Basic lesions, aphthae and aphtoses of the oral mucosa

Basic lesions, aphthae and aphtoses of the oral mucosa

Introduction :

In Dermatology, the elementary lesion translates at the morphological level, a lesion process, and allows a rational classification of the pathology. In the oral cavity, one can attempt a transposition of the elementary dermatological lesions, but the primitive elementary lesions of the oral cavity are rapidly modified by the presence of saliva which dissociates the epithelial layers, and by the incessant movements of the tongue, lips and teeth.

In practice, there is a tendency to oversimplify the description of basic lesions of the oral mucosa by speaking of white lesions and red lesions, whether they are flat or raised.

1. The main elementary lesions of the oral mucosa:
2. Stains, beaches, and cupboards: 

• Macules correspond to a change in the color of the mucosa over a limited surface without relief or infiltration.
• A plaque or patch corresponds to a change in the color of the oral mucosa whose diameter exceeds 0.5 cm in diameter.
• These single or multiple lesions most often have clear limits and may be erythematous, white or pigmented, or on the contrary hypochromic or achromic.
• Subjective signs include: a burning sensation, annoyance.
• On histological examination, they respond to capillary dilation without extravasation of red blood cells, sometimes epithelial atrophy is observed.

2. Plaques and papules:

• Raised and circumscribed lesions, solid, not containing liquid, we speak of plaque when the diameter exceeds 0.5 cm in diameter.
• They may be related to an increase in the diameter of the epithelium, or an increase in the volume of the chorion; 
• Papules may be chorioepithelial, well-circumscribed, and may be erythematous, white, pigmented, or hypochromic.

3. Nodules:

• These are round, protruding bumps, with a diameter greater than 1 cm, 
• correspond to a deep infiltration of the chorion by cellular proliferation
• These are most often tumors, whether benign or malignant.

4. The vesicles:

• Small intra-epithelial elevations containing a clear, serous or serohaematic fluid of 0.5 to 5 mm in diameter, these vesicles leave small rounded erosions, isolated from each other or confluent.
• These flat and superficial erosions have a base covered with a fibrinous and flat coating often surrounded by an erythematous areola. The etiology is essentially viral.

5. Bullous lesions:

• Bullae are rounded or oval epithelial detachments of variable size, they contain a serous or hemorrhagic fluid, their presence is generally ephemeral because of the fragility of the roof, oral humidity and food trauma.
• Bullous conditions may occur in isolation or in association with a skin rash.

6. Erosions: 

• They can be primitive or secondary: 
• It is a loss of superficial substance, without necrosis of the underlying tissues, the bottom of the lesion retains a more or less red color;
• The well-circumscribed character with a whitish epithelial collar suggests post-bullous or post-vesicular erosion.

7. Ulcerations:

• Deep loss of substance with destruction of the oral epithelium and the upper part of the chorion, unlike erosion or loss of substance only concerns the superficial part of the epithelium.

8. Vegetations:

• Papillomatous growths forming circumscribed-based elevations.

9. Pustules: 

• They are rarely observed and cause a lifting of the epithelium containing pus.

10. The cracks: 

• Linear erosions of the epithelium and the superficial part of the chorion 
• They are normally observed on the dorsal surface of the tongue;
• They affect the corners of the lips in certain chronic candidiasis, giving the appearance of angular cheilitis.

Basic lesions, aphthae and aphtoses of the oral mucosa

2. Aphthae and aphthosis of the oral mucosa:

Aphtha is the lesion common to all forms of aphthosis. Aphthosis are usually classified into minor and herpetiform forms, which seemed to us to be more consistent with the situations encountered in practice.

Whatever the clinical form, the basic lesion is the same. Sometimes preceded by a burning sensation.

II.1 ) The different clinical forms:

1. Isolated canker sore, basic lesion: 

• The initial lesion is an eryhematous macule
• Round or oval ulceration, surrounded by an erythematous halo, with a yellowish background 
• Location: lips, palate, inner side of cheeks, gingivolabial groove, etc.
• Non-infiltrated lesion, without satellite adenopathies.
• The differential diagnosis is made with traumatic ulceration, oral chancre of oral syphilis

2. Common aphthosis:

• The thrust consists of one to three elements measuring from 3.6 to 10 mm.
• Spontaneous evolution towards healing in 8 days.
• Triggering circumstances are mentioned and are specific to each patient: food, dental care, stress, fatigue, etc.
• Outbreaks are rare, with latency periods of several months.
• The assessment of common aphthosis is essentially etiological 
• Treatment is symptomatic.
• Canker sore outbreaks are relieved by the application of topical agents: antiseptics, topical anesthetics, analgesics.

3. Multiple aphthosis:

• Rare, made of 4 to 10 well-individualized elements;
• Sometimes confluent, they take on a herpetiform appearance.
• The assessment is essentially etiological; trying to find the triggering circumstances in order to be able to avoid them; 
• The general condition is preserved, 
• Treatments are symptomatic but do not reduce the duration of the outbreak.

4. Miliary aphthosis: 

• Special form of multiple aphthosis
• The elements are numerous from 10 to 100, rarely confluent; 
• Extremely painful
• This form must be differentiated from primary infection herpetic stomatitis, 
• Miliary aphthosis must be differentiated from primary infection herpetic stomatitis, clinical diagnosis is sometimes difficult, but certain elements can point towards viral infection: confluence of elements, alteration of the general condition, fever, perioral lesions
• Treatment of miliary aphthosis remains symptomatic.

Basic lesions, aphthae and aphtoses of the oral mucosa

5. Giant aphthosis:

• Size greater than 1 cm
• The lesion is most often unique; 
• The ulceration is sometimes infiltrated with edema, sometimes necrotic, and develops over several weeks, sometimes several months;
• Functional signs are important, such as dysphagia, dysphonia, hypersalivation.
• Treatment: Thalidomide at a rate of 100mg per day and causes in a few days a spectacular sedation of the pains which had been developing for several weeks, but it remains an old drug which causes serious congenital malformations in pregnant women. Treatment with local corticosteroids has demonstrated its effectiveness.

6. Special forms:

• in digestive pathologies: Crohn’s disease, ulcerative colitis, 
• in hematological pathologies
• in vitamin deficiencies.

II.2 )  exploration of aphthous ulcers: Initial biological assessment

• may be proposed for the purpose of etiological diagnosis , or pre- therapeutic evaluation
• Blood count NFS, 
• Platelet count, 
• Sedimentation rate, 
• Liver and kidney function, 
• HIV serology.

Conclusion :

Oral dermatology remains a very vast field, knowledge of the elementary lesions of the oral mucosa helps with diagnostic orientation, sometimes the diagnosis of a general pathology is made by the dentist through initial lesions of the oral mucosa.

Basic lesions, aphthae and aphtoses of the oral mucosa

  Untreated cavities can reach the nerve of the tooth.
Porcelain veneers restore a bright smile.
Misaligned teeth can cause headaches.
Preventative dental care avoids costly treatments.
Baby teeth serve as a guide for permanent teeth.
Fluoride mouthwash strengthens tooth enamel.
An annual checkup helps monitor oral health.
 

Basic lesions, aphthae and aphtoses of the oral mucosa