oral ulcers

• 1.ULCERS INJURY TO THE ORAL MUCOSA MAY RESULTIN A LOCALIZED DEFECT OF THE SURFACE INWHICH THE COVERING EPITHELIUM ISDESTROYED LEAVING AN INFLAMMED AREAOF EXPOSED CONNECTIVE TISSUE. SUCH DEFECTS ARE CALLED ULCERS OREROSIONS (TERM COMMONLY USED FORSUPERFICIAL ULCER) THIS MAY EITHER FOLLOW MOLECULARDEATH OF SURFACE EPITHELIUM OR ITSTRAUMATIC REMOVAL. ULCERATION IS THE MOST COMMON LESION

2. THE SURFACE OF AN ULCER IS COVERED BY MASSOF FIBRIN WITH INTERMINGLED, DEAD AND DYINGPOLYMORPHS WHICH WOULD DRY ON THE SKIN TOFORM A CRUST OR SCAB. A SUPERFICIAL ULCER WITH NO EVIDENCE OFSIGNIFICANT FIBRINOUS EXUDATION ON THESURFACE OF POLYMORPH EXUDATION SUGGESTSTHE POSSIBILITY OF BULLOUS DISORDER. A HEAVY INFLAMMATORY INFILTRATE EXTENDSDEEP INTO THE UNDERLYING CONNECTIVE TISSUEN BLOOD VESSELS MAY SHOW SLIGHTINFLAMMATORY VASCULITIS. GRANULATION TISSUE IS FORMED WITH DILATEDBLOOD VESSELS AND HEAVY INFITRATE OF PLASMA 3. PARTS OF AN ULCERULCER CONSISTS OF:1. EDGE:-THIS IS AN IMPORTANT FINDING OF AN ULCER WHICH BY ITSELF NOT ONLY GIVES CLUE TO DIAGNOSIS ULCER BUT ALSO TO THE CONDITION OF ULCER.2. FLOOR:- THIS IS THE EXPOSED PART OF AN ULCER. THE COVERING OF FLOOR IS IMPORTANT. RED GRANULATION TISSUE HEALTHY AND HEALING PALE AND SMOOTHSLOW HEALING ULCER GRANULATION TISSUE BLACK MASS MALIGNANT MYELOMA3. BASE (ON WHICH THE ULCER RESTS):- FLOOR IS THE EXPOSED SURFACE OF AN ULCER WHEREAS THE BASE IS ON WHICH THE ULCER RESTS. FLOOR IS SEEN BUT THE BASE IS FELT.4. MARGIN:- ITS THE POINT WHERE THE ULCER JOINS THE 4. NON SPECIFIC ULCERS 5. CLASSIFICATION OF ULCERSTWO TYPES OF CLASSIFICATON OF ULCERS IS POSSIBLE:-1.CLINICAL:TYPESSURROUNDIN ULCER FEATURESOTHER G SKIN FEATUERS1.SPREADIINFLAMED NO GRANULATIONNGTISSUE IS SEEN2.HEALINGNOTGRANULATION SLIGHT INFLAMMEDTISSUE IS PRESENT SEROUSIN FLOORDISCHARGE ISSEEN3.CALLOUSINDURATONS PALE GRANULATIONNO TENDENCYTISSUE IS SEEN AT TOWARDSFLOOR AND HEALINGINDURATIONS ARESEENAT BASE AND 6. 2. PATHOLOGIC ULCERS ULCERATIONS ARE CLASSIFIED ON THE BASIS OF ETIOLOGY. CAUSES OF ORAL ULCERATIONS:-1. INFECTIVE DISEASES2. TRAUMATIC ULCERATIONS3. IMMUNOLOGIC DISEASES4. NEOPLASTIC 7. TRAUMATICULCERATON TRAUMATIC INJURY CAN OCCUR BY THEFOLLOWING MEANS:-1. MECHANICAL2. CHEMICAL3. THERMAL4. FACTITIOUS INJURY5. RADIATION6. EOSINOPHILIC ULCER (TRAUMATIC GRANULOMA) 8. MECHANICAL TRAUMATIC ULCERATION MECHANICAL TRAUMA OCCURS THROUGH BITING, SHARPCUSPS, OUTSTANDING