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口腔粘膜疾患とは？
What is oral mucosal diseases
口腔粘膜疾患
口腔粘膜とそれに付随する諸組織を含む
Oral mucosal diseases 軟組織の病変の総称である。
General term for disorder in soft tissue involving
oral mucosa and some appendages

口腔健康科学
Oral health science
太田 耕司
Kouji Ohta

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口腔粘膜の構造を復習します
Review structure of normal oral mucosa
口腔粘膜疾患の臨床所見と診断
Method of diagnosis of oral mucosal diseases
角化層
Keratinized layer
口腔粘膜は上皮組織と結合組織
からなる。
顆粒細胞層
Granular layer
上皮組織は４層からなる。
棘細胞層 問診と臨床所見から得る情報が診断の基本
Prickle layer The oral mucosa is mucos となる。
基底細胞層 membrane consists of stratifiied
Basal layer squamous epithelium and connective
tissue (lamina propria)
The clinical symptom obtained from the history
and clinical examinations will be the basis of
Basement membrane presents
between epithelium and connective
diagnosis of oral mucosal diseases
tissue
The epithelium consists of four layers

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口腔粘膜疾患は問診が重要です。 口腔粘膜疾患は性状の把握が重要です。
It is Important to hearing of medical history It is important to understand characteristic feature
1. 部位 5. 境界
1. 年齢，性別 4. 全身疾患 (投薬歴も） Boundary
Localization
Age, Gender Presence of systemic diseases (well-defind or irregular…. )
and medication 2. 表面形態
2. 主訴 Surface figure 6. 弾性
5. 初発時期 Elastic
Chief complain Initial time that symptom occur (hardness, soft…)
3. 色調
(presenting problem)
Color
6.持続性，再発，消長の有無 7. 個数
3. 原因 Number
Continuous, recurrence, 4. 大きさ
Cause (solitary or multiple)
Presence of disappearance Size

口腔粘膜疾患には特徴的な臨床病態を示します。 口腔粘膜疾患は特徴的な「みため」を示します。
Oral mucosal diseases shows specific clinical condition Oral mucosal diseases shows specific clinical feature

全身疾患や投薬に関係して発症する疾患があります。 視診、触診は重要です
Some oral mucosal disease is associated with medication and systemic diseases It is important for diagnose to perform physical exam and palpation

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本題に入る前に７つの専門的用語を勉強します。 本題に入る前に７つの専門的用語を勉強します。
You learn seven technical term for clinical examination You learn seven technical term for clinical examination

腫脹 Swellig
斑；隆起のない限局性の色調変化
局所が腫れていること
Transients abnormal enlargement of local area(not to
Patch; Localized flat color change
cell proliferation)

腫瘤 Lump
局所の組織の限局した増大 （かたまり）
A piece of mass in local area

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本題に入る前に７つの専門的用語を勉強します。 本題に入る前に７つの専門的用語を勉強します。
You learn seven technical term for clinical examination You learn seven technical term for clinical examination

びらん; 上皮内までの組織欠損 アフタ

Erosion; loss of surface tissue within epithelial
粘膜の円形の比較的浅い潰瘍
(superficial) Aphtha ; small round superficial mucosal ulcer

潰瘍; 上皮下の組織欠損
水疱
Ulcer; loss of surface tissue under epithelial (deep) 限局性の半球状隆起で液体含む
Blister ; vesicle contains water fluid

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口腔粘膜に水疱を形成する病変 ヘルペス性口内炎
Diseases that form blister in oral mucosa Herpetic stomatitis

1) ウイルスに起因するもの
Disease that caused by virus 単純性ヘルペスの感染によって口や陰部に
水疱性の口内炎が生じる。
○ ヘルペス性口内炎
Stomatitis like blisters is caused by Herpes simplex
Herpetic stomatitis
virus (HSV) in the mouth and genital regions.
○ その他のウイルス性疾患
Diseases caused by other virus
口腔は主に１型ヘルペス、陰部は２型ヘルペスの
2) 自己免疫性水疱症 感染によって生じる。
Autoimmune vesiculobullous disorders Oral herpes mainly is caused by HSV-1, and
○ 尋常性天疱瘡 genital herpes is caused by HSV-2.
Phemphigus vulgaris Diseases that form blister in oral
mucosa are divided into two
○ 類天疱瘡
groups broadly
Phemphigoide

