Diferential Diagnosis Of Ulcers.

Rajendran Navaradnasinkam , CRI .



INFECTIVE LESIONS BACTERIAL DISEASES  SYPHILIS  GONORRHOEA  TUBERCULOSIS  LEPROSY  ACTINOMYCOSIS  NOMA  ANUG VIRAL DISEASES  ACUTE HERPETIC GINGIVOSTOMATITIS  HERPES LABIALIS  HIV INFECTION  INFECTIOUS MONONUCLEOSIS  HERPES ZOSTER  MEASLES

FUNGAL DISEASES SPOROTRICHOSIS HISTOPLASMOSIS CRYPTOCOCCOSIS MUCORMYCOSIS

TRAUMATIC CONDITIONS MECHANICAL THERMAL CHEMICAL FACTITIOUS INJURY RADIATION INJURY

IMMUNOLOGICAL DISORDERS APHTHOUS ULCER BECHET’S SYNDROME

REITER’S SYNDROME ERYTHEMA MULTIFORME PEMPHIGUS PEMPHIGOID ULCERATIVE LICHEN PLANUS DISCOID LUPUS ERYTHEMATOUS

SYSTEMIC DISEASES LEUKEMIA AGRANULOCYTOSIS CYCLIC NEUTROPENIA PERNICIOUS ANAEMIA CHRON’S DISEASE

NECROTIC CONDITIONS MALIGNANT RETICULOSIS OSTEORADIONECROSIS

MALIGNANT CONDITIONS SQUAMOUS CELL CARCINOMA VERRUCOUS CARCINOMA

MISCELLANEOUS LESIONS ANGULAR CHELITIS CONGENITAL LIP PITS COMMISSURAL PITS NECROTIZING SIALOMETAPLASIA OROANTRAL FISTULA

PRIMARY ORAL HERPES History of generalized prodromal symptoms that precede the oral lesions by 1-2 days. Small vesicles appear on the oral mucosa. They are thin walled surrounded by inflammation. They rupture leaving shallow round discrete ulcers. Entire gingiva is edematous and inflammed.

ERYTHEMA MULTIFORME Starts as a bullae on an erythematous base. It rapidly breaks into irregular ulcers. Lesions are larger, irregular, deeper and often bleed. Involvement of lips are prominent while gingiva is rare.

CONTACT ALLERGIC STOMATITIS

• Reaction occurs at the site of contact. • Includes burning sensation or soreness accompanied by erythema and occasionally forming vesicles and ulcers. ACUTE NECROTIZING ULCERATIVE GIGIVITIS

• Necrotic punched out ulcerations mostly developing in the interdental papillae and marginal gingiva. • A gray pseudomembranous covering. • Putrid halitosis and bad taste.

RECURRENT APHTHOUS STOMATITIS

• Ulcers confined to oral mucosa with no other symptoms. • Recurrent crops of dozens of small ulcers throughout the oral mucosa. • Initially, a localized area of erythema develops, within hours, a small white papule forms ulceration and gradually enlarges over the next 4272 hrs. • Individual lesions are round, symmetric and shallow. • Lesions less common on heavily keratinized palate or gingiva. • Healing occurs without scarring.

BEHCET’S SYNDROME

•Triad of symptoms include recurrent oral ulcers, recurrent genital ulcers and eye lesions. •Most common single site is the oral mucosa. •Lesions are similar to recurrent aphthous ulcers.

RECURRENT HERPES SIMPLEX VIRAL INFECTION

• Occurs in patient with previous history of herpes simplex infection. • Prodromal period of tingling or burning, accompanied by edema at the site of the lesion. • Its followed by formation of a cluster of small vesicles. • Large lesions are common in immuno suppressed individuals. PEMPHIGOUS VULGARIS

• Lesions begin as a classic bullae on a noninflamed base. • Oral lesions appear 3 months before skin lesions. • Lesions are shallow and irregular, and others have detached epithelium at the periphery.

CICATRICIAL PEMPHIGOID

• Lesions present as intact vesicles of the gingival or other mucosal surface but appear more as nonspecific erosions BULLOUS PEMPHIGOID

• Gingival lesions include edema, inflammation and desquamation with localized of discrete vesicle formation. EROSIVE LICHEN PLANUS

• Present as white lesion. • Presence of vesicles, bullae or irregular shallow ulcers of the oral mucosa. • Lesions present for weeks to months.

HISTOPLAMOSIS

• Lesions appear as a papule, a nodule, an ulcer or a vegetation. • If a single lesion is left untreated, it progresses from a firm papule to a nodule which ulcerates and slowly enlarges. MUCORMYCOSIS

• ulceration of the palate, which results from necrosis due to invasion of palatal vesicles. • The lesions is large and deep, causing denudation of underlying bone. • Ulcers in gingiva, lip and alveolar ridge. OSTEORADIONECROSIS

• Ulceration in overlying skin or mucosa especially following extraction of a tooth, denture ulceration, trauma, etc. • Secondary infections lead to radiation osteomyelitis.

LEUKEMIA

• Gingival hyperplasia with bleeding in the most common oral manifestation. • Ulceration of the sulcular epithelium and necrosis of the connective tissue leads to severe spontaneous gingival bleeding.

ANGULAR CHELITIS

•Feeling of dryness of the mouth and burning sensation at the corner of the mouth. •Epithelium at the commisures appear wrinkled. In time, wrinkling becomes more pronounced to form deep fissures or cracks which appear ulcerated, but which do not tend to bleed.

SYPHILIS

PRIMARY SYPHILIS • Chancre occurs on the lip, tongue, palate, gingiva, tonsils, etc. • Chancre are ulcerated, indurated lesions covered by a grayish white membrane and often mistaken for early carcinoma.

SECONDARY SYPHILIS • Mucous patches are seen over the tongue, gingiva, larynx, pharynx, cheek, etc. • Multiple mucous patches in the oral cavity coalesce together and form snail like track like ulcers. • Papules are seen often at the angle of the mouth and they have a typical split pea like appearance. TERTIARY SYPHILIS • Gumma are seen on the hard and soft palate, lips and tongue. • They frequently ulcerate by central necrosis and have a punched out edge with leathery floor

NOMA

• Formation of a painful, red, undurated papule over the alveolar margin. • It is soon followed by the formation of an ulcer which spreads rapidly exposing the underlying bone. Ulcer extends to the mucosal surface of the lips and cheeks. • Later a dark area appears on the skin over the cheek which rapidly undergoes gangrenous necrosis. • A large hole of few inches in size develops on the cheek due to sloughing of the tissue which exposes the inside of mouth, causing severe disfigurement. ACUTE HERPETIC GINGIVOSTOMATITIS

• Reddening of the oral mucosa followed by diffuse, large, whitish ulcers which are surrounded by a red ring of inflammation. • Ulcers are often covered by purulent material.

HERPES ZOSTER

• Produces clusters of vesicles over the face and oral mucosa on one side of face with stinging pain and parasthesia in the region. • Spreads along the distribution of the sensory nerve unilaterally on one side of face while the other side is asymptomatic. • The fragile vesicle rupture and leaves a painful ulcer.

TRAUMATIC ULCER

• Frequently develop on the tongue, vestibule, alveolar ridge or palate. • The lesion exhibits solitary painful ulcer of short duration.