Summary
Differentials
Common
- Inadvertent trauma
- Lichen planus
- Pemphigus
- Mucous membrane pemphigoid
- Squamous cell carcinoma
- Contact stomatitis
- Oral lichenoid reaction
- Recurrent aphthous stomatitis
- Intraoral dental sinus (parulis)
- Herpes simplex virus (HSV) infection
- Herpangina
- Hand-foot-and-mouth disease
- Crohn disease
- Ulcerative colitis
- Celiac disease
Uncommon
- Iatrogenic trauma (medical or dental procedure)
- Self-inflicted trauma
- Iron deficiency anemia
- Folate deficiency
- Vitamin B12 deficiency
- Vitamin C deficiency
- Chronic ulcerative stomatitis
- Linear IgA bullous dermatosis
- Epidermolysis bullosa acquisita
- Drug-induced
- Erythema multiforme
- Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis
- Behcet disease
- Periodic fever syndromes
- Reactive arthritis
- Systemic lupus erythematosus
- Giant cell arteritis
- Granulomatosis with polyangiitis (formerly known as Wegener granulomatosis)
- Necrotizing ulcerative gingivitis
- Syphilis
- Gonorrhea
- Tuberculosis (TB)
- Varicella-zoster virus (VZV) infection
- Cytomegalovirus infection
- Mucormycosis (formerly zygomycosis)
- Aspergillosis
- Histoplasmosis
- Blastomycosis
- Paracoccidioidomycosis
- Infectious mononucleosis
- Malignant salivary gland tumors (mucoepidermoid carcinoma and adenoid cystic carcinoma)
- Non-Hodgkin lymphoma
- Kaposi sarcoma (KS)
- Oral melanoma
- Antiresorptive agent-induced osteonecrosis of the jaw (ARONJ)
- Mpox
Contributors
Authors
Diana V. Messadi, DDS, MMSc, DMSc
Professor of Dentistry, Chair
UCLA School of Dentistry
Section of Oral Medicine, Oral Pathology and OroFacial Pain
Los Angeles
CA
Disclosures
DVM declares that she has no competing interests.
Takako I. Tanaka, DDS, FDS RCSEd
Professor of Clinical Oral Medicine
Director of Oral Medicine Postgraduate Program
University of Pennsylvania School of Dental Medicine
Philadelphia
PA
Disclosures
TIT declares that she has no competing interests.
Acknowledgements
Dr Messadi and Dr Tanaka would like to gratefully acknowledge Dr Michaell A. Huber, a previous contributor to this topic.
Disclosures
MAH is an author of a number of references cited in this topic. He lectures extensively on oral medicine-related topics. He has prepared online CE courses for DentalCare.com and online Quality Resource Guide CE courses for Metlife Insurance Company. MAH is a Consultant member of the Dentalcare.com Advisory Board for Proctor and Gamble.
Peer reviewers
Joel J. Napeñas, DDS FDSRCS(Ed)
Clinical Associate Professor
Wake Forest School of Medicine
Director, Oral Medicine Residency
Atrium Health Carolinas Medical Center
Winston-Salem
NC
Disclosures
JJN declares that he has no competing interests.
Parham Hazrati, DDS, PgC
University of Michigan School of Dentistry
Ann Arbor
MI
Disclosures
PH declares no competing interests.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
References
Key articles
Compilato D, Cirillo N, Termine N, et al. Long-standing oral ulcers: proposal for a new 'S-C-D classification system'. J Oral Pathol Med. 2009 Mar;38(3):241-53. Abstract
Fitzpatrick SG, Cohen DM, Clark AN. Ulcerated lesions of the oral mucosa: clinical and histologic review. Head Neck Pathol. 2019 Mar;13(1):91-102.Full text Abstract
Tarakji B, Gazal G, Al-Maweri SA, et al. Guideline for the diagnosis and treatment of recurrent aphthous stomatitis for dental practitioners. J Int Oral Health. 2015 May;7(5):74-80.Full text Abstract
Zeng X, Jin X, Zhong L, et al. Difficult and complicated oral ulceration: an expert consensus guideline for diagnosis. Int J Oral Sci. 2022 Jun 1;14(1):28.Full text Abstract
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.

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