TEETH OR ILL-FITTING INTRAORALAPPLIANCES. SUCH ULCERS DONT PRESENT A PROBLEM CLINICALLY,BUT 3 CRITERIA MUST BE FOLLOWED.1. A CAUSE OF TRAUMA MUST BE IDENTIFIED.2. THE CAUSE MUST FIT THE SIZE, SITE AND SHAPE OF ULCER.3. ON REMOVAL OF THE CAUSE, THE ULCER MUST SHOW SIGNS OF HEALING WITHIN 10DAYS. CHRONIC TRAUMATIC ULCERS MAY PRESENT FORSEVERAL WEEKS AND MAY BE DEEP CRATER LIKELESIONS WITH ROLLED EDGES WHICH ARE INDURATED 9. CHEMICAL TRAUMATICULCERATION A VARIETY OF CHEMICALS MAY CAUSE ORALULCERATION. IT INCLUDES IRRITANTS OR CAUSATIVE AGENTSUSED IN DENTAL PRACTICE. THE PREPARATIONS USED BY PATIENTS IN SELFTREATMENT OF ORAL COMPLAINTS SUCH ASANTISEPTIC MOUTHWASHES AND ASPIRIN (MISUSEDAS OBTUNDANT FOR TOOTH RELIEF). THE ACTION OF ASPIRIN IS TIME AND DOSEDEPENDENT. THE SEVERITY RANGES FROM ODEMATO NECROSIS OF THE EPITHELIUM. ODEMATOUS EPITHELIUM RESEMBLES LEUKOEDEMAWHEREAS THE NECROTIC EPITHELIUM RESEMBLES 10. THERMAL AND FACTITIOUSTRAUMATIC ULCERS ULCERATION DUE TO THERMAL TRAUMA OCCURS DUE TO VERY HOT FOOD OR DRINKS, CAN OCCUR IN ANY PART OF ORAL MUCOSA BUT MOST COMMONLY SEEN IN PALATE. FACTITIOUS ULCERS MAY BE THE MANIFESTATION OF STRESS, ANXIETY OR EMOTIONAL DISTURBANCES. COMMON CAUSE ARE BITING OR CHEWING OF LIPS, CHEEKS OR TONGUE AND DAMAGE (TO GINGIVA FROM SHARP NAIL BITES) 11. FACTITIOUS ULCER-CHRONIC ULCERATION OFTHE MANDIBULARALVEOLAR RIDGETRAUMATIC ULCER DUESECONDARY TO SELF-TO THERMAL BURNINDUCED TRAUMA 12. RADIATION TRAUMATICULCERATION ORAL MUCOSA MAY SUFFER IMMEDIATE DAMAGEDUE TO DIRECT EFFECTS OF RADIATION ON CELLSOR DELADED EFFECTS DUE TO EPITHELIAL ATROPHYAND DAMAGE TO UNDERLYING VASCULAR BEDDURING RADIOTHERAPY OF HEAD N NECK CANCER. THE IMMEDIATE EFFECTS ARE ERYTHEMIA,RADIATION MUCOSITIS AND ULCERATION. OEDEMA DUE TO OBSTRUCTION OF REGIONALLYMPHATICS MAY OCCUR. RADIATION ULCERS ARE PAINFUL. 13. EOSINOPHILIC ULCER ITS ALSO REFERRED TO AS TRAUMATICGRANULOMA OR EOSINOPHILIC GRANULOMA OFSOFT TISSUES. IT IS PARTICULARLY ASSOCIATED WITH TRAUMA NINJURY TO MUSCLE ALTHOUGH THEPATHOGENESIS IS UNCLEAR. IT OCCURS MOST COMMONLY ON THE TONGUE ANDPRESENTS CLINICALLY AS CHRONIC, WELLDEMARCATED ULCER WHICH MAY MIMIC A SQ.CELL CARCINOMA. 