Assessment of oral ulceration

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Summary

Oral mucosal ulcerations are common. Most are self-resolving and transient (e.g., after a simple cheek bite). However, some may require the intervention of a medical or dental practitioner. For example, the serious and potentially life-threatening condition oral carcinoma often initially manifests as a solitary oral mucosal ulceration. View image The diagnosis of the more common oral ulcerations, in an otherwise healthy patient, is straightforward and determined from the medical history and clinical examination. However, patients with impaired immunological function (e.g., HIV, chemotherapy, malnutrition) may present with more severe, widespread, atypical presentations that require a comprehensive assessment.

Pathophysiology

Most of the mucosa lining the oral cavity (e.g., floor of the mouth, cheeks, ventral tongue) is thin and delicate, rendering it susceptible to trauma. By contrast, the mucosa of the hard palate and gingiva is keratinised and more resistant to injury. The biologically dynamic nature of the oral mucosa makes it vulnerable to the effects of systemic disease. [1]

An oral ulcer or ulceration is caused by the complete loss of epithelium accompanied by variable loss of the underlying connective tissue, which results in a crateriform appearance. It may be augmented by oedema and/or proliferation of the surrounding tissue. [2]

Ulcers that do not heal within 2 weeks may be considered persistent or chronic. A classification system based on distinguishing whether the ulceration is simple, complex, or destroying has been suggested. [2]

  • Simple: a single ulcer without the involvement of the remaining mucosa.

  • Complex: a single or multiple ulcers with changes to the surrounding mucosa, skin, and/or systemic manifestations. The lesion may be white, red, or vesiculobullous.

  • Destroying: diffuse lesion with tissue destruction and severe systemic involvement.

Epidemiology

Oral ulcerations are common, but most occurrences go unreported because they tend to resolve within a few days without the need for medical or dental intervention. Of those ulcerations that are reported, the most common is recurrent aphthous stomatitis, which affects 5% to 25% of the general population. [3] View image

Differential diagnosis

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Last updated: Nov 07, 2011
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