Department of Oral and Maxillofacial Surgery, Ansbach General Hospital, Ansbach, Germany.
Oral Surg Oral Med Oral Pathol Oral Radiol. 2013 May;115(5):e28-33. doi: 10.1016/j.oooo.2012.12.008.
The differential diagnosis of ulcerative oral lesions is diverse. This report discusses the rare causes of oral mucosal ulceration and suggests approaches for diagnosis and treatment.
Two cases of methotrexate-induced stomatitis in patients receiving low dose methotrexate for rheumatoid arthritis are presented with a review of the current literature. In case 1, mucositis was caused by an unintended methotrexate overdose. In case 2, oral lesions were the result of chronic methotrexate toxicity. The treatment for methotrexate-induced mucositis required hospitalization in case 1, methotrexate discontinuation in both cases and oral folic acid supplementation in case 2.
In both cases, the mucositis healed and no relapse was observed.
Mucositis may be an early sign of systemic conditions, and dental providers are often the first doctors involved in the assessment of oral mucosal diseases. Meticulous questioning of the patient's history and the physical examination is important for elucidating the underlying cause.
溃疡性口腔病变的鉴别诊断多种多样。本报告讨论了口腔黏膜溃疡的罕见病因，并提出了诊断和治疗方法。
报告了两例接受低剂量甲氨蝶呤治疗类风湿关节炎的患者发生甲氨蝶呤相关性口腔炎的病例，并对当前文献进行了回顾。在病例 1 中，口腔黏膜炎是由于甲氨蝶呤意外过量引起的。在病例 2 中，口腔病变是由于慢性甲氨蝶呤毒性引起的。甲氨蝶呤相关性黏膜炎的治疗在病例 1 中需要住院治疗，两例均需停止使用甲氨蝶呤，病例 2 需口服叶酸补充剂。
在这两例中，黏膜炎均愈合，未观察到复发。
口腔黏膜炎可能是全身疾病的早期表现，牙医通常是参与口腔黏膜疾病评估的首批医生之一。仔细询问患者的病史和进行体格检查对于阐明潜在病因很重要。