14. HISTOLOGICALEXAMINATION SHOWSAN ULCER COVERED BYTHICK LAYER OFFIBROUS EXUDATEWITH A DENSE,CHRONICINFLAMMATORY CELLINFILTRATE IN ITS BASEINVOLVING UNDERLYINGDAMAGED MUSCLE. THE DEEPER PARTSCONTAIN INFILTRATERICH IN HISTIOCYTESAND EOSINOPHILS. TRUE GRANULOMAS 15. IMMUNOLOGIC DISEASES IDIOPATHIC ULCERS BEHCETS SYNDROME REITERS SYNDROME ERTHEMA MULTIFORME DRUG REACTIONS CONTACT ALLERGIES WEGNERS GRANULOMATOSIS MIDLINE GRANULOMA CHRONIC GRANULOMATOUS DISEASE CYCLIC NEUTROPENIA 16. IDIOPATHIC ULCERS THERE ARE A GROUP OF IDIOPATHIC ULCERSWHOSE IS CHARACTERISED BY FREQUENTREOCCURANCES. SUCH ULCERS ARE TERMED AS RECURRENTAPHTHOUS STOMATITIS(RAS). BASED ON PRIMARILY THEIR CLINICAL FEATURES, 3TYPES OF ULCERS ARE RECOGNISED:-1. MINOR APHTHOUS ULCERS2. MAJOR APHTHOUS ULCES3. HERPETIFORM ULCERS 17. ETIOLOGY OF RECURRENTAPHTHOUS STOMSTITIS1. HEREDITARY PREDISPOSITION2. TRAUMA3. EMOTIONAL STRESS AND PSYCOLOGICAL FACTORS4. BACTERIAL AND VIRAL INFECTIONS5. ALLERGIC DISORDERS6. HAEMATOLOGICAL AND DEFICIENCY DISORDERS7. GASTROINTESTINAL DISORDERS8. HORMONAL DISORDERS. 18. CLINICAL FEATUERS OF RECURRENTAPHTHOUS STOMATITISMINOR MAJOR HERPETIFORMAGE OF ONSET 10-1910-19 20-29(YEARS)NUMBER OF 1-5 1-1010-100ULCERSPRINCIPAL LIPS, CHEEKS, PALATE, PHARYNX FLOOR OF MOUTH,SITES TONGUEPALATE, PHARYNX,GINGIVASIZE OF 10 1-2 BUT OFTENULCERS(MM)COALEASEDURATION IN 7-14>30 10-30DAYS 19. MINOR APHTHOUS ULCERATION THIS ACCOUNTS FOR 80% OR MORE CASES OFRAS. ITS CHARACTERISED BY ROUND OR OVALULCERS WHICH AFFECT NON-KERATINISEDAREAS OF ORAL MUCOSA AND THEY HAVEGREY/YELLOW BASE WITH ERYTHEMATOUSMARGIN. THEY HEAL WITHOUT SCARRING AND TENDTO RECUR AT 1-4 MONTH INTERVALS, WHICH ISVARIABLE 20. MINOR APHTHOUS ULCERATION 21. MAJOR APHTHOUS ULCERATION THEY OCCUR ANYWHERE IN MOUTH INCLUDINGTHE KERATINISED ORAL MUCOSA BUT THE LIPS,SOFT PALATE, TONSILLAR AREAS AND OROPHARYNXARE COMMON SITES. THEY HEAL WITH SCARRING AND TEND TO RECURAT LESS MONTHLY INTERVALS AND MAY BEASSOCIATED WITH SEVERE DISCOMFORT ANDWITH DIFFICULTY IN EATING AND SPEAKING. THE EXTENSION IS DEEPER AND MAY PRESENT ASCRATER LIKE ULCERS WITH ROLLED MARGINSWHICH ARE INDURATED ON PALPATION BECAUSEOF UNDERLYING FIBROSIS. 22. MAJOR APHTHOUS LCERS 23. HERPTIFORM ULCERATION ITS CHARACTERISED BY MULTIPLE, SMALL, PIN-HEADED ULCERS THAT CAN OCCUR N ANY PARTOF ORAL MUCOSA. WHEN HUNDREDS OF ULCERS ARE CLUSTEREDTOGETHER, CONFLUENCE TOGETHER WHICHRESULTS IN LARGER AREAS OF ULCERATIONWITH IRREGULAR OUTLINE. THEY HEAL WITHIN 2-3WEEKS WITH SCARRING. THE ULCERS TEND TO RECUR AT LESS THANMONTHLY INTERVEL AND MAY BE ASSOCIATEDWITH SEVERE DISCOMFORT. 