LONG CASE

PRESENTATION
ANURTHA K
Personal data
 Name : Farsana
 Age and sex : 16/f
 OP no. 20826 /16 address : kalavu
 Occupation :student
Chief complaint
 Patient came for dental check up after
surgery on gums of lower front tooth two
weeks back
History of presenting illness
 Patient gives history of surgical excision of gums
in relation to mandibular right lateral incisor two
weeks back
 No h/o pain or sensitivity
 MEDICAL HISTORY
 No relevant medical history

 DENTAL HISTORY
 Gingivectomy

 Family history
 Father is diabetic and is under medication

 PERSONAL HISTORY
 Mixed diet
 No deleterious habits
 Brushes twice daily using soft brush and paste
 GENERAL EXAMINATION
 Steady gait
 Moderately built and nourished
 Well oriented to time place and date
 VITAL SIGNS
 BP -
 Pulse rate -
 Respiratory rate – DEFERED
 Temperature -

 Pallor
 Icterus
 Cyanosis
 Clubbing ABSENT
 Lymphadenopathy
 Edema
Extra oral examination

 Face
 Nose
 Eyes
 Skin NAD
 TMJ
 Salivary glands
 Muscles of mastication
 Lymph node
SOFT TISSUE EXAMINATION
 GINGIVA
 Color –red
 Contour - scalloped
 Consistency - soft & oedematous
 Position - at CEJ
 Bleeding on probing - present irt lower

anteriors
 Surface texture – stippling absent
 Periodontal pockets – absent
 Buccal mucosa -NAD
 Labial mucosa-pin point ulceration on the left labial
mucosa
 Floor of mouth
 Tongue
 Palate
 Vestibule : NAD
 Lips
 Tonsils
 Oropharynx
Hard tissue examination
 Teeth present - 28
 Missing teeth - 18 ,28,38,48
 Dental caries - 47
 Dental caries with pulpal involvement – absent
 Root stumps - absent
 Wasting disease - absent
 Mobility – absent
 Occlusion – Bilateral Angles class 1
 Fractured teeth - absent
 Deposits – moderate amount of calculus and mild
amount of plaque and stains
Local examination
 SOFT TISSUE EXAMINATION
On inspection –Gingiva is red in colour ,
sippling lost wrt 42
 On palpation – bleeding on probing present

wrt lower anteriors

HARD TISSUE EXAMINATION.
 On ispection moderate amount of

calculus,mild amount of plaque&.stain present

.
 Incidental finding : INSPECTION: A single
ulcer of size 4x 6 mm with well defined
magins and white color floor and an
erythematous halo is situated on left labial
mucosa. Surrounding area is normal .

 PALPATION: the ulcer is tender tpalpation.,no

disc
Case summary
 Farsana 16 year old female hailing from kalavu
came to the clinic for dental check up after gingival
excision in relation to mandibular right lateral
incisor ,on examination gingiva is red in colour ,soft
&oedematous ,stippling is lost in relation to 42 .

 Moderate amount of calculus ,mild amount of

plaque &stain were found
 Incidental finding is well defined , single , shallow
white colored ulceration of size 4x6mm with
erythematous halo situated on left buccal mucosa .

 Slight tenderness on palpation.no discharging

present.surrounding area is normal.
Provisional diagnosis
 Chronic generalsed gingivitis
 Recurrent Aphthous ulcer minor
 dental caries wrt47
treatment
 oral prophylaxis
 Dolo gel ointment for topical administration

and kenacoat for topical administration

 Restoration wrt 47
aphthous ulcer
 Recurrent aphthous ulcer is characterized by recurring ulcers
confined to oral mucosa in patients with no other signs of
disease.

 ETIOLOGY
1. Bacterial infection : alpha hemolytic streptococci , streptococcus
sanguis
2. Immunological abnormalities
3. Psychological factors - stress
4. Allergic factors - ex; asthma , hay fever , food or drug
allergy
5. Local factors - trauma and smoking
6. Hematological deficiency - serum iron , folate , vit b 12
deficiency
Clinical classification
1. Recurrent aphthous ulcer minor
2. Recurrent aphthous ulcer major
3. Reccurrent herpetiform ulcerations
4. Aphthous ulcer related to behcets syndrome
Recurrent aphthous ulcer minor
• Age - more in younger women
• Site - mostly on non keratinized mucosa - buccal and

lingual mucosa , buccal and lingual sulcus , soft palate

pharynx.
• Symptoms :

 most common form

 painful small sized lesions - (2.3 - 10 mm)
 begin as single or multiple erosions covered by
a greyish membrane and
inflammatory halo.
 healing occurs in 7-14 days
 no evidence of scarring
Recurrent aphthous ulcer major
 More common in HIV patients
 Large sized painful lesions occuring on

keratinized mucosa
 Lesion exceeds 1 cm in diameter.
 Persists upto 6 weeks and healing occurs with

scarring.
Recurrent herpetiorm ulcerations
 Crops of multiple ulcers often upto 100 in
number
 More painful
 Begin as small pinhead sized erosions

which gradually enlarge and coalesce.

 Perists 1 – 3 years
Laboratory findings
• Biopsies - indicated only when it is
necessary to exclude other diseases
particularly granulomatous diseases such
as crohn disease sarcoidosis or blistering
diseases such as pemphigus or pemphigoid.
• Hematological findings - reduced levels of
serum iron , folate , vit B12 in patients with
minor and major aphthous ulcer.
DIFFERENTIAL DIAGNOSIS
 Erythema multiforme
 Erosive lichen planus
 Herpetic stomatitis
management
• In mild cases with two or three small lesions , protective
emollient such as orabase or zilactin, a topical anesthetic is
all that necessary.

• Pain relief of minor lesions can be obtained with use of o

topical anesthetic agent or a topical diclofenac
• In more severe cases - fluocinonide , betamethasone or
clobetasol (high potency topical steroid preparation).

• Other topical preparations that have been shown to decrease

the healing time of RAS lesion Include amlexanox paste
and topical tetracycline, which can be used either as
mouth rinse or applied on gauze sponges.

• Steroid gel – can be carefully applied directly to the lesion

after meals and at bed time two or three times a day
REFFERENCE
• BURKETS ORAL MEDICINE
• SHAFERS ORAL PATHOLOGY
THANK YOU