Dr. Shahzadi Tayyaba Hashmi

ORAL ULCERATION

ORAL ULCERATIONOral mucosa is composed of stratified squamous

epithelium, which covers and protects the underlying connective tissues from the oral cavity

An ulcer is formed when there is a break or defect in the epithelial covering and the underlying connective tissue is exposed to saliva and microorganisms of the oral cavity

The surface of the ulcer is covered by a white-grey slough

Causes of oral ulceration

Trauma

Idiopathic Apthous ulceration

Traumatic ulcerationThere are many causes of trauma in the oral cavity and

these include mechanical, chemical and thermal traumaMechanical trauma:May be caused by sharp cusps, orthodontic appliances

and ill-fitting denturesDiagnosis of this type of ulceration is not difficultOnce the cause is removed, the ulceration usually starts

to heal within 10 days

Ulcers caused by ill-fitting dentures and orthodontic appliances

Traumatic ulceration

Chemical ulceration:Relatively uncommonMay be caused by the drugs and other oral medications taken by the patientAspirin tablets placed in the oral cavity can cause this type of ulceration

Thermal trauma:Relatively commonCaused by the ingestion of very hot food or drinksThe oral cavity heals quickly without scarring

Apthous ulcerationAlso known as recurrent Apthous stomatitisApthous ulcers are relatively commonTheir characteristic feature is recurrence and

typically they start in childhood and tend to decrease in frequency with age

Exact cause of Apthous ulceration is unknown but there is family history in 45% of patients

Other causes are stress, trauma and menstruation

Types of Apthous ulcerationThree clinical types have been identified:1. Minor apthae2. Major apthae3. Herpetiform ulcers

Minor apthaeMost common type of ulcerationUlcers are typically small, about 2-5mm across, oval

and covered by a grey sloughSurrounding mucosa may be ErythmatousThey affect non- keratinized mucosa ,for example

they are present on the lateral border of tongue, floor of the mouth, buccal mucosa and lips

Lasts about 10-14 daysMay be very painful and pain increases towards the

end of the 14-day periodTREATMENT:Symptomatic treatment

Major apthaeThese ulcers are not commonLarger and usually greater than 5-10mm in diameterThey are often multiple and affect keratinized as well

as non- keratinized mucosaLips, cheeks and soft palate are common areasThey last between 4 and 6 weeks and may be very

painfulHeal with scarring

TRATMENTSystemic and topical steroidsAntimicrobial rinses to prevent secondary

infection