24. HERPTIFORM ULCERS 25. BEHCET SYNDROME ITS A RARE DISORDERCHARACTERISED BYRECURRENT APHTHOUSSTOMATITIS. IT MAY BE SEEN ASGENITAL ULCERS, EYELESIONS, SKIN LESIONS ORRAPID ACUTEINFLAMMATION OF SKIN INRESPONSE TO MINORTRAUMA. IMMUNE MEDIATEDMUCOSAL DAMAGE ANDVASCULITIS ASSOCIATEDWITH HYPERACTIVITY OFNEUTROPHILS AREINVOLVED IN PATHOGENESISOF LESIONS. 26. THERE IS A CONSIDERABLELOSS OF TISSUE DEPRESSINGULCER WELL BELOW THESURFACE ANDINFLAMMETION EXTENDSDEEPLY INTO SUBCUTANEOUSFAT. THE SURFACE IS COVERED BYFIBRINOUS EXUDATEINFILTRATED BYPOLYMORPHS FORMING SCAB. A LAYER OF GRANULATIONTISSUE WITH DILATEDCAPILLARIES AND EDEMA ISSEEN. SOME BLOOD VESSELS SHOWEXTENSIVE FIBROUSPROLIFERATION OFSUBENDOTHELIAL CONECTIVETISSUE. 27. REITERS SYNDROME CLINICAL FEATURES INCLUDE ARTHRITIS,URETHRITIS, CONJUNCTIVITIS OR UVEITIS, ORALULCERS. THE CAUSE IS UNKNOWN BUT IT S IMMUNERESPONSE TO BACTERIAL ANTIGENWHICHUSUALLY FOLLOWS STD OR SHIGELLADYSENTARY. IT MAY RECUR . THE DURATION IS WEEKS TOMONTHS. ORAL LESIONS HAVE BEEN DESCRIBED ASRELATIVELY PAINLESS APHTHOUS ULCERSOCCURING ALMOST ANYWHERE IN THE MOUTH. 28. DIAGNOSIS IS DEPENDENT ON RECOGNITION OFTHE VARIOUS SIGNS AND SYMPTOMSASSOCIATED WITH THE SYNDROME. THE ERYTHROCYTE SEDIMENTATION RATE ISELEVATED IN THE ACUTE PHASE OF THE DISEASEBUT PERSISTS AFTER ARTHRITIS RESOLVES. 29. ERYTHEMA MULTIFORME (EM) EM IS A SELF LIMITINGHYPERSENSITIVITY REACTIONCHARACTERISED BY TARGETSKIN LESIONS AND ORALULCERATIVE LESIONS. ITS DIVIDED INTO A MINORFORM USUALLY ASSOCIATEDWITH HSV TRIGGER AND ASEVERE FORM TRIGGERED BYCERTAIN SYSTEMIC DRUGS. OTHER FACTORS LIKEMALIGNANCY, AUTOIMMUNEDISEASES, RADIOTHERAPYTRIGGER EM. DRUGS PRECIPITATING EMARE BARBITURATES,SULFONAMIDES ANDANTISEIZURE MEDICATIONS. 30. EM IS USUALLY ACUTE, SELFLIMITED PROCESS THAT AFFECTSSKIN OR MUCOUS MEMBRANEAFFECTING MOSTLY YOUNGADULTS. THE TERM ERYTHEMAMULTIFORME WAS COINED TOINDICATE THE MULTIPLE NVARIED CLINICAL APPEARANCESTHAT ARE ASSOCIATED WITHCUTANEOUS MANIFESTATIONS. THE CLASSIC SKIN LESIONCONSISTS OF CONCENTRICERYTHEMATOUS RINGS SEPARATEDBY RINGS OF NEAR NORMALCOLOR. OTHER TYPE OF MANIFESTATIONSINCLUDE MACULES, PAPULES,VESICLES, BULLAE ANDURTICARIAL PLAQUES. 31. EM PRESENTS ASULCERATIVE DISEASEVARYING FROM APHTHOUSTYPE LESIONS TO MULTIPLEWIDE SPREAD ULCERS. LIPS BUCCAL MUCOSA,PALATE AND TONGUE AREMOSTLY AFFECTED. FROM MILD DISCOMFORTTO SEVERE PAIN IT MAYEVEN LEAD TO HEADACHE,HIGH BODY TEMPERATUREAND LYMPHADENOPATHY. STEVENS-JOHNSONSSYNDROME A MAJOR FORMOF EM IS CHARACTERISEDBY CRUSTING ULCERATONAT VERMILION BORDERTHAT MAY CAUSE IMMENSEPAIN. 