Aphthous Stomatitis Medical Presentation

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Published on : Oct 23, 2019 | Views : 1963 | Downloads : 12

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Aphthous Stomatitis
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Introduction Recurrent aphthous stomatitis is a disorder characterised by recurring ulcers confined to the oral mucosa in patients with no other signs of disease. The greek word aphtha means ulceration. Prevalence varies from 5%-66%
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Etiology BACTERIAL INFECTION –a pleomorphic transitional L form of an alpha hemolytic streptococci , streptococcus sanguis play significant role. IMMUNOLOGIC ABNORMALITIES. Iron , vitamin B12 , folic acid deficiency. TRAUMA-due to self inflicted bites, oral surgical procedures , tooth brushing , dental procedures ,needle injections , dental trauma. ENDOCRINE CONDITION-during prementrual period and post ovulation period. ALLERGIC FACTORS-hay fever, asthma ,drug/food allergy.
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Pathogenesis PRIMARY IMMUNO DYSREGULATION DECREASE IN MUCOSAL BARRIER INCREASED ANTIGENIC EXPOSURE
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Classification MINOR aphthous ulceration: Most common method of stomatitis accounting about 80- 85% . Lesions are 2-3mm in diameter. They affect the non keratinised mucosa such as labial, Buccal mucosa ,lateral borders of tongue. Healing takes 7 -10 days.
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MAJOR aphthous stomatitis: About 10% of all the cases are affected. Lesions are more than 10mm in diameter and ulceration is deeper. Healing takes longer abut 20 -30 days. Usually affects oral epithelium but less commonly keratinised mucosa may be involved such as dorsum of tongue, gingiva, oropharynx, soft palate.
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MAJOR APHTHOUS STOMATITIS
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HERPETIFORM ULCERATION: Lesions resemble with herpes simplex virus but it is not caused by herpes virus. Ulcers are less than 1mm in diameter. Healing occurs within 15 days. They affect both keratinised and non keratinised epithelium. Seen in females than males .
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RAS type of ulceration: This is associated with systemic conditions. Persons with systemic diseases may be prone to oral ulceration
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Symptoms Prodermal sensations such as; burning ,itching and pain in the lesions, uncomfortable during chewing and speaking. Ulceration usually occurs 3- 6 times per year Typically begin with erythematous macules which develop into ulcers.
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A yellow-grey fibrinous membrane that can be scraped away. A reddish "halo" surrounds the ulcer.
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Causes Immunity People are genetically predisposed to suffering with oral ulceration. HLA-B12, HLA-B51, HLA-Cw7, HLA-A2, HLA-A11, and HLA-DR2 are examples of human leukocyte antigen types associated with aphthous stomatitis. Stress has effects on the immune system. Ulceration is exacerbated during examination periods. Oral parafunctional activities such as lip or cheek chewing.
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Immuno-dysregulation, e.g. cyclic neutropenia and human immunodeficiency virus infection. The relative increase in percentage of CD8+ T cells, caused by a reduction in numbers of CD4+ T cells may be implicated in RAS-type ulceration in HIV infection.
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Mucosal barrier The thickness of the mucosa may be an important factor in aphthous stomatitis. Usually, ulcers form on the thinner, non-keratinizing mucosal surfaces in the mouth. Factors which decrease the thickness of mucosa increase the frequency of occurrence.
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Factors Nutritional deficiencies Local trauma is also associated with aphthous stomatitis Hormonal factors Smoking
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Antigenic sensitivity Various antigenic triggers, including L forms of streptococci, herpes simplex virus, varicella-zoster virus, adenovirus, and cytomegalovirus. Possible allergens highly acidic foods, toothpastes(containing Sodium lauryl sulphate), and mouthwashes.
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Systemic disorders Behçet's disease Celiac disease Cyclic neutropenia Nutritional deficiencies IgA deficiency Immunocompromised states, e.g. HIV/AIDS MAGIC syndrome PFAPA syndrome Reactive arthritis Ulcus vulvae acutum
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Diagnosis Photographic comparison of: 1) a canker sore – inside the mouth, 2) herpes, 3) angular cheilitis, and 4) chapped lips
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Areas of the skin on the back are stimulated with various common allergens. The ones which cause an inflammatory reaction may also be involved in recurrent oral ulceration Patch Test
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Blood test Blood is often taken to assess the hemoglobin, iron, folate and vitamin B12 levels.
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Treatment
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Treatment-contd..
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Other Treatments Silver nitrate Aloe vera Myrtus communis Potassium alum Zinc sulfate Nicotine Polio virus vaccine Prostaglandin E
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Treatment Goals Reduce the pain symptoms Reduce the severity of condition Reduce the duration and size of lesion Use medication with least side-effects.
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Epidemiology Aphthous stomatitis affects between 5% and 66% of people, with about 20% of individuals in most populations having the condition to some degree. Aphthous stomatitis occurs worldwide, but is more common in developed countries. Males and females are affected in an equal ratio, and the peak age of onset between 10 and 19 years. About 80% of people with aphthous stomatitis first developed the condition before the age of 30. In the United States, aphthous stomatitis may be three times more common in white-skinned people than black-skinned people.
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