Materiały źródłowe

• #1 Mouth ulcers | Better Health Channel

  https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/mouth-ulcers

  A mouth ulcer is the loss or erosion of the delicate lining tissue of the mouth (mucous membrane). […] If your mouth ulcers dont clear up after 14 days, or if you get them frequently, see your dentist or doctor. […] An ulcer that wont heal may be a sign of mouth cancer. […] See your dentist or doctor if your mouth ulcers dont clear up within 2 weeks, or if you get them frequently. […] If your oral health professional cannot determine the cause of your mouth ulcers, or if the ulcers do not respond to the normal treatments, you may need to have a biopsy of part of the ulcer and some of the surrounding tissue. A biopsy is a procedure where a tissue sample is taken for examination and diagnosis. […] In some cases, you may need blood tests if it is suspected that you have an underlying deficiency (such as an iron, folate or vitamin B deficiency) or an inflammatory medical condition.

• #2 Mouth ulcers | Lima Memorial Health System

  https://www.limamemorial.org/health-library/HIE%20Multimedia-TextOnly/1/001448

  Mouth ulcers are sores or open lesions in the mouth. […] Most of the time, a health care provider or dentist will look at the ulcer and where it is in the mouth to make the diagnosis. You may need blood tests or a biopsy of the ulcer may be needed to confirm the cause. […] Contact your provider if: A mouth ulcer does not go away after 3 weeks. You have mouth ulcers return often, or if new symptoms develop.

• #3 Canker sore – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/canker-sore/diagnosis-treatment/drc-20370620

  Tests aren’t needed to diagnose canker sores. Your doctor or dentist can identify them with a visual exam. […] In some cases, you may have tests to check for other health problems, especially if your canker sores are severe and ongoing. […] Your doctor or dentist can diagnose a canker sore based on its appearance.

• #4 Mouth ulcers | Lima Memorial Health System

  https://www.limamemorial.org/health-library/HIE%20Multimedia-TextOnly/1/001448

  Mouth ulcers are sores or open lesions in the mouth. […] Most of the time, a health care provider or dentist will look at the ulcer and where it is in the mouth to make the diagnosis. You may need blood tests or a biopsy of the ulcer may be needed to confirm the cause. […] Contact your provider if: A mouth ulcer does not go away after 3 weeks. You have mouth ulcers return often, or if new symptoms develop.

• #5 Mouth ulcer – Wikipedia

  https://en.wikipedia.org/wiki/Mouth_ulcer

  Diagnosis of mouth ulcers usually consists of a medical history followed by an oral examination as well as examination of any other involved area. The following details may be pertinent: The duration that the lesion has been present, the location, the number of ulcers, the size, the color and whether it is hard to touch, bleeds or has a rolled edge. As a general rule, a mouth ulcer that does not heal within 2 or 3 weeks should be examined by a health care professional who is able to rule out oral cancer (e.g. a dentist, oral physician, oral surgeon, or maxillofacial surgeon). […] The diagnosis comes mostly from the history and examination, but the following special investigations may be involved: blood tests (vitamin deficiency, anemia, leukemia, Epstein-Barr virus, HIV infection, diabetes) microbiological swabs (infection), or urinalysis (diabetes). A biopsy (minor procedure to cut out a small sample of the ulcer to look at under a microscope) with or without immunofluorescence may be required, to rule out cancer, but also if a systemic disease is suspected.

• #6 Evaluation of oral ulceration – Differential diagnosis of symptoms | BMJ Best Practice US

  https://bestpractice.bmj.com/topics/en-us/1119

  Oral mucosal ulcerations are common. Most are self-resolving and transient (e.g., after a simple cheek bite). However, some may require the intervention of a medical or dental practitioner. For example, the serious and potentially life-threatening condition oral carcinoma often initially manifests as a solitary oral mucosal ulceration. The diagnosis of the more common oral ulcerations, in an otherwise healthy patient, is straightforward and determined from the medical history and clinical exam. However, patients with impaired immunologic function (e.g., HIV, chemotherapy, malnutrition) may present with more severe, widespread, atypical presentations that require a comprehensive assessment. […] An oral ulcer or ulceration is characterized by the complete loss of epithelium accompanied by variable loss of the underlying connective tissue, which results in a crateriform appearance. It may be augmented by edema and/or proliferation of the surrounding tissue. […] Ulcers that do not heal within 2 weeks may be considered persistent or chronic. A classification system based on distinguishing whether the ulceration is simple, complex, or destroying has been suggested.

