Aphthous Ulcers see p 172 ff

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An area of white superficial ulceration is surrounded by a hyperemic mucous membrane. These commonly occur in crops of two or more, and heal spontaneously in about one week. They are also acutely tender, and affect the nonkeratinizd oral mucous membrane. Although there is no induration on palpation, the histological inflammatory changes are not superficial, and may extend into the underlying muscle.

Hydrocortisone pellets to suck, or triamcinolone with Orabase ointments applied to the ulcer, are the most effective present treatments to relieve the pain. As the etiology of these extremely common ulcers remains unknown, treatment is empirical.

Hydrocortisone Pellets
Fig. 4.14a, b Ulceration and swelling of dental origin. In b an aphthous-like ulcer overlying the apex of this deciduous tooth suggests the diagnosis of an apical dental abscess.
Traumatic Ulcer Tongue

Fig. 4.15 Aphthous ulcers on the tongue. Aphthous ulcers on the tongue margin are often traumatic from tooth irregularity.

Aphthous Ulcer

Fig. 4.16 Trauma from a denture. This may be an irritating factor, as may any minor trauma to the mucous membrane in a person susceptible to aphthous ulcers.

Fig. 4.15 Aphthous ulcers on the tongue. Aphthous ulcers on the tongue margin are often traumatic from tooth irregularity.

Fig. 4.16 Trauma from a denture. This may be an irritating factor, as may any minor trauma to the mucous membrane in a person susceptible to aphthous ulcers.

Fig. 4.17 Aphthous ulcers on the soft palate. Aphthous ulcers are not uncommon on the soft palate.

Fig. 4.18 Solitary aphthous ulcer. This ulcer (periadenitis mucosa necrotica recurrens) looks similar to a simple aphthous ulcer and is the same histologically, but it behaves differently. It is less common, larger, persists for several weeks or months and may leave a scar. It occurs in more varied sites affecting the soft palate and even the pyriform fossa, where it presents with severe dysphagia. Carbenox-olone is used topically forthe lesions in the oral cavity.

Fig. 4.18 Solitary aphthous ulcer. This ulcer (periadenitis mucosa necrotica recurrens) looks similar to a simple aphthous ulcer and is the same histologically, but it behaves differently. It is less common, larger, persists for several weeks or months and may leave a scar. It occurs in more varied sites affecting the soft palate and even the pyriform fossa, where it presents with severe dysphagia. Carbenox-olone is used topically forthe lesions in the oral cavity.

Erythema Multiforme Palate Aphthous Ulcers Soft Palate

Fig. 4.20 Parotid salivary calculus. An ulcer in the region of the orifice of the parotid duct (a, arrow) suggests a possible salivary calculus. Parotid calculi are considerably less common than those in the sub-mandibular duct, but occasionally they may occlude the orifice of the duct, causing painful intermittent parotid swelling which requires incision and removal (b, c).

4 Fig. 4.19 Multiple oral ulcers. These may be the herpetiform type of aphthous ulceration, but are possibly caused by a blood dyscrasia. If the ulcers are crusted and hemorrhagic, the condition is either erythema multiforme or pemphigus. Hemorrhagic bullae may also be seen on the soft and hard palate. An iritis and genital ulceration may be present (Behcet's syndrome). High doses of systemic steroids are usually needed to control this type of severe ulceration.

The snail-track ulcers of secondary syphilis must be remembered also in the differential diagnosis of oral ulceration (see Fig. 4.59).

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  • Belladonna
    Is it an abscess or ulcer?
    2 years ago

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