32. THE MICROSCOPICPATTERN OF EMCONSISTS OFEPITHELIALHYPERPLASIA ANDSPONGIOSIS. EPITHELIAL NECROSISIS SEEN. CONNECTIVE TISSUECHANGES USUALLYAPPEAR ASINFILTRATES OFLYMPHOCYTES AND ORAL ERYTHEMIA MULTIFORMEMACROPHAGES INBIOPSY SPECIMEN SHOWINGPERIVASCULAR SPACES EPITHELIAL EDEMA AND LYMPHOIDAND IN CONNECTIVEINFILTRATETISSUE PAPILLAE. 33. DRUG REACTIONS IT AFFECTS SKIN OR MUCOSA. ERYTHEMIA , WHITE LESIONS,VESICLES OR ULCERS MAY BE SEEN. HISTORY OF DRUG INGESTIONSIS IMPORTANT. THIS IS CAUSED BY POTENTIALLY ANY DRUG VIA STIMULATON OFIMMUNE SYSTEM. REACTIONS SUCH AS ANAPHYLAXIS OR ANGIOEDEMA MAYREQUIRE EMERGENCY CARE; AND HIGHLY VARIABLE CLINICALPICTURE CAN MAKE DIAGNOSIS DIFFICULT. THE PATHOGENESIS OF DRUG REACTIONS MAY BE IMMUNOLOGICOR NONIMMUNOLOGIC. THE IMMUNOLOGIC MECHANISMS ARE TRIGGERED BY ANANTIGENIC C OMPONENT ON DRUG MOLECULE RESULTING INIMMUNE RESPONSE OR DRUG ALLERGY. DRUG REACTIONS THAT ARE NONIMMUNOLOGIC IN NATURE DONTSTIMULATE AN IMMUNE RESPONSE BUT THEY DIRECTLY AFFECTMAST CELLS CAUSING RELEASE OF CHEMICAL MEDIATORS. 34. ACQUIRED ANGIOEDEMA IS IgE-MEDIATEDREACTION THAT IS PRECIPATED BY DRUGS ORFOODS(NUTS AND SHELL FISH) HERIDITARY ANGIOEDEMA IS A RAREAUTOSOMAL-DOMINANT TRAIT DEVELOPING ASPONTANEOUS MUTATON. THIS RESULTS INDEFICIENCY OF INHIBITOR OF THE FIRSTCOMPONENT OF COMPLEMENT C1 ESTERASELEADING TO SERIOUS CLINICAL MANIFESTATIONS. ANGIOEDEMA BY EITHER PATHWAY APPEARS ASSOFT, DIFFUSE, PAINLESS SWELLING USUALLY OFLIPS, NECK OR FACE. 35. ORAL MANIFESTATIONSMAY BEERYTHEMATOUS,VESICULAR ORULCERATIVE. THEY MAY ALSOMIMIC LICHEN PLANUSSO, THEY ARE KNOWNAS LICHENOID DRUGREACTIONS. THE NONSPECIFICFEATURES INCLUDESPONGIOSIS,APOPTOTICKERATINOCYTES,LYMPHOIDINFILTRATES,EOSINOPHILS ANDULCERATION. 36. CONTACT ALLERGIES LESIONS ARE CAUSED BY DIRECT CONTACTWITH FOREIGN ANTIGEN; ERYTHEMA, VESICLESAND ULCERS MAY BE SEEN ITS CAUSED BY POTENTIALLY ANY FOREIGNANTIGEN THAT CONTACTS SKIN OR MUCOSA;CINNAMON IS FREQUENTLY CITED IN ORALCONTACT STOMATITIS. THE IMMNUNE RESPONSE IS PREDOMINANTLYT-CELL MEDIATED. PATCH TESTIN G MAY BE HELPUL FORDIAGNOSIS; HISTORY IS IMPORTANT. 