• #7 Common benign and malignant oral mucosal disease

  https://www1.racgp.org.au/ajgp/2020/september/common-benign-and-malignant-oral-mucosal-disease

  The most commonly encountered mucosal surface lesions are those of an epithelial break (ulcer) or an alteration in thickness, texture or colour (white, red or pigmented lesion). […] An ulcerated lesion is most commonly traumatic or immunological (aphthous) in origin; however, the most important lesion to exclude is an oral malignancy. […] Persistence, as opposed to episodic recurrence, of an ulcer is an importance feature. Mucosal turnover should occur in 10 days; therefore, any persistent ulcer that has been present for 2 weeks should be referred to an oral and maxillofacial surgeon or oral medicine specialist for biopsy. […] If an ulcer is suspected to have any suspicious malignant features, then immediate referral to an oral and maxillofacial surgeon or specialist unit in a tertiary hospital is indicated. A tissue diagnosis is established, followed by completion of staging (computed tomography [CT], magnetic resonance imaging [MRI], ultrasonography +/ positron emission tomography [PET]).

• #8 Azthena logo with the word Azthena

  https://www.news-medical.net/health/Diagnosis-of-canker-sores.aspx

  Canker sores are the commonest cause of mouth ulcers. They are usually benign and resolve on their own in 1 to 3 weeks. […] The sores are commonly diagnosed clinically by examining them. […] The process of diagnosis of canker sores involves taking a complete medical history, categorizing the level of pain and so forth. […] Diagnosis is begun with a complete medical history. This is helpful in diagnosis of: tobacco or alcohol use, food and other allergies, hormonal fluctuations, recent dental work, decreased or impaired immunity, history of oral sexual intercourse and herpes virus infections and other causes that may lead to increased propensity of canker sores. […] Diagnosis is commonly made by looking at the canker sore. The sore has a typical appearance of a round or oval while cheesy or greyish base or the ulcer and raised red and swollen edges.

• #9 Oral ulcers in children- a clinical narrative overview | Italian Journal of Pediatrics | Full Text

  https://ijponline.biomedcentral.com/articles/10.1186/s13052-021-01097-2

  A detailed history of the patient is essential to identify whether there are other symptoms present indicating a possible underlying infection, a background of an autoimmune process, immunosuppression or the involvement of the gastrointestinal tract, or whether it is just a local problem. […] The range of differential diagnosis for oral ulcers in children is enormously wide. Although it is a common symptom, an accurate history, as well as a proper physical examination is of highest importance in order to be able to make a diagnosis. Ulcers can be classified by their size and the duration of symptoms, which can give further hints for the cause of the ulcer. […] General recommendations about treatment/diagnosis of children with oral ulcers do not yet exist, therefore an attempt was made to provide a clinical overview for clinicians.

• #10 Diagnostic Features of Common Oral Ulcerative Lesions: An Updated Decision Tree

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5066016/

  Diagnosis of oral ulcerative lesions might be quite challenging. […] This narrative review article aims to introduce an updated decision tree for diagnosing oral ulcerative lesions on the basis of their diagnostic features. […] In order to arrive at a definitive diagnosis, it is imperative to consider differential diagnoses. […] According to the literature, many cases of oral malignant ulcerations were misdiagnosed as nonneoplastic lesions up to several months before the definite diagnosis was established. […] A decision tree is a flowchart that organizes features of lesions so that the clinician can make a series of orderly decisions to reach a logical conclusion. […] The first decision to be made is whether the ulcerative lesion is of an acute, chronic, or recurrent nature; thereafter, the lesion(s) should be placed in one of the five subgroups. […] The newly updated decision tree includes 29 oral ulcerative lesions based on duration and number of lesions, which helps clinicians establish a stepwise method to rule out improbable conditions to arrive at a logical diagnosis.