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ヘルペス性口内炎 ヘルペス性口内炎の治療
Herpetic stomatitis Treatment of herpetic stomatitis

症状）口唇，頬粘膜，舌，歯肉に痛みを伴う水疱が生じる。
破れてびらん，発赤を生じる。その後，痂皮が形成，治癒する。 10 日～１週間で治癒する。
Most patients will get well within
Symptom; Painful blisters occur in lip buccal mucosa, tongue, gingiva. 1 weeks to 10 days without treatment.
ulcers, erosion, cold sores, contagious will be formed
when the blisters rupture
Later, ulcer developed dry scab, and healing 治療；局所の含嗽，栄養の補給，全身的に発症
している場合は抗ウイルス薬を内服
診断）主に臨床所見で見るが，場合によりHSV 抗原の血清テスト Treatment; mouth wash, getting enough sleep and taking
Diagnosis; is largely clinical, occationally, serological test for a good diet may be helpful.
detection for HSV antibody prescribe anti-viral drugs if given in patients who have
severe, wider spread lesions

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帯状疱疹 診断と治療
Herpes zoster Diagnosis and treatment

帯状疱疹は水痘・帯状疱疹ウイルス（VZV) の 確定診断は抗体の証明
感染で，再活性化すると知覚神経の走行に
一致して激しい痛みと小水泡が帯状に発現する。 Serological test for detection for VZV antibody
Herpes zoster is a Varicella zoster virus infection of the
sensory nerve, that results in a painful and blisters on the
affected dermatome being supplied by the peripheral nerve.
治療はアシクロビル錠を内服
片側性顔面で三叉神経の支配領域の１枝に多い acyclovir tablets are used as antiviral drug.
It is caused by the virus reactivating in the
especially, ophthalmic division of the trigeminal
nerve unilaterally.

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Ramsay-Hunt 症候群 Ramsay-Hunt 症候群の治療

Ramsay-Hunt syndrome Treatment of Ramsay-Hunt syndrome

水痘・帯状疱疹ウイルス（VZV)の顔面神経領域の感染による病型
Ramsay Hunt syndrome occurs when VZV infection affects the 治療は抗ウイルス薬、顔面神経麻痺に対して
facial nerve ステロイド，痛みに関しては星状神経節ブロックが施行される。
Three symptoms are important ！ Anti-viral drugs such as acyclovir is
prescribed for infection.
１）外耳道、耳介周辺部の帯状疱疹
Corticosteroids are often prescribed
Blisters occurs in and around one ear
to reduce inflammation of the facial
２）末梢性顔面神経麻痺（Bell 麻痺） nerve.
Stellate ganglion block reduce pain
Bell's palsy also is a result of injury to
the facial nerve by virus infection

３）第Ⅷ脳神経症状として難聴、めまい耳鳴り、神経痛様疼痛
Severe pain, hearing loss, dizziness
as the symptom of eight cranial nerve

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その他のウイルス性水疱性疾患とキーワード ヘルパンギーナ
Diseases caused by other virus and key words Herpangina

ヘルパンギーナ：コクサッキーウイルス、エンテロウイルス
Herpangina: enterovirus or coxsackieviruses,
軟口蓋，口蓋扁桃，夏，水疱
soft palate, tonsillar pillar, summer, blister
手足口病：コクサッキーウイルスA16
Hand, foot, mouth disease : coxsackieviruses
手掌，足，口腔，夏，水疱
Skin of the hands, feet, and oral cavity, summer, blister
主に小児の軟口蓋，口蓋扁桃に痛みを生じる小水疱を認める
大多数はエンテロコッカスウイルスによる感染である。
Herpangina, also called mouth blisters, is the name of a painful
mouth infection caused by almost enterovirus Most cases occur
in the back area of the mouth,
especilly, soft palate or tonsillar pillar in children.
A16

Keeping in mind to remember is beneficial

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手足口病 口腔粘膜に水疱を形成する病変
Hand, foot, mouth disease Diseases that form blister in oral mucosa

