubella, lupus
erythematosus, & sarcoidosis
V In oral cavity ± hyperplastic
candidiasis often presents as
yellow- white papules.
V Blisters containing
purulent material
V Eg: erpes virus
infection
V
resent deeper in dermis
/ mucosa
V May protrude above skin
/ mucosa ± but are
generally wider than high
V ral mucosa nodule :
irritational fibroma
V Elevated blisters
containing clear fluid <
1cm diameter
V Elevated blisters
containing clear fluid >
1cm diameter
V Eg: bullous pemphigoid,
epidermolysis bullosa
V ed lesions often caused
by rupture of vesicles or
bullae or trauma & are
generally moist skin
V Eg:
emphigus Vulgaris
V Well circumscribed ,
often depressed lesions
with an epithelial defect
that is covered by a fibrin
clot, causing a yellow-
white appearance
V Eg: aphthous ulcer
V eddish to purple bruises
caused by blood from vessels
leaking into the connective
tissue
V Do not blanch when pressure
is applied.
V Classified by size:
3
etechiae < 0.5 cm
3 Ecchymoses : larger
purpuric lesions
V Eg: trauma, lupus, pemphigus
ë
ë

CASSIjICATI  j UCEATIVE,
VESIC BU US ESI S I
V erpes simplex virus (SV)infection
V Varicella zoster virus (VZV) infection
V Cytomegalovirus (CMV) infection
V Coxsackievirus (CV) infection
3 and foot - & - mouth disease (jM)
3 erpangina
3 ymphonodular pharyngitis
V ecrotizing ulcerative gingivitis (U) & periodontitis (U
)
V Erythema multiforme(EM)
V Stevens johnson syndrome (SJS) & toxic epidermal necrolysis
(TES)
V
lasma cell stomatitis & oral hypersensitivity reactions
V ecurrent Aphthous Stomatitis (AS)
V Behcet Disease [BD (Behcet Syndrome)]
V
emphigus
3
emphigus vulgaris (
V)
3
emphigus joliaceus
3
araneoplastic
emphigus (


)
3 Drug related pemphigus
3
emphigus vegetans variant of
V
3
emphigus erythematosus variant of
emphigus joliaceus
V Subepithelial bullous dermatoses
V Bullous pemphigoid (B
)
V Mucous membrane pemphigoid [MM
(Cicatricial
emphigoid)]
V inear IgA diaease (AD)
V Epidermolysis Bullosa Aquisita (EBA)
V Chronic bullous disease of childhood (CBDC)
V Traumatic injuries causing solitary ulcerations
V Traumatic Ulcerative ranuloma, Eosinophilic
Ulcer f Tongue
V istoplasmosis
V Blastomycosis
V Mucormycosis (
hycomycosis)
CASSIjICATI  j UCES II

V According to etiology & pathology

Traumatic

V Due to mechanical irritation

V Chemical irritant
V Thermal burns
V adiation burns
V Anesthetics necrosis
V ral trauma front sexual practice
Infection
Viral infection
V erpes simplex infection
V erpes zoster
V and-foot and mouth disease
V erpangina
V Chickenpox
V Smallpox
V Measles
V Infectious mononucleosis
V AIDS²IV
Bacterial infection
V AU
V Tuberculosis
V Syphilis
V onorrhea
V Scarletfever
V Diphtheria
jungal infection
V istoplasniosis
V Blastontycosis
V Mucormycosis
V Cryptococcosis
Allergy

V ocal (St matitis venenata)

V Systemic
V Secondary vaccinia
V Acrodynia
eoplastic

V Squamous cell carcinoma

V Malignant melanoma
V on-odgkin's lymphoma
Systemic disorders

V Blood disorder
V Agranulocytosis
V Cyclic neutropenia
V eukemia
V Aplastic anemia
utritional deficiency

V Scurvy
V iboflavin deficiency
V
ellagra
V
rotein deficiency
V Malabsorption syndrome
V Xerostomia
V and-Schiiller-Christian disease
V etterer Siwe disease
V Acrodermatitis enteropathica (Zinc deficiency)
Disease of unknown etiology
V Aphthous stomatitis
V Erythema multiforme
V
emphigus
V Bullous pemphigoid
V Mucous membrane pemphigoid
V Erosive lichen planes
V Epidermolysis bullosa
V Systemic lupus erythematous
V Dermatitis sialometaplasia
V Wagener's granulomatosis
V Eosinophilic ulcer of the oral mucosa
Syndromes

V Stevens-Johnson syndrome
V Behcet's syndrome
V eiter's syndrome