Oral Ulceration and Other Abnormalities

Discontinuity in the oral mucosa

Solitary ulcer

  • Trauma
  • Possible malignancy
  • Infective - TB, tertiary syphilis

Multiple ulcers

Recurrent aphthous ulceration

  • Most common cause
  • Patient usually otherwise well
  • Autoimmune
  • Can be made worse by B12/iron deficiency and stress

Bechet’s disease

  • Hereditary systemic vasculitis that produces almost identical ulcers to RAU
  • Additional symptoms - genital ulceration, uveitis, erythema nodosum and other systemic features

Anaemia

  • Can cause oral ulceration

Infective causes

  • e.g. herpes simplex

Lichen planus

  • Inflammatory condition
  • Ulcers are bilateral
  • Can be asymptomatic
  • Skin may be affected

Vesiculobullous disease

  • Pemphigus vulgaris - oral lesions proceed skin lesions by 1 year or more
  • Pemphigoid - painful oral ulceration, other mucous membranes affected e.g. eye

Lupus erythematosus

  • Oral manifestations include ulceration, white patches or red and white patches

Additional oral abnormalities

White patches

  • If they wipe off, usually pseudomembranous candidiasis (thrush)
  • If they don’t wipe off - lichenoid inflammation, trauma, epithelial dysplasia, neoplasia chronic mucocutaneus candidiasis

Red patches

  • Usually dysplasia/malignancy