ORAL ULCERATION

Dr. Shahzadi Tayyaba Hashmi

shahzadi@inaya.edu.sa

• Oral 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

ORAL ULCERATION

Trauma

Idiopathic Apthous ulceration

Causes of oral ulceration

• There are many causes of trauma in the oral cavity and these include mechanical, chemical and thermal trauma

Mechanical trauma:• May be caused by sharp cusps, orthodontic appliances and ill-

fitting dentures• Diagnosis of this type of ulceration is not difficult• Once the cause is removed, the ulceration usually starts to heal

within 10 days

Traumatic ulceration

Ulcers caused by ill-fitting dentures and orthodontic appliances

Chemical ulceration:• Relatively uncommon• May be caused by the drugs and other oral medications taken by the patient• Aspirin tablets placed in the oral cavity can cause this type of ulceration

Thermal trauma:• Relatively common• Caused by the ingestion of very hot food or drinks• The oral cavity heals quickly without scarring

Traumatic ulceration

• Also known as recurrent Apthous stomatitis• Apthous ulcers are relatively common• Their 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

Apthous ulceration

• Three clinical types have been identified:

1. Minor apthae

2. Major apthae

3. Herpetiform ulcers

Types of Apthous ulceration

• Most common type of ulceration• Ulcers are typically small, about 2-5mm across, oval and covered

by a grey slough• Surrounding mucosa may be Erythmatous• They 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 days• May be very painful and pain increases towards the end of the 14-

day period

TREATMENT:• Symptomatic treatment

Minor apthae

• These ulcers are not common• Larger and usually greater than 5-10mm in diameter• They are often multiple and affect keratinized as well as non-

keratinized mucosa• Lips, cheeks and soft palate are common areas• They last between 4 and 6 weeks and may be very painful• Heal with scarring

Major apthae

• Systemic and topical steroids• Antimicrobial rinses to prevent secondary

infection

TRATMENT

THANK YOU