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 42-
72 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.