Diagnostic Features of Common Oral Ulcerative Lesions: An Updated Decision Tree
Table 1
Clinical characteristics of acute oral ulceration [2, 3, 11–20].
Lesion
Gender predominance
Age predilection
Location
Shape of ulcer
Number of ulcers
Distinguishing features
Traumatic ulcer
Men
NA
Tongue, lip, buccal mucosa
Symmetrical/asymmetrical
Solitary
Slightly raised and reddish borders, necrotic pseudomembrane, which heals within 10 days
Necrotizing sialometaplasia
Men
Middle age
Posterior palate, lower lip, retromolar pad
Crater-like
Solitary
Ulcers with indurated borders, self-limiting after 5 to 7 weeks
Primary herpetic gingivostomatitis
NA
2-3 years
Keratinized and nonkeratinized mucosa
Ulcers with scalloped borders and erythematous halo
Multiple
Prodromal fever, nausea, anorexia, and irritability generalized gingivitis, painful ulcers covered by a yellowish pseudomembrane, submandibular lymphadenitis, halitosis, and dysphagia, self-limiting after 5 to 7 days
Herpes zoster infection (shingles)
NA
>50 years of age
Hard palate, gingivae, tongue
Ulcers with scalloped borders, Zosteriform pattern
Multiple
Prodromal unilateral pain, clustered small ulcers with characteristic unilateral pattern, self-limiting, healing within 10–14 days
Herpangina
NA
<10 years of age
Oropharynx, soft palate, tonsillar pillars
Small ulcers
Multiple
Vesicular exanthema and ulcers
Hand-foot-and-mouth disease
NA
<10 years of age
Tongue, hard, and soft palate, buccal mucosa
Small ulcers
Multiple
Oral ulcers along with skin rash on the hands and feet
Erythema multiforme
men
20–40 years
Lips, buccal mucosa, tongue
Large and confluent
Multiple
Prodromal skin target lesions, bullae and ulcerations with irregular borders and inflammatory halo, bloody encrustations on the lips
Necrotizing ulcerative gingivitis
NA
Young adults (18–20 years of age)
Papillary and marginal gingivae
Crater like
Multiple
Sore gums, bleeding gums, ulceration, and necrosis of the interdental papillae, fetid odor, fever, and malaise
Oral hypersensitivity reactions
NA
NA
Any site intraorally
Several clinical manifestations
Multiple
Lichenoid reactions, fixed drug eruption, swelling of the lips, and oral allergy syndrome