• #11 Recurrent aphthous stomatitis (episodic mouth ulcers) – Symptoms, diagnosis and treatment | BMJ Best Practice US

  https://bestpractice.bmj.com/topics/en-us/564

  Clinically, three forms of recurrent aphthous ulceration exist: major, minor, and herpetiform. […] Diagnosis is based on the history and clinical examination with exclusion of a systemic etiology; there are no specific laboratory findings. […] Key diagnostic factors include oral ulcers, afebrile status, absence of genital or ocular ulceration, no history of immunodeficiency, and absence of pallor. […] Tests to consider for diagnosis include CBC, serum ferritin, serum folate, serum vitamin B12, serum IgA-tTG, viral serology (e.g. HIV or Epstein-Barr virus), erythrocyte sedimentation rate and CRP, biopsy, antinuclear antibody test, and serum HIV test.

• #12 Mouth ulcer – Wikipedia

  https://en.wikipedia.org/wiki/Mouth_ulcer

  Diagnosis of mouth ulcers usually consists of a medical history followed by an oral examination as well as examination of any other involved area. The following details may be pertinent: The duration that the lesion has been present, the location, the number of ulcers, the size, the color and whether it is hard to touch, bleeds or has a rolled edge. As a general rule, a mouth ulcer that does not heal within 2 or 3 weeks should be examined by a health care professional who is able to rule out oral cancer (e.g. a dentist, oral physician, oral surgeon, or maxillofacial surgeon). […] The diagnosis comes mostly from the history and examination, but the following special investigations may be involved: blood tests (vitamin deficiency, anemia, leukemia, Epstein-Barr virus, HIV infection, diabetes) microbiological swabs (infection), or urinalysis (diabetes). A biopsy (minor procedure to cut out a small sample of the ulcer to look at under a microscope) with or without immunofluorescence may be required, to rule out cancer, but also if a systemic disease is suspected.

• #13 Mouth | Oral Ulcers – Causes, Symptoms, Diagnosis, Treatment and Prevention

  https://www.medindia.net/health/conditions/mouth-ulcers.htm

  Diagnosing mouth ulcers is often straightforward. However, doctors may conduct several investigations to identify the exact cause when ulcers recur. […] Physical Examination – Your primary care doctor will carefully inspect your mouth and gather your medical history to reach a conclusion. […] Blood Tests – The blood tests include: […] Complete Blood Count (CBC): Checks overall health and looks for issues like infection, anemia, or leukemia. […] Erythrocyte Sedimentation Rate (ESR): Provides clues about inflammation in the body. […] Serum Ferritin: Evaluates the amount of iron present in the body. Iron deficiency can lead to recurrent mouth sores. […] Serum Vitamin B12: Assesses the amount of vitamin B12 in the body. Vitamin B12 deficiency can lead to recurrent aphthous ulcers. […] Skin Biopsy – A small skin tissue is taken for analysis in a medical laboratory.

• #14 Aphthous ulceration (aphthae, ulcers)

  https://dermnetnz.org/topics/aphthous-ulcer

  Aphthous ulcers are usually diagnosed clinically. Investigations are rarely required, but are undertaken if there are recurrent attacks of multiple or severe oral ulcers or complex aphthosis. […] Blood tests may include: Blood count, iron, vitamin B12, and folate studies. […] Swabs for microbiology evaluate the presence of Candida albicans, Herpes simplex virus and Vincent’s organisms.

• #15 Recurrent aphthous stomatitis (episodic mouth ulcers) – Symptoms, diagnosis and treatment | BMJ Best Practice US

  https://bestpractice.bmj.com/topics/en-us/564

  Clinically, three forms of recurrent aphthous ulceration exist: major, minor, and herpetiform. […] Diagnosis is based on the history and clinical examination with exclusion of a systemic etiology; there are no specific laboratory findings. […] Key diagnostic factors include oral ulcers, afebrile status, absence of genital or ocular ulceration, no history of immunodeficiency, and absence of pallor. […] Tests to consider for diagnosis include CBC, serum ferritin, serum folate, serum vitamin B12, serum IgA-tTG, viral serology (e.g. HIV or Epstein-Barr virus), erythrocyte sedimentation rate and CRP, biopsy, antinuclear antibody test, and serum HIV test.

