Documenti di Didattica
Documenti di Professioni
Documenti di Cultura
allergies.
Immunologic factors T-cell
mediated
Nutritional deficiency Vitamin B12,
B9 & iron deficiencies.
Traumatic injuries Oral surgical &
dental procedures, needle injections,
dental trauma
Toothbrushing and self-inflicted
bites, ,
Hormonal influences Incidence of
aphthae is higher in premenstrual &
post-ovulation period relating to
the blood levels of progesterone.
Stress
Systemic diseases Behçet’s syndrome,
cyclic neutropenia, HIV infection, Reiter’s
disease, Sweet syndrome, Celiac disease,
nuntritional deficiencies, MAGIC
syndrome (major aphthous and
generalised inflamed cartilage) & PFAPA
syndrome (periodic fever, aphthae,
pharyngitis,and cervical adenitis)
Clinically Categorised in 3 classical
Clinical Features
forms
Minor aphthae (Canker sore) Most
common form of RAS & accounts for 70%
Burning
& prickling sensation
Pre-ulcerative lesion
Histopathology
Exhibits focal vacuolation and
supra basal epithelial cell
degeneration.
Lymphocyte infiltration in the
lamina propria
Deeper stroma Presents with
periductal and perivascular
distribution of these cells.
Neutrophil margination may also
be observed.
Ulcerative lesion
Reveals fibro purulent area
covering the ulcer
Occasionally superficial colonies
of the micro-organisms are also
noted
Neutrophilic infiltration is seen
beneath the ulcer in the connective
tissue
Lymphocytes prevail in deeper
areas, causing perivascular and
periductal fibrosis
Margins of the lesion show increased
endothelial & fibroblastic proliferation
with granulation tissue at the base of the
lesion
Smear taken from areas around the
Cytological Smear
aphthae Epithelial cells presents
with elongated nuclei, containing a
linear bar of chromatin
Radiating process of chromatin
extending towards the nuclear
membrane.
These cells are called
Antischkow's cells
Seen abundantly in patients with
RAS
Also found in Patients Sickle cell
and iron deficiency anemia
Children
with chemotherapy treatment for
cancer
Sometimes in
normal individuals.
Differential diagnosis for multiple
aphthous ulcers:
Intraoral recurrent herpes simplex
infection (IRHS)
Erythema multiforme
Pemphigus vulgaris
Cicatricial pemphigoid
Differential Diagnosis Erosive lichen planus
Herpetiform
Feature Minor Aphthae Major Aphthae
Aphthae
predilection
1 to 10 ulcers Clusters of 10 to
< 5 ulcers present
No. of ulcers present at any one 100 individual
at any one time
time ulcers
Painful ulcers Larger (>1 cm), Ulcers resemble
that are shallow, more destructive those seen in
round or oval, Deeper ulcers primary herpes
Clinical
hence the
presentation of the well-demarcated that last longer &
name
ulcers Small (<1 cm; recur more herpetiform
usually about 3– frequently than Numerous,
5 mm in minor aphthae. pinhead-sized,
diameter)
Covered with
Painful &
gray membrane
bleeding ulcers gray-white
Crateriform and erosions(1 to 2
fibrinopurulent mm in diameter)
asymmetric
pseudomembran Individual
Unilateral ulcers
e can be lesions coalesce
with a red raised to form large
removed by
inflammatory ulcers
rubbing red
border Borders are less
bleeding ulcer
AIDS patients sharp than those of
base exposed.
Similar ulcers major aphthae &
Prominent develop on vagina, wide spread area
erythematous penis, rectum & of erythema
border surrounds larynx.
the fibrinous
pseudomembrane.
During an attack
New lesions may
continually appear
Persists for 4 to 6 Lasts for 2 to 3
Duration for 3 to 4 week
weeks weeks.
period, with each
lesion lasting for
10 to 14 days
formation
"geographic" tongue.
Clinically Lesions seen on the glans
penis, produces circinate balanitis
Epithelium Parakeratinized
stratified squamous epithelium,
acanthosis & polymorphonuclear
leukocyte infiltration
Histopathology
Sometimes with microabscess
formation seen like psoriasis
Connective tissue Lymphocyte &
plasma cell infiltrate
Erythrocyte sedimentation rate (ESR)
Elevated in the acute stage of the
disease & remains after arthritis
resolves.
Diagnosis By tissue typing Over 70% of
patients will have the HLA-B27
genotype.
Mild leukocytosis & pyuria also be
noticed.
SARCOIDOSIS
granulomatous disease”
Disease of unknown etiology
CurrentlyInfectious etiology is more
favored mostly Mycobacterium and
Propionibacterium
Etiopathogenesis
Studies stated Interferon gamma (IFN-
γ) and cytokines like TNF-α, IL-12 and IL-
18 have a significant role in the
development of granulomatous lesions
Clinical Features Age 1 peak -- 25 & 35 years, 2
st nd
Laminated basophilic
calcifications present within the
granulomas Schaumann bodies
may be present.
Stellate inclusions asteroid bodies
may also be present within the
granulomas
An intracutaneous test of sarcoidosis
Kveim-Siltzbach test, The test
agent Sterilized suspension of
human sarcoid tissue by intradermal
injection
Within 4 to 6 weeks of interval
Papulonodular lesion noticed in
Diagnosis injected site of a affected patient.
Serum angiotensin converting enzyme
(ACE) levels Elevated
ESR & serum calcium levels
Elevated
Eosinophilia, leukopenia, anemia,
thrombocytopenia are also noticed in
blood picture
WEGNER’S GRANULOMATOSIS
Serious, systemic disease of unknown etiology
Related to inflammatory condition
Affects the vascular, renal and respiratory systems of the human body.
Clinical Features
Age 4th & 5th decade
Gender M>F
Clinical presentation Multi-organ involvement
Usually first characterized by Presence of rhinitis, sinusitis and otitis or ocular
symptoms.
Patient also developsCough and hemoptysis along with joint pains & fever.
Skin lesions Hemorrhagic or vesicular lesions
Oral manifestations Gingiva, the most common site represented as
“strawberry gingivitis”
Oral ulcerations Non-specific & occurs on any mucosal surface.
Histopathology
Pattern of mixed inflammatory infiltrate found centrally around the blood
vessels.
Gingival & other lesions Nonspecific granulomatous process with scattered
giant cells.
Etiopathogenesis
Clinical Features
Sites involved Tongue, chin, eyes, face around the lips, , pharynx and larynx.
Sometimes Hands, arms, legs buttocks and genitals are involved.
Clinical presentation
Angioedema Soft, non-tender diffuse edematous swelling of relatively
rapid onset, which may be solitary or multiple.
Eyes Swollen and lips are extremely puffy
Oral manifestations :
Histopathology: