Oral Ulcers: Clinical features, Causes & Treatment

Traumatic ulcers in healing stage caused by sharp teeth

An ulcer is a tissue defect which has penetrated the epithelial-connective tissue border, with its base at a deep level in the submucosa, or even within muscle or periosteum. An ulcer is a deeper breach of the epithelium than an erosion or an excoriation, and involves damage to both epithelium and lamina propria.

An erosion is a superficial breach of the epithelium, with little damage to the underlying lamina propria. A mucosal erosion is an erosion which specifically occurs on a mucous membrane. Only the superficial epithelial cells of the epidermis or of the mucosa are lost, and the lesion can reach the depth of the basement membrane. Erosions heal without scar formation. Excoriation is a term sometimes used to describe a breach of the epithelium which is deeper than an erosion but shallower than an ulcer. This type of lesion is tangential to the rete pegs and shows punctiform (small pinhead spots) bleeding, caused by exposed capillary loops.

Clinical Features

Type of Edges of an Ulcer

  1. Rolled out or Everted: Commonly seen in Squamous cell carcinoma
  2. Raised or Beaded: Commonly seen in Basal cell carcinoma or Rodent ulcer
  3. Undermined: Commonly seen in Tubercular ulcer
  4. Punched out: Commonly seen in Trophic ulcer or Decubitus ulcer or in Gummatous ulcer
  5. Sloping ulcer: Healing ulcer

Etiology 

Local Causes

1. Infective
  • viral
  • bacterial
  • fungal

2. Traumatic
  • Mechanical
  • Thermal
  • Chemical
3. Factitious injury
4. Radiation
5. Eosinophilic ulcer or traumatic granuloma
6. Idiopathic
  • Recurrent aphthous stomatitis (RAS)
  • Minor aphthous ulcers
  • Major aphthous ulcers
  • Herpetiform ulcers

Ulcers associated with systemic diseases

  1. Haematological diseases
  2. Gastrointestinal diseases
  3. Behcet's syndrome
  4. HIV infection
  5. Other diseases

Ulcers associated with dermatological conditions

  1. Lichen Planus
  2. Chronic discoid lupus erythematosus
  3. Vesiculobullous disease
  4. Neoplastic
  5. Squamous cell carcinoma

Investigation

  • CBP
  • DLC
  • Histopathology of local tissue
  • Investigations of specific disease suspected of causing it.

Treatment

The ulcers that are manifested due to systemic diseases should be treated for that particular disease along with the treatment regime of local ulcers.

The local treatment includes application of soothing agents for relieve of pain along with supplementation of fortified vitamin supplementation for one week.

For details of each ulcer, readers are advised to refer to specific type of ulcer.
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