コクサッキーウイルスA16 型による感染で夏から秋にかけて 1) ウイルスに起因するもの

小児に発症。 Disease that caused by virus
手掌，足の小水疱，口唇，舌，軟口蓋の水疱形成 ○ ヘルペス性口内炎
Herpetic stomatitis
Hand, foot, mouth disease is caused by coxsackie virus
(A16 type commonly ) infection. Maclopapular rash ○ その他のウイルス性疾患
involve the skin of the hands, feet, and oral cavity. Diseases caused by other virus
HFMD is typically affects children during the summer and autumn
months. Symptom include fever and feeling tired.
Most cases of the diseases go away on their own.
2) 自己免疫性水疱症
Autoimmune vesiculobullous disorders
○ 尋常性天疱瘡
Phemphigus vulgaris Diseases that form blister in oral
mucosa are divided into two
○ 類天疱瘡
groups broadly
Phemphigoide

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細胞接着装置 尋常性天疱瘡
Epithelial Cell attachment mechanism
Phemphigus vulgaris

デスモゾーム
上皮細胞同士
粘膜上皮 デスモゾームを構成するデスモグレイン1, 3 の特異的抗体によって
Desmosome is a
Epithelial structure for epithelial 引き起こされる皮膚，口腔粘膜における自己免疫水疱性疾患
cell-to cell adhesion
Phemphigus vulgaris is autoimmune disease with skin or oral
lesion caused by antibodies against desmoglein 1 and 3
基底細胞層 that is component of desmosome
Basal layer of epithelial ヘミデスモゾーム
基底膜 基底細胞と基底膜
Basal Hemidesmosome is
Key words; Desmosome, Desmoglein 1,3
lamina a structure for
connecting the basal
face of the cell to
結合組織 connective tissue basal lamina

Desmosome and hemidesmosome are Cell attachment molecule.

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細胞接着装置 細胞接着装置
Epithelial Cell attachment mechanism Epithelial Cell attachment mechanism

デスモゾーム
粘膜上皮 上皮細胞同士 粘膜上皮 尋常性天疱瘡は
Desmosome is a デスモゾームを構成
Epithelial structure for epithelial Epithelial
するデスモグレイン1,3 の
cell-to cell adhesion
特異的抗体によって引き起
こされる
基底細胞層 基底細胞層
Basal layer of epithelial ヘミデスモゾーム Basal layer of epithelial Phemphigus vulgaris is
基底細胞と基底膜 caused by antibodies
基底膜 基底膜 against desmoglein 1 and 3
Basal Hemidesmosome is Basal (that is component of
lamina a structure for lamina desmosome)
connecting the basal
face of the cell to
結合組織 connective tissue basal lamina 結合組織 connective tissue

Desmosome and hemidesmosome are Cell attachment molecule. Desmosome and hemidesmosome are Cell attachment molecule.

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細胞接着装置 尋常性天疱瘡の症状
Epithelial Cell attachment mechanism Symptom of Phemphigus vulgaris

粘膜（表皮内）と皮膚に水疱を形成、水疱は破れてびらん、
尋常性天疱瘡 潰瘍になる
上皮内水疱
Occur blister formations in the oral mucosa or skin. The blister
棘融解が起こる
are easily broken, leading to ulcer, erosion

基底細胞層 Are seen mainly on the buccal mucosa, lips, gingiva and skin
Antibodies occur intra
Basal layer of epithelial epithelial split ( blister
基底膜 in epithelial ),
Basal acantolysis ニコルスキー現象；健常にみえる粘膜をこすると水疱が形成
lamina され、はがれる
Nikolsky phenominan; When slight rubbing of mucosa like
結合組織 connective tissue healthy, top layer of mucosa slip away.

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ニコルスキー現象は尋常性天疱瘡の特徴です 類天疱瘡
Nikolsky phenominan is a characteristic of Phemphigus vulgaris Phemphigoid

ヘミデスモゾームを構成するBP 抗原の特異的抗体によって
引き起こされる皮膚，口腔粘膜における自己免疫水疱性疾患
Phemhigoid is autoimmune disease with skin or oral lesion caused by
antibodies against BP antigen that is component of hemidesmosome

Key words; Hemidesmosome, BP antigen

健常にみえる粘膜をこすると水疱が形成され、はがれる
When slight rubbing of mucosa like healthy, top layer of mucosa slip away.

