TAILIEUCHUNG - Chapter 032. Oral Manifestations of Disease (Part 7)

Ulcers Ulceration is the most common oral mucosal lesion. Although there are many causes, the host and pattern of lesions, including the presence of systemic features, narrow the differential diagnosis (Table 32-1). Most acute ulcers are painful and self-limited. Recurrent aphthous ulcers and herpes simplex infection constitute the majority. Persistent and deep aphthous ulcers can be idiopathic or seen with HIV/AIDS. Aphthous lesions are often the presenting symptom in Behçet's syndrome (Chap. 320). Similar-appearing, though less painful, lesions may occur with Reiter's syndrome, and aphthous ulcers are occasionally present during phases of discoid or systemic lupus erythematosus (Chap. 316) | Chapter 032. Oral Manifestations of Disease Part 7 Ulcers Ulceration is the most common oral mucosal lesion. Although there are many causes the host and pattern of lesions including the presence of systemic features narrow the differential diagnosis Table 32-1 . Most acute ulcers are painful and self-limited. Recurrent aphthous ulcers and herpes simplex infection constitute the majority. Persistent and deep aphthous ulcers can be idiopathic or seen with HIV AIDS. Aphthous lesions are often the presenting symptom in Behqet s syndrome Chap. 320 . Similar-appearing though less painful lesions may occur with Reiter s syndrome and aphthous ulcers are occasionally present during phases of discoid or systemic lupus erythematosus Chap. 316 . Aphthous-like ulcers are seen in Crohn s disease Chap. 289 but unlike the common aphthous variety they may exhibit granulomatous inflammation histologically. Recurrent aphthae in some patients with celiac disease have been reported to remit with elimination of gluten. Of major concern are chronic relatively painless ulcers and mixed red white patches erythroplakia and leukoplakia of more than 2 weeks duration. Squamous cell carcinoma and premalignant dysplasia should be considered early and a diagnostic biopsy obtained. The importance is underscored because early-stage malignancy is vastly more treatable than late-stage disease. High-risk sites include the lower lip floor of the mouth ventral and lateral tongue and soft palate-tonsillar pillar complex. Significant risk factors for oral cancer in Western countries include sun exposure lower lip and tobacco and alcohol use. In India and some other Asian countries smokeless tobacco mixed with betel nut slaked lime and spices is a common cause of oral cancer. Less common etiologies include syphilis and Plummer-Vinson syndrome iron deficiency . Rarer causes of chronic oral ulcer such as tuberculosis fungal infection Wegener s granulomatosis and midline granuloma may look identical to .

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