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
Plasma cell stomatitis	NA	NA	Gingivae, sulcus, buccal mucosa	Desquamative gingivitis	Multiple	Ulceration, epithelial sloughing, and desquamation, angular cheilitis, atrophic fissured lips, self-limiting
Chemotherapy-related ulcers	NA	NA	Any site intraorally	Asymmetrical ulcers	Multiple	Erythema and ulceration 5 to 7 days after onset of chemotherapy, spontaneously resolution after completion of chemotherapy

NA: not assigned.