• #16 Aphthous ulceration (aphthae, ulcers)

  https://dermnetnz.org/topics/aphthous-ulcer

  Aphthous ulcers are usually diagnosed clinically. Investigations are rarely required, but are undertaken if there are recurrent attacks of multiple or severe oral ulcers or complex aphthosis. […] Blood tests may include: Blood count, iron, vitamin B12, and folate studies. […] Swabs for microbiology evaluate the presence of Candida albicans, Herpes simplex virus and Vincent’s organisms.

• #17 Azthena logo with the word Azthena

  https://www.news-medical.net/health/Diagnosis-of-canker-sores.aspx

  Once located the doctor wears gloves to physically palpate the lesion or ulcer. This may be painful and is usually performed gently. […] In patients with recurrent ulcers that tend to persist or recur frequently other disorders are suspected. Tests are conducted for disorders like erythema multiforme, drug allergies, infections with herpes virus, bullous lichen planus etc. […] A biopsy may be undertaken in these patients. This involves snipping off a small bit of tissue from the ulcer and its surrounding areas, staining it with appropriate dyes and examining the same under the microscope. Canker sores are not cancer and do not lead to cancer if they recur.

• #18 Mouth ulcers | Better Health Channel

  https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/mouth-ulcers

  A mouth ulcer is the loss or erosion of the delicate lining tissue of the mouth (mucous membrane). […] If your mouth ulcers dont clear up after 14 days, or if you get them frequently, see your dentist or doctor. […] An ulcer that wont heal may be a sign of mouth cancer. […] See your dentist or doctor if your mouth ulcers dont clear up within 2 weeks, or if you get them frequently. […] If your oral health professional cannot determine the cause of your mouth ulcers, or if the ulcers do not respond to the normal treatments, you may need to have a biopsy of part of the ulcer and some of the surrounding tissue. A biopsy is a procedure where a tissue sample is taken for examination and diagnosis. […] In some cases, you may need blood tests if it is suspected that you have an underlying deficiency (such as an iron, folate or vitamin B deficiency) or an inflammatory medical condition.

• #19 Difficult and complicated oral ulceration: an expert consensus guideline for diagnosis | International Journal of Oral Science

  https://www.nature.com/articles/s41368-022-00178-0

  The complexity of oral ulcerations poses considerable diagnostic and therapeutic challenges to oral specialists. The expert consensus was conducted to summarize the diagnostic work-up for difficult and complicated oral ulcers, based on factors such as detailed clinical medical history inquiry, histopathological examination, and ulceration-related systemic diseases screening. Not only it can provide a standardized procedure of oral ulceration, but also it can improve the diagnostic efficiency, in order to avoid misdiagnosis and missed diagnosis. […] For oral ulceration that cannot be diagnosed after collection of clinical medical history and oral examination, especially those with the course over 2 weeks, or cases which do not respond to 12 weeks of treatments, a biopsy should be considered. Note that blood test is necessary before the biopsy, aiming to exclude contraindications. More importantly, blood test can also provide clues of further clinical examination and diagnosis.

• #20 Difficult and complicated oral ulceration: an expert consensus guideline for diagnosis | International Journal of Oral Science

  https://www.nature.com/articles/s41368-022-00178-0

  If the diagnostic clues cannot be found by blood test before a biopsy, and there is no contraindication, evaluation of the oral ulceration will enter the Part 2a biopsy. […] Sometimes patients are not eligible to have a biopsy due to contraindications or poor general conditions. Even if the oral biopsy is carried out, a definitive diagnosis is often difficult to obtain. […] Evaluation of oral ulceration will get into Part 3 if patients with inoperable conditions or the diagnosis remain unestablished after consultation. That is, we step back and perform further screening of ulceration-related systemic diseases. […] For oral ulcers located on or near the hard tissue, maxillofacial CT examination would find out whether there is bone destruction or not. […] If there is no abnormality after the above medical history collection and additional examinations, diagnostic treatment with low-dose and short-term oral glucocorticoids, a second biopsy, or the multi-disciplinary team consultation may be performed if necessary.