37. CONTACT ALLERGY ISFREQUENTLY SEEN ON SKINAND ITS UNCOMMONINTRAORALLY. MATERIALS CAUSINGINTRAORAL ALLERGY ARETOOTHPASTE, MOUTHWASH,CANDY, TOPICALANTIMICROBIALS, TOPICALSTEROIDS, IODINE, DENTUREBASE MATERIAL ETC. THIS CONDITION PRIMARILYAFFECTS ATTACHED GINGIVAAS BRIGHT BILATERAL BAND. MICROSCOPICALLY,EPITHELIUM ANDCONNACTIVE TISSUE SHOWINFLAMMATORY CHANGES. BLOOD VESSELS MAY BEDILATED AND EOSINOPHILSMAY BE SEEN. 38. WEGENER GRANULOMATOSIS CLINICAL FEATURES INCLUDE INFLAMMATORY LESIONSOF LUNG, KIDNEY AND UPPER AIRWAY; MAY AFFECTGINGIVA WHEN INTRAORAL. THE HEAD AND NECK MANIFESTATIONS ARE SINUSITIS,RHINORRHEA, NASAL STIFFNESS AND EPITAXIS. INTRAORAL LESONS CONSIST OF RED, HYPERPLASTIC,GRANULAR LESONS OF ATTACHED GINGIVA. KIDNEY INVOLVEMENT CONSISTS OF FOCALNECROTIZING GLOMERULITIS AND THE FINAL OUTCOMEIS RENAL FAILURE. THIS IS A RARE DISEASE OF MIDDLE AGE. THE CAUSE IS POSSIBLY IMMUNE DEFECT ORINFECTION. IT MAY BECOME LIFE THREATING AS A RESULT OFTISSUE DESTRUCTION IN ANY OF 3 INVOLVED SITES. 39. THE BASICPATHOLOGIC PROCESSIS GRANULOMATOUSWITH CHARACTERISTICNECROTIZINGVASCULITIS. NECROSIS ANDMULTINUCLEATEDGIANT CELLS MAY BESEEN IN THEGRANULOMATOUSAREAS. DIAGNOSIS MAY BEMADE BY EXCLUSIONOF OTHER DISEASESPARTICULARLYMIDLINE GRANULOMA. 40. MIDLINE GRANULOMA THIS IS RARE BUT DESTRUCTIVE, NECROTIC,NONHEALING LESIONS OF NOSE, PALATEAND SINUSES. BIOPSY SHOWS NONSPECIFIC INFLAMMATIONDISTINCT FROM WEGENERSGRANULOMATOSIS. MIDLINE GRANULOMA REPRESENTS NK/T-CELL LYMPHOMA. PROGNOSIS IS POOR; DEATH MAY FOLOWWHEN ERODED INTO MAJOR BLOODVESSELS. 41. MIDLINE GRANULOMA ISA UNIFOCALDESTRUCTIVE DISEASE INTHE MIDLINE OFORONASAL REGION. OTHER DISEASES THATPRODUCE THIS KIND OFLESIONS ARE WEGENERSGRANULOMATOSIS,INFETIOUS DISEASE ANDCARCINOMA. MICROSCOPICALLY THISPROCESS APPEARS ASACUTE AND CHRONICINFLAMMATION INPARTIALLY NECROTICTISSUE WITHANGIOCENTRICINFLAMMATION ASCOMMON FINDING. 42. CHRONIC GRANULOMATOUSDISEASE THIS DISEASE IS RARE AND PRESENTS ASRECURRENT INFECTIONS IN VARIOUS ORGANS. MOSTLY OCCCURS IN MALES. ITS A GENETIC DISEASE (X-LINKED) THIS IS CAUSED BY THE DEFECT IN NICOTINAMIDEADENINE DINUCLEOTIDE PHOSPHATE OXIDASECOMPLEX THAT RESULTS IN ALTEREDNEUTROPHIL AND MACROPHAGE FUNCTIONRESULTING IN INABILITY TO KILL BACERIA ANDFUNGI. MANIFESTATIONS APPEAR DURING CHILDHOODDUE TO MORE FREQUENT X-LINKED INHERITANCEPATTERN. 43. CYCLIC NEUTROPENIA THE CLINICAL FEATURES INCLUDE ORAL ULCERSWITH PERIODICITY; INFECTIONS, ADENOPATHY;PERIODONTAL DISEASE. THIS IS CAUSED BY MUTATIONS IN NEUTROPHILELASTASE GENE. CYCLIC NEUTROPENIA RESULTS IN RARE BLOODDYSCRASIA. FEVER, MALAISE, ORAL ULCERS, CERVICALLYMPHADENOPATHY AND INFECTIONS CANOCCUR. 44. INFECTIVE ORAL ULCERATIONS BACTERIAL:- FUNGAL:- SYPHILIS DEEP FUNGAL GONORRHEA INFECTIONS TUBERCULOSIS SUBCUTANEOUS: SPOROTRICHOSIS LEPROSY ACTINOMYCOSIS OPPORTUNISTIC: PHYCOMYCOSIS NOMAAND ASPERGILLOSIS 45. BACTERIAL - SYPHILIS THIS IS SEXUALLY TRANSMITTED BY ASPIROCHETE-TREPONEMA. CLASSIFICATION:-1. PRIMARY(CHANCRE)- SINGLE, INDURATED NONPAINFUL ULCER AT THE SITE OF SRIROCHETE ENTRY, SPONTANEOUSLY HEALS IN 4-6 WEEKS.2. SECONDARY- MACULOPAPULAR RASH ON SKIN, ORAL ULCERS COVERED BY MEMBRANE(MUCOUS PATCHES)3. TERTIARY- GUMMAS, CARDIOVASCULAR AND CNS LESIONS.4. CONGENITAL- HUTCHINSON TRIAD(DEAFNESS, INTESTINAL KERATITIS, DENTAL ANOMALIES) 46. SYPHILIS PRIMARY AND SECONDARYFORMS ARE HIGHLYINFECTIOUS. SECONDARY FORMDEVELOPS IN 2-10 WEEKS. LATENCY PERIODS ARESEEN BETWEEN PRIMARYAND SECONDARY STAGESAND BETWEEN SECONDARYAND TERTIARY STAGES. 47. OTHERCLINICAL FEATURE CAUSESIGNIFICANCEINFEC-TIONSGONORRHEAGENITAL LESIONS WITH RAREN.gonorrheaMAY BE CONFUSED WITH ORAL MANIFESTATIONS;OTHER ULCERATIVE ERYTHEMA OR ULCERSDISEASESTUBERCULOS INDURATED, CHRONIC ULCER M.tuberculosis INFECTIOUS ORALIS THAT MAY BEPAINFUL- ON ANYLESIONS ARE ALWAYS MUCOSAL SURFACE RESULT OF LUNG LESIONSLEPROSYSKIN DISEASE WITH RARE M.leprae COMMON IN SOUTHEAST NODULES OR ULCERS ASIA, INDIA, SOUTHAMERICAACTINOMYCO TYPICALLY SEEN INA.israelii INFECTION FOLLOWSSISMANDINLE, WOOD HARD ENTRY THROUGH NODULE WITH SULFURSURGICAL SITE, GRANULESPERIODONTAL DISEASE OR OPEN ROOT CANALNOMA NECROTIC, NONHEALING ANAEROBES IN OFTEN ASSOCIATED WITH ULCER OF GINGIVA ORPATIENT WHOSEMALNUTRITION; MAY BUCCAL MUCOSA; RARE; SYSTEMIC HEALTH IS RESULT IN TISSUE AFFECTS CHILDREN COMPROMISEDDESTRUCTION 48. DEEP FUNGAL INFECTIONS DEEP FUNGAL INFECTIONS ARECHARACTERISED BY PRIMARY INVOLVEMENTOF THE LUNGS. ORAL INFECTIONS FOLLOW IMPLANTATIONOF INFECTED SPUTUM IN ORAL MUCOSA. ORAL LESIONS ARE USUALLY PRECEDED BYPULMONARY INFECTION. PRIMARY INVOLVEMENT OF ORAL MUCOUSMEMBRANE IS UNLIKELY MODE OFINFECTION. 49. DEEP FUNGAL INFECTIONS INCLUDEHISTOPLSMOSIS, COCCIDIOMYCOSIS,BLASTOMYCOSIS, CRYPTOMYCOSIS 50. THE BASICINFLAMMATORYRESPONSE IN A DDEPFUNGAL INFECTIONIS GRANULOMATOUS. MACROPHAGES ANDMULTINUCLEATEDGIANT CELLSDOMINATE THEHISTOLOGIC PICTURE. PECULIAR TOBLASTOMYCOSIS ISPSEUDOEPITHELIO-MATOUSHYPERPLASIAASSOCIATED WITHSUPERFICIALINFECTION . 