口腔外科ハンドマニュアル 08 より

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細胞接着装置 細胞接着装置
Epithelial Cell attachment mechanism Epithelial Cell attachment mechanism

デスモゾーム
粘膜上皮 上皮細胞同士 粘膜上皮 類天疱瘡
Desmosome is a ヘミデスモゾームを
Epithelial structure for epithelial Epithelial 構成するBP 抗原の特異的抗体に
cell-to cell adhesion よって引き起こされる

基底細胞層 基底細胞層
Basal layer of epithelial ヘミデスモゾーム Basal layer of epithelial Phemhigoid is caused by
基底細胞と基底膜 antibodies against BP
基底膜 基底膜 antigen that is component of
Basal Hemidesmosome is Basal hemidesmosome
lamina a structure for lamina
connecting the basal
face of the cell to
結合組織 connective tissue basal lamina 結合組織 connective tissue

Desmosome and hemidesmosome are Cell attachment molecule. Desmosome and hemidesmosome are Cell attachment molecule.

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細胞接着装置
Epithelial Cell attachment mechanism
類天疱瘡の症状
Symptom of Phemphigoid
健常な皮膚，口腔粘膜に大小さまざまな水疱，潰瘍を多発する
The oral symptom is occurrence of blisters and ulcer formation in skin,
類天疱瘡 oral mucosa.
上皮下水疱 尋常性天疱瘡と臨床所見は似ているが、組織的に棘融解がなく、上皮下の水疱を形成
が起こる Clinical feature is similar to that of phemhigus vulgalis. Histologically,
without Acantholysis, a submucosal split (blister under epithelial ) is observed.
基底細胞層 Antibodies occur a
submucosal split 眼に症状がでることがある。
Basal layer of epithelial
(blister under Scar formation in the eye rarely occur, and loss sight.
基底膜 epithelial )
Basal
lamina

結合組織 connective tissue

Desmosome and hemidesmosome are Cell attachment molecule.

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病理組織学的違い 自己免疫水疱症の治療
Difference of histopathological analysis Treatment of autoimmune vesiculobullous disorders

尋常性天疱瘡：病理組織学的には上皮層内水疱、棘融解
副腎皮質剤軟膏塗布、副腎皮質剤（プレドニン）、免疫抑制剤
Phemphigus vulgaris：intra epithelial split ( blister in epithelial ),
acantolysis In mild case, steroid ointment is typically used, and Prednisolone
or immunosuppressive agents is used in severe case

類天疱瘡：組織的に棘融解がなく、上皮下の水疱を形成
Phemhigoid：a submucosal split (blister under epithelial ) ,
他科との連携が大切 （皮膚科、眼科、耳鼻咽喉科）
without acantolysis
The symptoms are sometimes are found in skin, eye, and pharyngeal
Medical cooperation of dermatological, opthalmic, otolaryngological
depertment are needed for treatment.

対症療法；Symptomatic treatment is medical

therapy of a disease that only affects its
symptoms, not its cause

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扁平苔癬
Lichen planus
口腔粘膜の白斑を主徴とする病変
Diseases that involve in white lesion in oral mucosa
皮膚や口腔粘膜に白色の線状，レース状，斑状などの模様を
呈する慢性炎症性病変
〇扁平苔癬
Lichen planus is a chronic inflammatory diseases that presents
Oral lichen planus white striation, lace-like reticular, and patches in oral mucosa
or skin
〇カンジダ症
Oral candidiasis

〇白板症
Leukoplakia

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扁平苔癬の3 大臨床所見 扁平苔癬の見た目

Clinical Characteristic of Lichen planus Clinical symptom of Lichen planus

中高年、40 歳以上に多く、女性に比較的多い
occurs in middle age adults over the age of 40, and affects women
more than 白色部はぬぐっても剥離しない
White striation lesions can not wipe away
頬粘膜に両側性にみられることが多い（１箇所でない）
affect any part of oral mucosa, but most common site is buccal mucosa
bilaterally

灼熱感、痛みを感じる
feel burning sensation and pain 白い網目のすきまが赤くなっている
Red lesion often seen between white striation lesions

口腔粘膜に生じる白色レース様病変
occur white striation, lace-like reticular patches in oral mucosa

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扁平苔癬の原因は不明だが？ 扁平苔癬の病理組織像 (3つの特徴）

Cause of Lichen planus is unknown, but Histopathology three appearances of Lichen planus

原因は不明、ストレス、金属アレルギー、免疫機構、 粘膜上皮の角化異常が認められる（過角化，過錯角化）
Abnormal keratinization, such as parakeratosis,
全身疾患との関与
hyperkeratosis is common seen
Etiology is unknown, have implicated stress, metal allergy,
autoimmune diseases, and systematic diseases 上皮脚の亢進 (鋸歯状上皮脚)
Development of saw-tooth appearance of the rete pegs

上皮直下の帯状Tリンパ球の浸潤
Subepithelial band-like Tcell infiltrate

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扁平苔癬の治療法 口腔カンジダ症
Treatment of lichen planus Oral candidiasis

対症療法として、副腎皮質ホルモン含有軟膏の塗布、 口腔内の常在菌、Candida 属、特にCandida albicans による

ステロイド錠、含嗽 日和見感染症
Steroid ointment in mild cases, or prednisolone tablets in severe Oral candidiasis is opportunistic infection diseases in oral cavity that
cases is prescribed as symptomatic treatment. Mouth wash caused by Candida species
prevent the build-up plaque .
The majority of cases are due to Candida albicans

悪性化に注意した経過観察が必要
Long-time follow is needed for the risk of cancer ( less than 1% )

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免疫低下患者
口腔カンジダ症 は 日和見感染症
Oral candidiasis is opportunistic infection What are immunocompromised patients？

高齢者
通常は弱い病原性しか持たない常在菌が， Elderly people
免疫機能の低下により病原性を発揮し，発症する感染 寝たきり患者 （脳血管障害など）
An infection by a microorganism that normally doesn't cause diseases, Bed ridden patients with cerebral vascular disorder
but becomes pathogenic when the immune system is weakened. 長期ステロイド治療患者 （自己免疫疾患 など）
Patients treated with steroid therapy for a long time (ex. autoimmune diseases)
Healthy Opportunistic infection
日和見感染症 免疫抑制剤治療患者 （臓器移植後 など）
Patients treated with immune suppressive therapy (ex. organ transplantation)
WIN
WIN HIV 感染患者
HIV-infected patients

Weakened がん治療などの周術期患者 （手術 /化学療法・放射線療法 /緩和ケア）

Candida etc. Perioperative patients undergoing cancer treatment, etc.
immune systems
(Surgery, chemotherapy, radiation therapy, palliative care)

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偽膜性カンジダ症の特徴
口腔カンジダ症の分類 Clinical symptoms of Pseudomembranous candidiasis
Classification of oral candidiasis
最もよくみられるcandida 症の臨床型
is most commonly seen as clinical feature of oral
偽膜性カンジダ症 (白いカンジダ症） candidiasis
Pseudomembranous candidiasis (white oral candidiasis) 白色から乳白色の苔が孤立性、多発性に付着 (鵞口瘡)
Creamy-white patches affect large areas of oral mucosa
萎縮性カンジダ症 (赤いカンジダ症）
Erythematous candidiasis (red oral candidiasis) 容易にはがれる。剥がれた後はびらん、時として出血
These can be wipe off easily, and reveal a raw, erythematous and
sometimes bleeding (Pseudomembranous types)
肥厚性カンジダ症 (厚くなるカンジダ症）
Hyperplastic candidiasis (thick oral candidiasis)

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偽膜性カンジダ症は免疫低下の原因が必ずあります 紅斑性カンジダ 症
Pseudomembranous candidiasis always occur immunocompromised people
Erythematous candidiasis

口腔粘膜の萎縮と発赤、ヒリヒリした疼痛を訴える
偽膜性カンジダ症の原因は高齢、ねたきり、ステロイド投薬、
Erythematous candidiasis is one variants of candidiasis,
周術期など免疫低下がある。 that presents as a red patch of atrophic or erythematous raw and
Pseudomembranous candidiasis is associated with painful mucosa.
immunocompromised situation, such as elderly, bed ridden,
steroid therapy, perioperative 外来で比較的健康な人にみられる。鑑別難しい。
健康な人で発症することはない。HIV 感染を疑う 診断は粘膜からカンジダの検出
Healthy people does not occur, If that, suspect infection of HIV. Found healthy people in out patient. It is difficult to diagnose,
that can detected candida from affected oral mucosa

