The strong contender under the clinical setting described above is BECHET'S SYNDROME, though it is said to have been eliminated. Now there are clear cut crireria like ISG and ICBG Which assaign points to differrent findings of the syndrome with 2 points to oral apthous ulcers and 2 points to ocular manifestations with one point for each of other manifestations. The diagnosis is acceptable if 3 points exist in favour..luckily here 2 points are already there and if we can rope in one more point, the diagnosis is clinched.This calls for deligent search for other systems involment by referring to respevtive specialists. For instance presence of posterior uveitis is enough to clinch but do we search our necks that much as to make a thorough exm of each system involved. This perticular case presence of genital apthosis is enough to clinch, but how honestly we have looked not asked for this finding? An apthous looking ulcer which is not an apthous ulcer is the lead point. The real apthoys ulcer has a red halow around the ulcers and some lymphadenitis of c. glands exist which is not the case here. Though the llok will disqualify, diagnoses like candiduasis, herpes, LP etc were considered and even treated- perfect example of shot gun therapy. But without result as expected. try for just one more finding by all means, and the efforts might be rewarding. All diseases should fall in the known spectrum, the failure to unearth is due to ourself rather than a mysterious disease . This may not be taken as an afront on any person but a soul searching attempt of self. Thanks for wasting ur valuable time. u may continue.
This is surely a chronic case of aphthous stomatitis. U have already done the relevant tests but probably serum iron and related tests with B12 and vitamin A and D3 should also be done along with bone marrow for malignant cells if not already done. Chronic constipation or worm infestation should be ruled out. l have treated a number of such cases with the following regime. Zocon50 --1 tab daily Supradyn --1 daily, Astimin MForte -1 tab Dail, BIFILAC cap 1BD, Medrol 4 --1BD Cetzine -1 daily, dilosyn tab 1 - bedtime and oral application of Metrogyl Gel +Tess Gel + Zytee Gel (all mixed in the ratio of 1:1:1 and apply 3 to 4 times a day orally and keeping mouth shut for 5 minutes each time
Gastrointestinal disordersare sometimes associated with aphthous-like stomatitis, e.g. most commonlyCeliac disease, but alsoinflammatory bowel diseasesuch asCrohn's diseaseorulcerative colitis.The link between gastrointestinal disorders and aphthous stomatitis is probably related to nutritional deficiencies caused bymalabsorption.Less than 5% of people with RAS have Celiac disease, which usually presents with severe malnutrition, anemia,abdominal pain,diarrheaandglossitis(inflammation of the tongue).Sometimes aphthous-like ulcerations can be the only sign of celiac disease.Despite this association, agluten-free dietdoes not usually improve the oral ulceration. Other examples of systemic conditions associated with aphthous-like ulceration includeReactive arthritis(Reiter's syndrome),and recurrenterythema multiforme.
Sir as I can see there is halo around the ulcer. So it looks like Aphthous ulcer , I understand there is a long history but also to be considerd is itbis on off, so may be just recurrent aphthous ulcer
I too think its apthous and not herpetic , continue triamcinolone , multivitamins and give short course of oral steroids
sir ,since u have entered the fray, how many pemphigus cases have come under observation in ur dental practice that could b confused with apthous like ulcers, it is just an idle curosity question for self satisfaction sir.
Sodium lauryl sulphate(SLS), adetergentpresent in some brands of toothpaste and other oral healthcare products, may produce oral ulceration in some individuals.It has been shown that aphthous stomatitis is more common in people using toothpastes containing SLS, and that some reduction in ulceration occurs when a SLS-free toothpaste is used.Some have argued that since SLS is almost ubiquitously used in oral hygiene products, there is unlikely to be a true predisposition for aphthous stomatitis caused by SLS.
chronic case of aphthous stomatitis folic acid bcom with zinc and choline salicylate gel application ( pansoral / gelora or hexigel ).Rull out local cause eg. sharp edge of tooth and calculus ( tarter) on lingual surface of lower teeth. systemic cause any drug therapy long time lastly food habit work In my practice one pt suffering from apthous stomatitis since 25 yrs He spend more than 3 lacs rs for tratment. simply food habit and business working style changed and subside without medicines
If you haven't ruled out oropharyngeal candidiasis then go for it, this can be painful in some cases. Can give empirical course of fluconazole. If still doesn't work then this can be labeled Complex aphthosis which is recurring multiple aphthus ulcers without the other criteria of Bechet's.
However, there are many factors that are thought to be involved with the development of canker sores, including: Weakened immune system.Allergies to food such as coffee, chocolate, cheese, nuts, and citrus fruits.Stress.Viruses and bacteria.Trauma to the mouth.Poor nutrition.Certain medications.
