Oral medicine: 1. ulcers: aphthous and other common ulcers

Ulceration is a breach in the oral epithelium, which typically exposes nerve endings in the underlying lamina propria, resulting in pain or soreness, especially on eating spicy foods or citrus fruits. Patients vary enormously in the degree to which they suffer and complain of soreness in relation to oral ulceration. It is always important to exclude serious disorders such as oral cancer (Article 3) or other serious disease, but not all patients who complain of soreness have discernible organic disease. Even in those with detectable lesions, the level of complaint can vary enormously – some patients with large ulcers complain little; others with minimal ulceration complain bitterly of discomfort. Sometimes there is a psychogenic or cultural influence.

Epithelial thinning or breaches may be seen in:

Ulcers and erosions can also be the final common manifestation of a spectrum of conditions, ranging from epithelial damage resulting from trauma, to an immunological attack as in lichen planus, pemphigoid or pemphigus, to damage because of an immune defect, as in HIV disease and leukaemia, infections as in herpesviruses, tuberculosis and syphilis, or nutritional defects such as in vitamin deficiencies and some gastrointestinal disease (Tables 1 and 2).