• #21 Common benign and malignant oral mucosal disease

  https://www1.racgp.org.au/ajgp/2020/september/common-benign-and-malignant-oral-mucosal-disease

  Any persistent ulcer that has been present for 2 weeks should be referred to an oral and maxillofacial surgeon or oral medicine specialist for biopsy. […] Leukoplakia and erythroplakia are clinical terms used to describe oral white and red patches respectively that cannot be scraped off and cannot be ascribed to any disease or condition. Referral for biopsy is mandatory as a significant proportion of these lesions will be dysplastic or malignant. […] Any tissue excised from the oral cavity should be sent for histopathological examination as the clinical appearance alone is insufficient to ensure a correct diagnosis.

• #22 Difficult and complicated oral ulceration: an expert consensus guideline for diagnosis | International Journal of Oral Science

  https://www.nature.com/articles/s41368-022-00178-0

  The complexity of oral ulcerations poses considerable diagnostic and therapeutic challenges to oral specialists. The expert consensus was conducted to summarize the diagnostic work-up for difficult and complicated oral ulcers, based on factors such as detailed clinical medical history inquiry, histopathological examination, and ulceration-related systemic diseases screening. Not only it can provide a standardized procedure of oral ulceration, but also it can improve the diagnostic efficiency, in order to avoid misdiagnosis and missed diagnosis. […] For oral ulceration that cannot be diagnosed after collection of clinical medical history and oral examination, especially those with the course over 2 weeks, or cases which do not respond to 12 weeks of treatments, a biopsy should be considered. Note that blood test is necessary before the biopsy, aiming to exclude contraindications. More importantly, blood test can also provide clues of further clinical examination and diagnosis.

• #23 Difficult and complicated oral ulceration: an expert consensus guideline for diagnosis | International Journal of Oral Science

  https://www.nature.com/articles/s41368-022-00178-0

  If the diagnostic clues cannot be found by blood test before a biopsy, and there is no contraindication, evaluation of the oral ulceration will enter the Part 2a biopsy. […] Sometimes patients are not eligible to have a biopsy due to contraindications or poor general conditions. Even if the oral biopsy is carried out, a definitive diagnosis is often difficult to obtain. […] Evaluation of oral ulceration will get into Part 3 if patients with inoperable conditions or the diagnosis remain unestablished after consultation. That is, we step back and perform further screening of ulceration-related systemic diseases. […] For oral ulcers located on or near the hard tissue, maxillofacial CT examination would find out whether there is bone destruction or not. […] If there is no abnormality after the above medical history collection and additional examinations, diagnostic treatment with low-dose and short-term oral glucocorticoids, a second biopsy, or the multi-disciplinary team consultation may be performed if necessary.

• #24 Diagnostic Features of Common Oral Ulcerative Lesions: An Updated Decision Tree

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5066016/

  Diagnosis of oral ulcerative lesions might be quite challenging. […] This narrative review article aims to introduce an updated decision tree for diagnosing oral ulcerative lesions on the basis of their diagnostic features. […] In order to arrive at a definitive diagnosis, it is imperative to consider differential diagnoses. […] According to the literature, many cases of oral malignant ulcerations were misdiagnosed as nonneoplastic lesions up to several months before the definite diagnosis was established. […] A decision tree is a flowchart that organizes features of lesions so that the clinician can make a series of orderly decisions to reach a logical conclusion. […] The first decision to be made is whether the ulcerative lesion is of an acute, chronic, or recurrent nature; thereafter, the lesion(s) should be placed in one of the five subgroups. […] The newly updated decision tree includes 29 oral ulcerative lesions based on duration and number of lesions, which helps clinicians establish a stepwise method to rule out improbable conditions to arrive at a logical diagnosis.

