Classification Of Vesiculobullous Lesions Of Oral Cavity Pdf Download

Persistent oral ulcers and erosions can be the final common manifestation, sometimes clinically indistinguishable, of a diverse spectrum of conditions ranging from traumatic lesions, infectious diseases, systemic and local immune-mediated lesions up to neoplasms. The process of making correct diagnosis for persistent oral ulcers still represents a challenge to clinicians. Major diagnostic criteria should include the clinical appearance of both ulcer and surrounding non-ulcerated mucosa, together with the evaluation of associated signs and symptoms, such as: number (single or multiple), shape, severity of the ulcer(s), conditions of remaining mucosa (white, red or with vesiculo-bullous lesions) and systemic involvement (e.g. fever, lymphadenopathy or evaluation of haematological changes). The aim of this paper was to review the literature relating to persistent oral ulcers and provide a helpful, clinical-based diagnostic tool for recognising long-standing ulcers in clinical dental practice. The authors, therefore, suggest distinguishing simple, complex and destroying (S-C-D system) ulcerations, as each requires different diagnostic evaluations and management. This classification has arisen from studying the current English literature relating to this topic, performed using MEDLINE / PubMed / Ovid databases.

Abstract:The aim of this study is to report on the oral lesions detected in 123 patients diagnosed at the University Hospital of Bari from October 2020 to December 2020, focusing on the correlation of clinical and pathological features in order to purpose a new classification. Methods. General and specialistic anamnesis were achieved and oral examination was performed. The following data were collected: age/gender, general symptoms and form of Covid-19, presence and features of taste disorders, day of appearance of the oral lesions, type and features of oral lesions and day of beginning of therapies. If ulcerative lesions did not heal, biopsy was performed. Results. Many types of oral lesions were found and classified into four groups considering the timing of appearance and the start of the therapies. Early lesions in the initial stages of Covid-19 before the start of therapies was observed in 65.9% of the patients. In the histopathological analysis of four early lesions, thrombosis of small and middle size vessels was always noticed with necrosis of superficial tissues. Conclusion. The presence of oral lesions in early stages of Covid-19 could represent an initial sign of peripheral thrombosis, a warning sign of possible evolution to severe illness. This suggests that anticoagulant therapies should start as soon as possible.Keywords: Covid-19; oral lesions; oral ulcers; classification

The prevalence of oral mucosal changes ranges between 10.8 and 61.6% in various populations [1,2,3,4,5,6]. Differences in the reported prevalence can be explained by study protocol, participant individual selection, genetics, age, and sex, as well as local and general risk factors in the study population [1, 2]. Oral mucosal changes can be divided by clinical features into the following major groups: normal variations and oral mucosal lesions (OML), including vesiculobullous lesions, ulcerative conditions, white lesions, red-blue lesions, pigmented lesions, verruca-papillary lesions, tongue and buccal mucosa swellings, gingival swellings, palatal swellings and floor of mouth swellings [7].

The incidence of OMLs increases with age, partially due to physiological changes in the oral cavity but also due to the sustained impact of risk habits. Decreased saliva flow and long-lasting effects of local and systemic factors, such as alcohol intake, smoking, snuff and drug use predispose individuals to various lesions which are not present in children, unlike some normal mucosal variations, such as geographic tongue, which already exist among youth [3, 7, 18].

Afterwards, oral pathologist (TS) and oral mucosal disease specialists (AK, TS) simultaneously re-analysed all the pictures and, based on them and on the documentation by the general dentists, they provided consensus diagnoses for all the findings. Specialists disagreed in 24.3% of the lesions and agreed in 54.8% of the proposed diagnosis by the general dentists. Of the documented lesions, 20.9% had no proposed diagnosis by the general dentists and were diagnosed afterwards based documentation and pictures by two specialists. The total number of examinees who had oral mucosal lesions was 206. There were no false-positive cases.

The number of mucosal lesions per person was calculated, and lesions and diseases were categorised into 11 main groups based on the Regezi et al. textbook [7] as following: no changes, normal variations, vesiculobullous lesions, ulcerative conditions, white lesions, red-blue lesions, pigmented lesions, verruca-papillary lesions, connective tissue lesions (CTL), divided by region into tongue and buccal mucosal swellings, gingival swellings and floor of mouth swellings.

In this cross-sectional study, we investigated the prevalence of oral mucosal changes in the Northern Finland Birth cohort (1966) of 1961 participants at the age of 46 years. The overall prevalence of any mucosal changes was 10.5%, of which 4% were grouped as potentially malignant disorders: OLD was found in 3.5% and leukoplakia in 0.5% of the study population. Unlike alcohol intake, both current smoking and snuff use significantly increased the number of mucosal changes. In general, males had mucosal lesions more often than females, related to their drinking, smoking and snuff use habits.