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*Stomatitis* Description of stomatitis The term stomatitis means inflammation of the mouth. It usually refers to all the mucosal linings of the mouth including the cheeks, tongue, and gums. Stomatitis can be painful and result in sores. The two most common sores are canker sores and cold sores. Aphthous stomatitis is usually defined as canker sores that recur on a somewhat regular basis and is a fairly common condition. ￼ Types There are two main types of stomatitis: Canker sores These are also known as aphthous ulcers and are part of the most common cause of stomatitis. The sores are pale white or yellowish in color with a red outer ring. Canker sores can develop singly or in a cluster and usually occur on the inside of the lips or cheek, or on the tongue. Canker sores lead to acute, temporary pain. In minor cases, which are the most usual, the ulcers heal within 4-14 days. In more severe cases, which account for about 1 in 10 of all cases of stomatitis, the sores can last up to 6 weeks. Anyone can get canker sores, although women and people in their teens and 20s are more likely to experience them. They can run in families but are not contagious. Cold sores Cold sores are small, painful, fluid-filled sores that usually occur on or around the lips near the edge of the mouth. Caused by the herpes virus (HSV), the condition is also known as herpes stomatitis. A person may experience a tingling or burning sensation before the sore appears, as well as tenderness. Cold sores dry up and crust over with a yellow-colored scab. Cold sores tend to last for around 5-7 days and can keep coming back. They are also very contagious. Stomatitis can be broken down into different categories, depending on which area of the mouth is affected: Cheilitis – Inflammation of the lips and around the mouth Glossitis – Inflammation of the tongue Gingivitis – Inflammation of the gums Pharyngitis – Inflammation of the back of the mouth Pathophysiology of stomatitis The oral mucosa is relatively resistant to irritants and allergens due to the following anatomical and physiological factors: High vascularization that favors absorption and prevents prolonged contact with allergens The low density of Langerhans cells and T lymphocytes Dilution of irritants and allergens by saliva that also buffers alkaline compounds What causes the onset of stomatitis? An infection of the herpes simplex 1 (HSV-1) virus causes herpes stomatitis. It is more common in young children between the ages of 6 months and 5 years. People exposed to HSV-1 may develop cold sores later in life as a result of the virus. HSV-1 is related to HSV-2, the virus that causes genital herpes, but it isn’t the same virus. Aphthous stomatitis can be one or a cluster of small pits or ulcers in the cheeks, gums, the inside of the lips, or on the tongue. It’s more common in young people, most often between 10 and 19 years of age. Aphthous stomatitis is not caused by a virus and is not contagious. Instead, it’s caused by problems with oral hygiene or damage to mucous membranes. Some causes include: Dry tissues from breathing through the mouth due to clogged nasal passages Small injuries due to dental work, accidental cheek bite, or other injuries Sharp tooth surfaces, dental braces, dentures, or retainers Celiac disease Food sensitivities to strawberries, citrus fruits, coffee, chocolate, eggs, cheese, or nuts Allergic response to certain bacteria in the mouth Inflammatory bowel diseases Autoimmune diseases that attack cells in the mouth HIV/AIDS Weakened immune system Deficiency in vitamin B-12, folic acid, iron, or zinc Certain medications Stress Candida albicans infection Risk Factors Genetic factors Food hypersensitivities/allergens; common ones include nuts; shellfish; cinnamon; fruits; metals; dental materials; and ingredients in toothpaste, mouthwash, and gum. Local trauma: poor-fitting dentures, tooth brushing, local anesthetic injection, dental work Hormonal changes (menstrual cycle, pregnancy, and dysmenorrhea) Stress/anxiety Nutritional deficiencies (iron, folate, ferritin, vitamin B6, vitamin B12) Tobacco cessation Medications, for example, methotrexate, NSAIDs, phenobarbital Immunologic: HLA-B12 Immunologic gastrointestinal diseases: Crohn disease, celiac disease Systemic diseases: Behçet syndrome; cyclic neutropenia; HIV infection; periodic fever, aphthous stomatitis, pharyngitis, cervical adenitis (PFAPA); reactive arthritis; Sweet syndrome; mouth and genital ulcers with inflamed cartilage (MAGIC) syndrome Cancer therapies Clinical manifestations of stomatitis Stomatitis often results in pain, stinging, and soreness. Each person may experience different symptoms. These can include: Mouth ulcers with a white or yellow layer and red base, usually inside the lips, cheek, or on the tongue Red patches Blisters Swelling Oral dysaesthesia – a burning feeling in the mouth Lesions that heal in 4-14 days and often recur ￼ Complications of stomatitis Some complications of stomatitis include: Life-threatening complications Meningoencephalitis Other Common Complications Recurrent skin and mouth infections Dissemination of the infection Noma Complications Teeth loss How your doctors diagnose stomatitis? History A patient will complain of pain, burning sensation, intolerance to temperature extremes, and irritation with certain foods. During the review of clinical history, determine the onset, progression, number of ulcers/lesions, size of lesion, duration of each lesion, frequency, size, and whether it heals with a scar or not. This information helps