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. The diagnosis of the more common oral ulcerations, in an otherwise healthy patient, is straightforward and determined from the medical history and clinical exam. However, patients with impaired immunologic function (e.g., HIV, chemotherapy, malnutrition) may present with more severe, widespread, atypical presentations that require a comprehensive assessment.
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 keratinized and more resistant to injury. The biologically dynamic nature of the oral mucosa makes it vulnerable to the effects of systemic disease.
An oral ulcer or ulceration is characterized 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 edema and/or proliferation of the surrounding tissue.
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:
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.
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.
- Inadvertent trauma
- Lichen planus
- Contact stomatitis
- Recurrent aphthous stomatitis
- Intraoral dental sinus (parulis)
- Herpes simplex virus (HSV) infection
- Hand-foot-and-mouth disease
- Iatrogenic trauma (medical or dental procedure)
- Self-inflicted trauma
- Iron deficiency anemia
- Folate deficiency
- Vitamin B12 deficiency
- Vitamin C deficiency
- Mucous membrane pemphigoid
- Linear IgA bullous dermatosis
- Epidermolysis bullosa acquisita
- Oral lichenoid reaction
- Erythema multiforme
- Stevens-Johnson syndrome and toxic epidermal necrolysis
- Necrotizing sialometaplasia
- Behcet disease
- Periodic fever syndromes
- Reactive arthritis (Reiter syndrome)
- Lupus erythematosus
- Giant cell arteritis
- Granulomatosis with polyangiitis (formerly known as Wegener granulomatosis)
- Graft-versus-host disease
- Necrotizing ulcerative gingivitis
- Varicella-zoster virus (VZV) infection
- Cytomegalovirus infection
- Infectious mononucleosis
- Squamous cell carcinoma
- Malignant salivary gland tumors (mucoepidermoid carcinoma and adenoid cystic carcinoma)
- Non-Hodgkin lymphoma
- Kaposi sarcoma
- Oral melanoma
- Antiresorptive agent-induced osteonecrosis of the jaw (ARONJ)
- Chronic ulcerative stomatitis
Michaell A. Huber, DDS
Oral Medicine Subject Expert
Department of Comprehensive Dentistry
UTHSCSA School of Dentistry
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.
Stephen Porter, PhD, MD, FDS RCS, FDS RCSE
Oral Medicine and Special Needs Dentistry Unit
Division of Maxillofacial Diagnostic, Medical and Surgical Sciences
UCL Eastman Dental Institute
Professor of Oral Medicine
University of London
SP declares that he has no competing interests.
Nathaniel Treister, DMD, DMSc
Oral Medicine Attending & Associate Surgeon
Division of Oral Medicine and Dentistry
Brigham and Women's Hospital
Department of Oral Medicine, Infection and Immunity
Harvard School of Dental Medicine
NT declares that he has no competing interests.
Angela Chi, DMD
Division of Oral Pathology
College of Dental Medicine
Medical University of South Carolina
AC declares that she has no competing interests.
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