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肥厚性カンジダ 症 口腔カンジダ症の診断
Hyperplastic candidiasis Diagnosis of oral candidiasis
臨床所見でカンジダ症を疑う場合，口腔粘膜を擦過し，Candida の
カンジダが粘膜に侵入することによって上皮の肥厚がおこる。 存在を顕微鏡検査や選択培地での培養検査で証明する。
白斑はぬぐいとれない If the diagnosis of oral candidiasis is made by clinical feature,
Smears collected by oral swabs, and demonstrate presenese of
Hyperplastic candidiasis is a rare variant of oral candidiasis that candida species by gram staining or incubation of selection
presents white patch that does not wipe off, and characterized medium
histologically by Parakeratosis inflammation with candida
invading the superficial layers of epithelium

口腔癌に似ている。癌を疑って生検したらカンジダ症だった！
Similar feature to oral cancer and leukoplakia. 上皮細胞
Suspected cancer and biopsy, as result It was hyperplastic candidiasis.

菌糸

カンジダ選択培地 (CHROMager :日本 B and D）

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口腔カンジダ症の治療 白板症
Leukoplakia
Treatment of oral candidiasis

抗真菌薬投与 Anti-fungal drugs are prescribed 口腔粘膜に生じた摩擦によって除去できない

白色の板状あるいは斑状の病変
アゾール系 Azole agents （他の診断可能な疾患に分類できないもの）
ミコナゾール、フルコナゾール Leukoplakia in the oral region is defined as a
Miconazole or Fluconazole predominantly white lesion (that not wipe away) of the
oral mucosa that can not be characterized as any other
diseases.

ポリエン系 Polyene agents

アンフォテリシン B
Amphotericin B

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白板症の臨床所見 白板症の原因と癌化率
Clinical feature of Leukoplakia Cause and malignant potential of Leukoplakia

中高年者の男性に好発
癌化率 10年間以上で3~17%
Occur predominantly in the middle-aged and
The malignant potential overall is in the region of
older men
3~17% over 10 years.
白斑の型は様々、どこでもできる
Various types is seen as Faintly white, thick, opaque, and 原因は不明，誘因は局所の刺激，嗜好物，全身疾患など）
affect
nodularany part of oral mucosa
The cause is largely unknown, but predisposing include irritation, and
habits, such as tobacco and alchol, and systematic diseases
特に症状はない，摩擦によって除去できない
There is no symptom in most cases, that not wipe away

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白板症はあくまで臨床診断名である。 白板症の診断と治療
一言で白板症といっても病理組織で見ると。。。。
Diagnosis and treatment of Leukoplakia
Leucoplakia is only clinical diagnosis.
Incisional biopsy is needed as diagnosis
Histologic appearance is variable.
Hyperkeratosis, dysplasia and some cases is 診断には生検が必要
seen as squamous cell carcinoma. A biopsy is required as diagnosis.
Dysplasia is wide ranges (mild, moderate,
and severe). That may become malignant
transformation in the future possibly.
治療; 切除あるいは経過観察 (4~6月ごと）
Treatment; excise or watchfull wating (4~6 monthly)
Checked (size change, red lesions, ulceration, new lesions)

前癌病変であることを意識

正常 上皮異形成 (低，中，高度） 扁平上皮癌 Leukoplakia is the possible to malignant transform,

角化の亢進
Dysplasia Squamous cell
And long-term following is required.
Normal Hyperkeratosis
(mild, moderate, and severe) carcinoma
Severe is carcinoma in situ

ノーマル Normal Malignant 悪い

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生理的色素沈着
色素沈着を主徴とする病変 Physical pigmentation
Diseases that form pigmentation in oral mucosa

１．生理的色素沈着 病的意義のない色素沈着，治療の必要はない。
Physical pigmentation
Variation of degree of pigmentation by increased melanin production
of oral mucosa are seen frequently, No treatment is required.
２．色素性母斑
Pigmented nevus