51. SUBCUTANANEOUS FUNGALINFECTIONS - SPOROTRICHOSIS THIS IS CAUSED BY SPOROTHIX SCHENCKIIAND RESULTS FROM INOCULATION OF SKIN ORMUCOSA BY CONTAMINATE SOIL OR THRONYPLANTS. LESIONS APPEAR AT SITE OF INOCULATION ANDSPREAD ALONG LYMPHATIC CHANNELS. THE INFLAMMATORY RESPONSE ISGRANULOMATOUS. CENTRAL ABSCESSES MAY BE FOUND IN SOMEOF GRANULOMAS AND OVERLING EPITHELIUMEXHIBITS PSEUDOEPITHELIOMATOUSHYPERPLASIA. 52. OPPURTUNISTIC FUNGAL INFECTIONS:PHYCOMYCOSIS AND ASPERGILLOSIS PHYCOMYCOSIS (MUCORMYCOSIS) ISCAUSED BY GENERA MUCOR ANDRHIZOPUS.ASPERGILLOUS IS UBIQUITOUS INTHE ENVIRONMENT THE ROUTE OF INFECTION IS THROUGHGASTROINTESTINAL TRACT OR RESPIRATORYTRACT. IN HEAD AND NECK, LESIONS ARE MOSTLIKELY TO OCCUR IN NASAL CAVITY,PARANASAL SINUSES AND OROPHARYNX. 53. ACUTE AND CHRONICINFLAMMATORYINFILTRATE IS SEEN INRESPONSE TOFUNGUS. CHARACTERISTICNECROTIC WALLSCONTAINING THROMBIAND FUNGI MAY BEEVIDENT. THE FUNGUSCONSISTS OF LARGEPALE STAINING NON -SEPTATE HYPHAETHAT TEND TOBRANCH AT 90DEGREES. 54. THE NEOPLASMS INCLUDE1. SQUAMOUS CELL CARCINOMA2. CARCINOMA OF MAXILLARY SINUS3. OTHER CARCINOMAS 55. ORAL AND OROPHARYNGEAL SQUAMOUS CELLCARCINOMAS REPRESENT ABOUT 3% OF CANCERSIN MEN AND 2% IN WOMEN. OF ALL THE FACTORS, TOBACCO IS REGARDED ASTHE MOST IMPORTANT ESP THE CIGAR, PIPE ANDREVERSE SMOKING. THE TIME-DOSE RELATIONSHIP OF CARCINOGENSFOUND IN TOBACCO IS OF MUCH IMPORTANCE INTHE CAUSE OF ORAL CANCER. MICRO ORGANISMS SUCH AS CANDIDA ALBICANSPRODUCES N-NITROSOBENZYLMETHYLAMINECARCINOGEN AND HPV SUBTYPES 16 AND 18PRODUCES ORAL SQUAMOUS CELL CARCINOMAS. 56. CARCINOMAS OFLOWER LIPS AREMORE COMMONTHAN UPPER LIPLESIONS BUT THEGROWTH RATE ISSLOWER. THEY APPEARCOMMONLY INELDERLY PATIENTSMOSTLY AFFECTINGMEN 57. SQUAMOUS CELLCARCINOMA OFTONGUE IS THEMOST COMMONINTRAORALMALIGNANCY THESE PRESENT ASAN INDURATED,NON HEALINGULCER, AS A REDLESION, AS AWHITE LESION ORAS A RED-WHITELESION. 58. MALIGNANCIES OF PARANASALSINUSES OCCUR MOST COMMONLYIN MAXILLARY SINUS. THIS AFFECTS ELDER PEOPLE ANDGENERALLY MEN. PAST HISTORY FREQUENTLYINCLUDES SINUSITIS. AS THE NEOPLASM EXTENDSTOWARDS APICES OF MAXILLARYPOSTERIOR TEETH, REFERRED PAINMAY OCCUR. TOOTHACHE WHICH ACTUALLYREPRESENTS NEOPLASTICMOVEMENT OF SUPERIOR ALVEOLARNERVE IS THE COMMON SYMPTOMOF MAXILLARY SINUSMALIGNANCIES. OCCASIONALLY IT MAY PRESENT ASPALATAL ULCER AND MASSREPRESENTING EXTENSIONTHROUGH THE BONE AND SOFTTISSUE OF PALATE.