diagnose localized versus systemic lesions. Physical Exam The physical exam should include a comprehensive oral examination. The extraoral exam includes inspection and palpation of cervical lymph nodes. Examine and palpate the lips, tongue, cheeks, and hard and soft palate as well as cervical, submandibular, and submental lymph nodes. Erythema and edema are the usual oral manifestations, often with ulcerations. Some will have constitutional symptoms: low-grade fever, malaise, lymphadenopathy, and headache. The pain will vary. Tests might include: Swabs, both bacterial and viral Tissue scrapings or swabs for fungal infections Biopsy, or the removal of cells or tissue for further study Blood tests Patch tests to identify allergy Treatment for common forms of stomatitis Mouth sores generally don’t last longer than two weeks, even without treatment. If a cause can be identified, your doctor may be able to treat it. If a cause cannot be identified, the focus of treatment shifts to symptom relief. The following strategies might help to ease the pain and inflammation of mouth sores: Avoid hot beverages and foods as well as salty, spicy, and citrus-based foods. Use pain relievers like Tylenol or ibuprofen. Gargle with cool water or suck on ice pops if you have a mouth burn. For canker sores, the aim of treatment is to relieve discomfort and guard against infection. Try the following: Drink more water. Rinse with saltwater. Practice proper dental care. Apply a topical anesthetic such as lidocaine or xylocaine to the ulcer (not recommended for children under 6). Use a topical corticosteroid preparation such as triamcinolone dental paste (Kenalog in Orabase 0.1%), which protects a sore inside the lip and on the gums. Blistex and Campho-Phenique may offer some relief of canker sores and cold sores, especially if applied when the sore first appears. For more severe sores, treatments may include: Lidex gel Aphthasol, an anti-inflammatory paste Peridex mouthwash ￼ If you seem to get canker sores often, you may have a folate or vitamin B12 deficiency. Talk to your doctor about being tested for these deficiencies. Anti-inflammatory drugs such as corticosteroids (including prednisone) are the most effective treatment for canker sores, as they will reduce swelling and pain. They are also effective for cold sores after the sore has been present for three to four days because at that point the virus has disappeared and only the inflammation remains. Not all people can take certain types of anti-inflammatory drugs. For example, if prednisone is given to people with diabetes, their blood sugars will go up. Talk to your doctor about any health conditions you have before starting a new medication. There is no cure for cold sores. Treatment includes: Taking a dose of valacyclovir (Valtrex) at the first sign of an attack Coating the lesions with a protective ointment such as an antiviral agent (for example, 5% acyclovir ointment) Applying ice to the lesion Taking L-lysine tablets may also help, as might antiviral mediations that a doctor prescribes. Some experts believe that these drugs shorten the time that the blisters are present. Not all sores are harmless. Schedule an appointment with your doctor if your mouth sores haven’t healed within two weeks. Prevention of Stomatitis About 90% of the population carries HSV. There’s little you can do to prevent your child from picking up the virus sometime during childhood. Your child should avoid all close contact with people who have cold sores. So if you get a cold sore, explain why you can’t kiss your child until the sore is gone. Your child should also avoid other children with herpetic stomatitis. If your child has herpetic stomatitis, avoid spreading the virus to other children. While your child has symptoms: Have your child wash his/her hands often. Keep toys clean and don’t share them with other children. Don’t allow children to share dishes, cups, or eating utensils. Don’t let your child kiss other children.Dr. Shailendra Kawtikwar6 Likes5 Answers
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57 year old male known case of HTN and DM. Complaints of soreness of mouth and tongue. Recurrent about 4 times per year. It was improved before on miconazole gel. No GI symptoms, not a smoker What do you think? It could be herps ?? Or aphthous ulcers? Underlying disease??Dr. Reema Sharma3 Likes19 Answers
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widespread ulcerative lesions present since 2 months in oral cavity, eye and genitals..no h/o medication, hiv, blood investigation all Normal.. biopsy gives allergic reaction...I was thinking in terms of vesiculobullous lesions.. patient is poor to go for other investigations..plz suggest diagnosis and treatment plan..Dr. Apala Baduni5 Likes24 Answers
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Diabetic middle aged male with 4-5 days history of Oral lesion. .suggestions please. .Dr. Ziaul Haque3 Likes27 Answers
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42 y/o male with no significant medical history presented with oral ulcerations x 1.5 weeks. Ulcerations initially scattered in only 3 to 5 mm, increasing in size until they coalesce together into one large ulcer (as seen on the hard palate) + submandibular lymphadenopathy, no fever, no other sx. Has had recurrent episodes, always unilateral, sometimes only on the lateral aspect of the tongue, subsequent episodes always with increased pain and ulcer size. Any ideas? Apthalmous ulcer? Oral shingles (doesn't cross midline)? Vitamin B-12/folate deficiency?Dr. Nitin Jaiswal2 Likes23 Answers