3 Benign Inflammatory Lesions
3 Benign Inflammatory Lesions
3 Benign Inflammatory Lesions
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within 24-48 hours with 0.05% betamethasone or clobetasol gel. These gels should be
applied 4-5 times daily and are more effective intraorally than ointments or creams.
For patients with multiple lesions, or RAS in difficult to reach locations such as the soft
palate or tonsillar pillars, syrups or elixirs may be more practical. For example,
prednisolone is available in syrup form and can be used in a swish and spit regimen.
Another product for use in the fauces is beclomethasone dipropionate aerosol spray. In
cases resistant to these medi- cations, systemic steroids in tablet form may be considered
or else a swish and swallow steroid syrup can be used for both topical and systemic effects
Prognosis: Good, if the patient can gain relief from pain and sustain adequate nutrition
and hydration.
Differential Diagnosis: They are commonly confused with herpetic ulcerations. Possible
differential diagnoses include: trauma, soft tissue lesions due to inflammatory bowel
disease.
2. Traumatic ulcer:-
An ulcer is a localized area of discontinuity in surface epithelium. Traumatic ulcers are
frequently observed in the oral cavity and can be of such varying size and shape that they
are difficult to characterize. Simple traumatic ulcers are most often found on the buccal
mucosa, tongue, and lips, but may also occur anywhere in the mouth. They appear as areas
of erythema covered by a yellowish membrane of variable thickness. A rolled
hyperkeratotic border may develop adjacent to the ulcer.
Etiology: In many cases of traumatic ulceration, there is a corresponding source of
irritation. They may be due to mechanical damage from food, self-inflicted injury (such as
biting), occur due to mastication, a result of toothbrushing injury, malocclusion, broken
down or sharp teeth, placement of restorations, prosthesis irritation or injury during sleep.
Ulcerations can also be caused by thermal, chemical or electrical burns.
A histologically specific type of ulcer with elevated and indurated margins called
traumatic ulcerative granuloma with stromal eosinophilia (TUGSE) resembles squamous
cell carcinoma. It most often affects the tongue and exhibits deep inflammation that
resolves more slowly and typically requires biopsy. An unusual occurrence is that
incisional biopsy often appears to initiate healing.
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Treatment: Relieving an obvious source of irritation or toxic agent should result in
resolution of an ulcer. Symptomatic relief can be provided by over-the-counter
bioadhesive preparations. In some cases clinicians advocate application of corticosteroids
to speed healing, while others claim this will delay healing.
Prognosis: When the source of the trauma is removed, the ulcer should resolve. If healing
does not occur in 2-3 weeks, a biopsy must be performed.
Differential Diagnosis: Squamous cell carcinoma, Riga-Fede disease, TUGSE, ulcerative
mucosal disease such as lichen planus.
4. Lichen planus:-
Lichen planus is a relatively common chronic, inflammatory, mucocutaneous disease seen
most often in middle-aged females. Cutaneous lesions appear as multiple pruritic, purplish,
polygonal papules. On close examination, the skin lesions, which occur mostly on
extensor surfaces of the extremities, will show a fine lace-like pattern of lines known as
Wickham’s striae. Oral lichen planus (OLP) occurs most often in the absence of skin
lesions. There are basically two main forms of OLP, reticular and erosive. The reticular
form is more common and usually appears as multiple lesions with a bilateral symmetrical
pattern. It begins as small white lesions which join to form an annular or plaque-like
pattern. The plaque-like form may be difficult to distinguish from leukoplakia. A typical
appearance shows slender white-gray lines radiating from the oral papules (Wickham’s
striae). Instead of the reticular pattern, the dorsal tongue may exhibit more of a keratotic
plaque-like lesion.
Erosive lichen planus lesions are usually symptomatic to patients and therefore the patient
is more likely to seek professional advice. Atrophic, erythematous lesions with central
ulceration and fine white striae on the periphery of the erosions are seen clinically. If
confined to the gingival mucosa in a pattern scalloping the teeth, this is termed
desquamative gingivitis.
Etiology: The cause is unknown, but appears to be multifactorial and is characterized by a
T- cell medicated chronic immune response and abnormal epithelial keratinization..
Treatment: The reticular and plaque-like lesions are usually asymptomatic and treatment
is not necessary. For symptomatic OLP, topical steroids, such as triamcinolone mouthwash
or mixed with orabase, clobetasol or fluocinonide are used first in treatment. If the OLP is
severe or affects large areas of the oral mucosa, systemic corticosteroids should be
prescribed. Patients should be advised that the lesions will most likely recur and the
possibility of candidiasis associated with corticosteroid use may occur. No therapy
currently cures OLP; the goal of treatment for symptomatic lesions is palliation.
Prognosis: There is still controversy whether OLP is associated with an increased risk of
malignancy. Excessive tobacco and alcohol use should be discouraged and it is
recommended that lesions are observed at least yearly. Isolated erosive lichenoid lesions
should also be biopsied to rule out premalignant or malignant lesions.
Differential Diagnosis: The clinical features may be diagnostic of the typical reticular
form of OLP. However, biopsy is necessary if the form is atypical or if clinical features
suggest the possibility of dysplasia or malignancy. There are many oral lichen planus-like
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or “lichenoid” lesions which can confuse the diagnosis of OLP. Drug reactions, graft-
versus-host disease, and oral contact stomatitis related to dental materials, most often
amalgam, may be indistinguish- able from OLP. In diagnosing erosive lichen planus, other
ulcerative or erosive diseases such as lupus erythematosis and chronic ulcerative stomatitis
should be ruled out by biopsy and immunofluorescent studies. Gingival lesions of erosive
lichen planus may also resemble pemphigoid or pemphigus vulgaris with biopsy and
immunofluorescence required.