３．外因性色素沈着
Exogeneous pigmentation

４．全身疾患にともなう口腔内色素沈着
Oral pigmentation associated with systematic diseases

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色素性母斑 補綴，充填物による色素沈着
Pigmented nevus Tatoo by prosthesis and filling

黒褐色の境界明瞭なメラニン色素形成異常を伴った腫瘤形成 充填物・補綴物除去の際の金属の溶出による着色
Benign neoplasm of melanocytes, Pigmented nevus appear as
brown coloration with a defining borders Tatoo in oral lesion is sometimes seen by tiny particles of
dental prosthesis and filling, such as amalgam. No treatment is
required.
切除を行う
Most lesion are small and treated incisional biopsy.

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全身疾患にともなう口腔内色素沈着とキーワード
Oral pigmentation associated with systematic diseases and key words
Adison Diseases

Adison 病； 自己免疫疾患に関連する副腎皮質の慢性機能不全による皮膚，
副腎皮質の慢性機能不全、皮膚、口腔粘膜の色素沈着 口腔粘膜の色素沈着
Adison Diseases；Adrenocortical insufficiency and That is caused by adrenocortical insufficiency by autoimmune
multiple melanotic macules in skin or oral lesions. diseases. Intraorally, multiple melanotic macules develop in
skin or oral lesions.

Peutz-Jeghers 病； 原因疾患の処置、副腎皮質ホルモン療法
遺伝性疾患、皮膚、口腔粘膜の多発性色素沈着、消化管ポリープ Steroid therapy is treated for primary diseases , no treatment is
Peutz-Jeghers syndrome; required for the oral Pigmentation.
Dominant genetic disorder, Multiple polyps in the
gastrointestinal tract, and Multiple melanotic macules in skin
and oral lesion.

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Peutz-Jeghers syndrome 口腔粘膜にアフタや潰瘍を形成する病変

Diseases that form aphtha and ulcer in oral mucosa

皮膚，口腔粘膜の多発性色素沈着，消化管ポリープを合併する ○ 再発性アフタ
優性遺伝性疾患 Recurrent aphthous stomatitis
Dominant genetic disorder is characterized by the development
of multiple polyps in the gastrointestinal tract, and multiple ○ ベーチェット病など全身疾患
melanotic macules occur in skin and oral lesion. Patients may
complain of abdominal pain, rectal bleeding, and diarrhea. no Bechet`s disease
treatment is required for the oral pigmentation.
○ 義歯などの刺激による外傷性アフタ
Aphtha caused by trauma
○ ウイルス性，薬剤性などの口内炎
Aphtha caused by virus and chemical drug

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再発性アフタ 再発性アフタの治療
Recurrent aphthous stomatitis Treatment of recurrent aphthous stomatitis
アフタが繰り返し、同じ場所あるいは場所を変えて
口腔粘膜に生じる。原因は不明だが、栄養失調、外傷、
ストレス、ホルモンバランスなどが原因 治療は対症療法でステロイド軟膏，含嗽，完全に
These are present as recurrent, multiple, small, round, painful ulcer in 再発を防ぐことはできない。
oral membrane.
Symptomatic treatment; steroid ointment, irrigation,
The cause is not understood. however, various factors implicated include
However it is difficult to prevent recurrence completely
nutritional deficiencies, local trauma, stress, hormonal influences

小アフタ型で10~14日、大アフタ型で4~6週続く
minor form ( 5mm ) typically heal 10-14 days, major form (1-3cm)
usually last for 4-6 weeks.

Bechet 病の１つの症状として同様のアフタが生じる
Similar recurrent aphtha can occur as typical one symptom of Behçet's
syndrome

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Bechet`s disease 外傷性アフタ，潰瘍

Traumatic aphtha and ulcer
原因不明の難治性の血管炎を伴うまれな全身性炎症性疾患
Bechet`s disease is a rare diseases that involves inflammation
of the blood vessels that causes problems in many parts of the
body 義歯などによる機械的刺激によって生じるアフタ，潰瘍
Aphtha and ulcer caused by mechanical injury, such as
These symptoms are important ！ denture
１）口腔粘膜の再発性アフタ
Recurrent aphthous stomatitis (in 90-80% in this diseases) 原因を除去すれば通常１～２週間で治癒する
Almost heal for 1-2 weeks by removal of the cause
２）外陰部潰瘍
Genital ulcers