Physical traumatic ulcers are more common in oral cavity. Mainly due to sharp tooth,ill- fitting dentures,rough fillings ,fractured restoration,orthodontic appliance,sharp foreign body,bitting1.Appears as yellow base with erythematous borders & heals in 7 -14 days if cause is removed.

Pyostomatitis vegetans is an uncommon inflammatory disease of the oral cavity.Occurs in upper & lower anterior vestibule.Sometimes hard & soft palate ,tongue involvement is uncommon.Many small projections show tiny pustules beneath the epithelium,which liberate purulent material when ruptured.These leaves areas of ulceration,which may coalesce into form an large areas of necrosis known as snail track ulcerations.Palatal lesion appeared as multiple apthous ulcers14.

Different viral agents, such as herpesviruses, human papillomavirus, and Coxsackie virus, are responsible for primary oral lesions, while other viruses, such as human immunodeficiency virus, affect the oral cavity due to immune system weakness. Interestingly, it has been reported that coronavirus disease 2019 (COVID-19) patients can show cutaneous manifestations, including the oral cavity. However, the association between oral injuries and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is still unclear. This narrative review aimed to summarize the available literature and provide an overview of oral lesions associated with COVID-19. An online literature search was conducted to select relevant studies published up to November 2020. The results of 17 studies showed variability in oral lesions associated with COVID-19, including ulcerations, aphthous-like lesions, and macules. The tongue, lips, and palate were the most frequent anatomical locations. According to current knowledge, the etiopathogenesis of multiple COVID-19-associated lesions seems to be multifactorial. The appearance of such lesions could be related to the direct or indirect action of SARS-CoV-2 over the oral mucosa cells, coinfections, immunity impairment, and adverse drug reactions. Nevertheless, COVID-19-associated oral lesions may be underreported, mainly due to lockdown periods and the lack of mandatory dispositive protection. Consequently, further research is necessary to determine the diagnostic and pathological significance of oral manifestations of COVID-19. All medical doctors, dentists, and dermatologists are encouraged to perform an accurate and thorough oral examination of all suspected and confirmed COVID-19 cases to recognize the disease's possible early manifestations.

Erythema multiforme is an acute, self-limited, and sometimes recurring skin condition considered to be a hypersensitivity reaction associated with certain infections and medications (Table 11,2).2,3 Previously, the condition was thought to be part of a clinical spectrum of disease that included erythema minor, erythema major (often equated with Stevens-Johnson syndrome [SJS]), and toxic epidermal necrolysis (TEN), with erythema minor being the most mild and TEN the most severe.4 An often-cited study from 1993 proposed a useful clinical classification of erythema multiforme, SJS, and TEN based on the pattern of individual skin lesions and the estimation of body surface area with detachment of the epidermis (i.e., blisters, denuded areas, or erosions) at the worst stage of the disease (Table 21,2,5,6).5 Although SJS and TEN may represent the same process with differing severity,6 erythema multiforme, with its minimal mucous membrane involvement and less than 10 percent epidermal detachment, now is accepted as a distinct condition. The remainder of this article will focus on erythema multiforme.

The skin lesions of erythema multiforme usually appear symmetrically on the distal extremities and progress proximally.2 Lesions on the dorsal surfaces of the hands and extensor aspects of the extremities are most characteristic.8 Palms and soles also may be involved.6 Mucosal lesions may occur but usually are limited to the oral cavity.1 Erythema multiforme resolves spontaneously in three to five weeks without sequelae, but it may recur.3 Patients in whom it recurs may have multiple episodes per year. In a study involving 65 patients with recurrent erythema multiforme, the mean number of attacks per year was six, with a range of two to 24; the mean duration of the disease was 9.5 years.29

Surprisingly, the reality is quite the opposite. Although this method can be used for the diagnosis of many erosive-vesiculobullous, tumoral and granulomatous diseases, its use is usually limited to herpes virus infections in daily dermatology practice2. In some clinics, this test is not used even for the diagnosis of herpes virus infections; instead patients receive local anesthesia followed by a skin biopsy3. Furthermore, when folliculitis patients are treated without cytological examination, patients with viral, parasitic and fungal folliculitis may receive unnecessary antibiotic treatments for years4. One of the reasons for this is the lack of experience in using this test. Efforts have been made in the past decade to reintroduce Tzanck smear test5,6,7,8,9,10 which has resulted in revived interest11,12,13. Still, this diagnostic tool is nowhere near its full potential. The main textbooks of dermatopathology do not include dedicated sections for cytology or Tzanck smear14,15. 153554b96e

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