• #25 Aphthous Ulcers Differential Diagnoses

  https://emedicine.medscape.com/article/867080-differential

  Mouth ulcers can arise from local causes, malignancy, drug adverse effects, and systemic conditions (particularly infections, blood disorders, gastrointestinal disorders, and skin diseases). […] A thorough patient history and clinical examination are essential to differentiate RAS from other pathologies. […] Conditions such as viral infections (eg, herpes simplex), autoimmune diseases (eg, lupus), systemic diseases (eg, celiac disease), and traumatic lesions should be considered in the differential diagnosis of RAS. […] Recurrent multiple ulcers are most typical of the following conditions (before making a diagnosis of RAS, potentially overlooked causes of oral ulcers must be considered): Hematinic deficiency (eg, iron, folate, vitamin B-12), Celiac disease, Crohn disease, Neumann bipolar aphthosis, Behet syndrome, Sweet syndrome, HIV infection, neutropenia, and other immunodeficiencies, Periodic fever, aphthous stomatitis, pharyngitis, and cervical adenitis (PFAPA) syndrome in children.

• #26 Recurrent Aphthous Stomatitis – Mouth and Dental Disorders – Merck Manual Consumer Version

  https://www.merckmanuals.com/home/mouth-and-dental-disorders/symptoms-of-oral-and-dental-disorders/recurrent-aphthous-stomatitis

  Recurrent aphthous stomatitis (canker sores, or aphthous ulcers) is the presence of small, painful sores (ulcers) inside the mouth that typically begin in childhood and recur frequently. […] Doctors or dentists make the diagnosis based on the pain and the appearance of the canker sores. […] A doctor or dentist identifies recurrent aphthous stomatitis by its appearance and the pain it causes.

• #27 Recurrent aphthous stomatitis (episodic mouth ulcers) – Symptoms, diagnosis and treatment | BMJ Best Practice US

  https://bestpractice.bmj.com/topics/en-us/564

  Clinically, three forms of recurrent aphthous ulceration exist: major, minor, and herpetiform. […] Diagnosis is based on the history and clinical examination with exclusion of a systemic etiology; there are no specific laboratory findings. […] Key diagnostic factors include oral ulcers, afebrile status, absence of genital or ocular ulceration, no history of immunodeficiency, and absence of pallor. […] Tests to consider for diagnosis include CBC, serum ferritin, serum folate, serum vitamin B12, serum IgA-tTG, viral serology (e.g. HIV or Epstein-Barr virus), erythrocyte sedimentation rate and CRP, biopsy, antinuclear antibody test, and serum HIV test.

• #28 A young boy with a painful oral ulcer | Medicine Today

  https://medicinetoday.com.au/dermatology-quiz/young-boy-painful-oral-ulcer

  Aphthous ulcers usually involve the lips, buccal mucosa and tongue, with large lesions sometimes affecting keratinised mucosa. They tend to heal within two weeks but large ones can last up to six weeks. […] A diagnosis of aphthous ulcer is made on a clinical basis; there is no specific diagnostic test available. A biopsy of an aphthous ulcer is nonspecific, revealing only loss of epithelium and a chronic mixed inflammatory infiltrate, and is therefore not indicated. It is rare that a patient will need any testing. […] For mild aphthous ulcers, the mainstays of treatment are avoidance of exacerbating factors (if any), analgesia and topical measures. Topical corticosteroids suppress inflammation and reduce pain; these were used to treat the patient described above.

• #29 Recurrent Aphthous Stomatitis – Dental Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/dental-disorders/symptoms-of-dental-and-oral-disorders/recurrent-aphthous-stomatitis

  Diagnosis of Recurrent Aphthous Stomatitis is based on appearance and on exclusion because there are no definitive histologic features or laboratory tests. […] Clinical evaluation is essential for diagnosing recurrent aphthous stomatitis. […] Similar recurrent episodes, often with multiple ulcers, can occur with Behçet disease, inflammatory bowel disease, celiac disease, HIV infection, PFAPA syndrome, and nutritional deficiencies; these conditions generally have systemic symptoms and signs. […] Viral testing and serum tests can identify these conditions.