３）光彩毛様体炎
Inflammation of iris in the eye ( can lead to permanent vision loss)
４）結節性紅班
Erythema nodosum

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口腔粘膜に潰瘍を形成する病変に対する注意
Important point of lesion that form ulcer in oral mucosa
口腔粘膜に潰瘍を形成する病変は症状時期において様々である。
Ulceration of the oral mucosa may be due to trauma.
And Blister, aphtha, and erythema in oral mucosal diseases will
developed ulcer formations. Ulcerations show various clinical
feature depending on time in oral mucosal disease.
初期口腔癌は外傷性のアフタと同様の所見を呈することがある。
誘発原因を取り除いても消失しない、消失することなく増大して
いる等，あれば口腔癌の疑いがあることを考えていかねばならない.
Early stage of oral carcinoma is sometimes looked like traumatic
ulcer. If you rejected predisposing factor and ulceration grow
larger, it is necessary to consider possibility of oral carcinoma

誘発原因を取り除いても消失しない，消失することなく増大している等、
あれば口腔癌の疑いがあることを考えていかねばならない.
If you rejected predisposing factor and ulceration grow larger,
It is necessary to consider possibility of oral cancer

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黒毛舌
Black hairy tongue

よく日常で診られる舌の病変 舌背中央部の糸状乳頭の伸長がみられる黒色の病変
Diseases of the tongue that seen commonly defined as the dorsum of the tongue is covered with elongated
filiform papillae with black color

原因；喫煙、口腔乾燥、抗生剤、ステロイドによる菌交代現象
Predisposing factor is smoking, xerostomia, microbial substitution by
antibiotic and steroid therapy

治療；原因の除去
Remove of the predisposing factor

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地図状舌 溝状舌
Geographic tongue Fissured tongue

舌背部にみられ中央部が紅色，周囲白色の鮮明な班が地図状に 舌背表面に多数の溝がみられる 形態異常，原因は不明

みられる。 （先天的，２次的に舌炎を併発することもある）
Is characterized by areas of atrophy and loss of papillae on dorsum That is a condition characterized by deep grooves in the dorsum
of tongue of the tongue. Some patients feel pain including with glossitis.
The cause is unknown.
原因は不明，特に治療は不要
Etiology is unknown. It sometimes associated with general
condition, menstrual cycle and genetics involvement. No 特に治療は不要，口腔衛生
treatment is required. Especially, no treatment is required, mechanical tongue cleansing
is beneficial

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正中菱形舌炎 鉄欠乏性貧血に関連する舌炎
Median rhomboid glossitis Glossitis associated with iron deficiency Anemia

舌背中央後方部に菱形の舌乳頭のない平滑な紅色の病変部 貧血は末梢血の赤血球数、ヘモグロビン量が減少した状態
Is characterized by an area of redness and loss of Anemia is condition that decrease peripheral red blood cell count
lingual papillae. hemoglobin amount.

貧血が原因となって舌乳頭萎縮による舌炎を起こすことがある
不対結節の発育異常、萎縮性カンジダ症の１型
Etiology is development abnormality associated with Tongue appear red, smooth, atrophic, and erythematous,
tuberculum impar, Recently, that is associated with and burning sensation and pain
Erythematous candidiasis
治療は鉄剤の補給
Iron supplements is prescribed for anemia.
特に治療は不要だ が、Candida 症が疑われる場合は抗真菌薬
No treatment is required, however,
in the case of oral candidiasis, antifungal therapy is performed.

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しかし 最後に
However….
歯科医師は口腔粘膜疾患を診断する必要が
あります。おのおの臨床的所見を理解しよう。 各病変時期において症状がしばしば変化する。
Clinical symptom of oral mucosal diseases is sometimes
change depending on period.
Dentists need to diagnose oral mucosal diseases.
Please understand the each clinical appearances. 原則にあてはまらない特殊な症例が必ず存在する。
Oral mucosal diseases presents exceptional rare cases
that does not belongs to the typical clinical symptom.

疑わしきはすぐ専門医療機関へ紹介する。
If you suspect diagnosis, You should referred patients to specialist.

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