Title Slide Center College of Dentistry University of Nebraska Medical Department of Oral Biology Dr. Nagamani Narayana of Differential Oral Ulcerations Diagnosis Title and Content • • Objectives Differential neoplastic ulcerations will be illustrated. Immune presented in a case etiology and management will be with special emphasis on the diagnosis, - mediated, traumatic and diagnosis of oral ulcerations - based format . Ulceration Title and Content History of Oral Lesions ofOral History List Medications:______List Medications:______Immunosuppression: diseases Autoimmune Skin lesions: symptoms: GI mucosa keratinized Location: _____NO ___Yes Recurrent: ___ ulcers: many How Painful ___ sores: of the Duration Name______: _____No pain _____Referred pain _____Referred pain _____No ______Present __Present Present Present Present ------DOB: __Absent __ __Absent __Absent Nonkeratinized Absent ______----- Keratinized (bound) vs. Non-keratinized (mobile) Mucosae

Keratinized Non-keratinized (bound) mucosae (mobile) mucosae Hard Palate Buccal mucosa Gingiva Lateral Tongue Floor of the mouth Vestibule Clinical Features of Acute vs. Chronic ulceration Acute Chronic 1. Pain 1. Little or no pain 2. History of trauma 2. History of trauma if 3. Yellow base with remembered a red halo 3. Yellow base with 4. Heals in 7-10 elevated margin days if cause 4. May mimic carcinoma eliminated and infectious ulcers 5. Delayed healing Acute vs. Chronic Ulcers Acute ulcer upper lip Chronic ulcer lingual vestibule Title and Content • • 4 - Seen by his pediatric dentist 2 days ago Sores in the mouth for 2 days for a restoration year - old male XX-year-old w photo 4 - year - old male Title and Content d. c. b. a. Diagnosis Benign migratory glossitis Acute traumatic ulcer Herpetic ulcer Aphthous ulcer 0% a. 0% b. 0% c. 0% d. Title and Content • • Management Chloraseptic Warm salt water rinses Sore Throat Relief Spray Title and Content • • 20 h/o of dental appointment one day ago Painful sores in the mouth for a day - year - old woman XX-year-old w photo 20 - year - old woman Title and Content d. c. b. a. Diagnosis Benign migratory glossitis Acute traumatic ulcer Herpetic ulcer Aphthous ulcer a. 0% 0% b. 0% c. 0% d. Title and Content • • • Management Magic mouthwash (Equal parts of Warm salt water rinses Reevaluation in 3 weeks rinse) Children’s Benadryl elixir +Maalox - Title and Content h/o dental appointment the previous h/o dentalappointment the previous day 25 - year - old woman XX-year-old w photo 25 - year - old woman Title and Content d. c. b. a. Diagnosis Acute chemical burn Acute traumatic ulcer Herpetic ulcer Aphthous ulcer a. 0% 0% b. 0% c. 0% d. XX-year-old w photo Acute Chemical Chemical Burn Acute Title and Content • Case of right lateral tongue lesion, little 59 discomfort reported by patient - year - old male with four - week hx XX-year-old w photo 59 - year - old male lesion ontongue Your Differential Diagnosis: a. Chronic traumatic ulcer b. Aphthous ulcer c. Pemphigus/pemphigoid d. Squamous cell carcinoma

0% 0% 0% 0%

a. b. c. d. Title and Content • • • Treatment Mouth guard Treated with warm salt water rinses Biotene mouthwash Title and Content Follow - up Examination up Title and Content • • 28 for a week h/o sores in the mouth present Painful, difficult to eat - year - old male XX-year-old w photo Soft palate anduvula palate Soft 28 - year - old male: Title and Content d. c. b. a. Your Diagnosis: Differential Aphthous Herpetic ulcer Squamous cell carcinoma Pemphigus/pemphigoid ulcer a. 0% 0% b. 0% c. 0% d. XX-year-old w photo lesion on the liplesion onthe 24 - year - old woman, XX-year-old w photo 24 - year - old woman Title and Content d. c. b. a. Your Diagnosis: Differential Traumatic ulcer Herpetic ulcer Pemphigus/pemphigoid Aphthous ulcer a. 0% 0% b. 0% c. 0% d. Blank White “ Sulphuric in acid and sulfonated sulfonated and acid aqueous solution” phenolics Treatment with Debacterol

Before After Title and Content • of Management Tailored to the patient – – – – If lesions are frequent: are If lesions therapy steroid Systemic therapy steroid Topical with ulcers Cauterize • Evaluate for Inflammatory bowel disease bowel Inflammatory for Evaluate Aphthous Debacterol ulcers Title and Content • • 19 one week h/o of sores in the mouth for the past h/o of fever - year - old woman Gingival Sores Sores in the Mouth XX-year-old w photo Enlarged Left Tonsil Left Enlarged Title and Content e. d. c. b. a. Diagnosis Aphthous Primary herpetic Acute ulcer Pemphigus Streptococcal pharyngitis ulcer a. 0% gingivostomatitis 0% b. 0% c. 0% d. 0% e. Title and Content • • Treatment Antibiotic therapy Symptomatic treatment Title and Content past 3 days in themouth h/o ofsores for the 25 - year - old Male Title and Content d. c. b. a. Diagnosis Recurrent herpetic infection Aphthous Basal cell carcinoma Pemphigoid/Pemphigus ulcer a. 0% 0% b. 0% c. 0% d. Title and Content d. c. b. a. Management Antiviral therapy Symptomatic therapy Antifungal therapy Antibiotic therapy a. 0% 0% b. 0% c. 0% d. Recurrent Herpes Aphthous Ulcer Comparison Between Aphthous and Recurrent Herpes Aphthous Herpes ulcers infection Triggers Stress, trauma, diet, HSV 1, Stress, hormones trauma Appearance No prodrome Prodromal No vesicles symptoms Single/multiple oval Vesicles precede ulcers ulcers Sites Mobile mucosa Bound mucosa Treatment Steroids Antiviral