• #30 Diagnosis of oral ulcers – PubMed

  https://pubmed.ncbi.nlm.nih.gov/9844367/

  Ulcers commonly occur in the mouth. Their causes range from minor irritation to malignancies and systemic diseases. Innocent solitary ulcerations, which result from trauma and infections, must be distinguished from squamous cell carcinomas, which also typically present as solitary ulcers. […] Multiple oral ulcers may be classified as acute, recurrent and/or chronic. The most common causes of rapid-onset oral ulcers include acute necrotizing ulcerative gingivitis, allergies and erythema multiforme. The two common forms of acute (short-term) recurrent oral ulcers, „cold sores” or „fever blisters,” which are caused by the herpes simplex virus, and recurrent aphthous ulcers („canker sores”), may be distinguished largely on the basis of their location. Most types of multiple chronic oral ulcers are associated with disturbances of the immune system. They include erosive lichen planus, mucous membrane pemphigoid and pemphigus vulgaris. Clinical criteria which are most useful in identifying the cause of oral ulcers are vesicles or bullae, which may not be seen because they rupture rapidly in the oral environment; constitutional signs and symptoms; and lesions on the skin and/or other mucosa. In some cases, diagnosis depends upon culture or biopsy, particularly with the application of immunofluorescence to the surgical specimen.

• #31 Herpetic stomatitis: MedlinePlus Medical EncyclopediaLock

  https://medlineplus.gov/ency/article/001383.htm

  Herpetic stomatitis is a viral infection of the mouth that causes sores and ulcers. These mouth ulcers are not the same as canker sores, which are not caused by a virus. […] Your child’s health care provider can most often diagnose this condition by looking at your child’s mouth sores. […] Sometimes, special laboratory tests are used to help confirm the diagnosis.

• #32 Aphthous Ulcers Differential Diagnoses

  https://emedicine.medscape.com/article/867080-differential

  Mouth ulcers can arise from local causes, malignancy, drug adverse effects, and systemic conditions (particularly infections, blood disorders, gastrointestinal disorders, and skin diseases). […] A thorough patient history and clinical examination are essential to differentiate RAS from other pathologies. […] Conditions such as viral infections (eg, herpes simplex), autoimmune diseases (eg, lupus), systemic diseases (eg, celiac disease), and traumatic lesions should be considered in the differential diagnosis of RAS. […] Recurrent multiple ulcers are most typical of the following conditions (before making a diagnosis of RAS, potentially overlooked causes of oral ulcers must be considered): Hematinic deficiency (eg, iron, folate, vitamin B-12), Celiac disease, Crohn disease, Neumann bipolar aphthosis, Behet syndrome, Sweet syndrome, HIV infection, neutropenia, and other immunodeficiencies, Periodic fever, aphthous stomatitis, pharyngitis, and cervical adenitis (PFAPA) syndrome in children.

• #33 Mouth Sores: Pictures, Causes, Types, Symptoms, and Treatments

  https://www.healthline.com/health/mouth-sores

  Mouth sores have many possible causes, such as infections, trauma, and tobacco use. […] If you have unexplained mouth sores or mouth sores that come back or last for a long time, it is best to visit a doctor for a diagnosis and treatment. […] If you have recurring ulcers, it may be due to other conditions, such as Crohns disease, celiac disease, vitamin deficiency, or HIV. […] Certain conditions may make you more prone to them. These can include: a weakened immune system because of illness or stress, hormone changes, such as menstruation, a vitamin deficiency, especially of folate and B12, intestinal issues, such as Crohns disease or ulcerative colitis, both types of inflammatory bowel syndrome (IBS). […] If you have gingivostomatitis, you may also experience mild, flu-like symptoms.

• #34 Management of Aphthous Ulcers | AAFP

  https://www.aafp.org/pubs/afp/issues/2000/0701/p149.html

  Aphthous ulcers are a common and painful problem. […] Aphthous ulcers that occur in conjunction with symptoms of uveitis, genital ulcerations, conjunctivitis, arthritis, fever or adenopathy should prompt a search for a serious etiology. […] The lack of clarity regarding the etiology of aphthous ulcers has resulted in treatments that are largely empiric. […] Several conditions should be considered in the differential diagnosis when evaluating patients with recurrent aphthae. […] Major aphthae can be associated with human immunodeficiency virus (HIV) infection; clinicians should consider HIV testing when aphthae are large and slow to heal. […] Infection-causing ulceration in the mouth should be considered when evaluating patients with oral symptoms. […] Several autoimmune diseases may mimic benign aphthous ulcers.

