Evaluation of oral ulceration

Last reviewed: 13 Jan 2026
Last updated: 03 Feb 2026

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
Full details

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
Full details

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

Declarações

JJN declares that he has no competing interests.

Parham Hazrati, DDS, PgC

University of Michigan School of Dentistry

Ann Arbor

MI

Declarações

PH declares no competing interests.

Créditos aos pareceristas

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Referências

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Principais artigos

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. Resumo

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.Texto completo  Resumo

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.Texto completo  Resumo

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.Texto completo  Resumo

Artigos de referência

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