• #35 Management of Aphthous Ulcers | AAFP

  https://www.aafp.org/pubs/afp/issues/2000/0701/p149.html

  Hematologic etiologies should be considered when evaluating recurrent or slow-healing mouth ulcers. […] A neoplasm such as squamous cell carcinoma must be ruled out when evaluating patients with persistent, nonhealing mouth ulceration. […] Aphthous ulcers are a poorly understood clinical entity that cause significant pain in otherwise healthy patients. […] When ulcers are slow to heal or if associated systemic symptoms are present (e.g., uveitis, arthritis, fever, adenopathy), other, more serious conditions should be ruled out.

• #36 Mouth Ulcers: Types, Causes & Treatment

  https://my.clevelandclinic.org/health/diseases/21766-mouth-ulcer

  A mouth ulcer that doesnt go away could be a sign of oral cancer. In most cases of mouth cancer, mouth ulcers appear on or under the tongue. […] If you have a mouth ulcer that doesnt heal after three weeks, schedule a visit with a healthcare provider. You might have an underlying condition that needs treatment.

• #37 Mouth ulcers | Better Health Channel

  https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/mouth-ulcers

  A mouth ulcer is the loss or erosion of the delicate lining tissue of the mouth (mucous membrane). […] If your mouth ulcers dont clear up after 14 days, or if you get them frequently, see your dentist or doctor. […] An ulcer that wont heal may be a sign of mouth cancer. […] See your dentist or doctor if your mouth ulcers dont clear up within 2 weeks, or if you get them frequently. […] If your oral health professional cannot determine the cause of your mouth ulcers, or if the ulcers do not respond to the normal treatments, you may need to have a biopsy of part of the ulcer and some of the surrounding tissue. A biopsy is a procedure where a tissue sample is taken for examination and diagnosis. […] In some cases, you may need blood tests if it is suspected that you have an underlying deficiency (such as an iron, folate or vitamin B deficiency) or an inflammatory medical condition.

• #38 Mouth Ulcers: Types, Causes & Treatment

  https://my.clevelandclinic.org/health/diseases/21766-mouth-ulcer

  Mouth ulcers can be alarming. However, theyre not a sexually transmitted infection (STI) and you cant get or spread them from kissing or sharing food and drinks. […] But some types of mouth sores could point to underlying health conditions like viruses, autoimmune diseases or gastrointestinal issues. […] A healthcare provider can diagnose a mouth ulcer with a visual examination. If you have a severe breakout, or if they suspect a specific health condition, they may order blood tests. […] If you have a mouth ulcer that hasnt gone away after three weeks, tell your healthcare provider. […] Anyone can get mouth ulcers. But you should call your healthcare provider if you have: Mouth sores that last for three weeks or longer. […] Anytime you have a mouth sore that lasts longer than three weeks, schedule a visit with your provider. Mouth ulcers that dont go away could point to other underlying health conditions.

• #39 Mouth ulcers

  https://www.nhs.uk/conditions/mouth-ulcers/

  Mouth ulcers are common and should clear up on their own within a week or 2. But see a GP or dentist if you have a mouth ulcer that lasts longer than 3 weeks. […] A pharmacist can recommend a treatment to speed up healing, prevent infection or reduce pain, such as: antimicrobial mouthwash, a painkilling tablet, mouthwash, gel or spray, corticosteroid lozenges, a salt (saline) mouthwash. […] Non-urgent advice: See a dentist or GP if your mouth ulcer: lasts longer than 3 weeks, is different to other mouth ulcers you’ve had before, for example if it’s bigger than usual or near the back of your throat, bleeds or becomes more painful and red this may be a sign of an infection. […] Although most mouth ulcers are harmless, a long-lasting mouth ulcer is sometimes a sign of mouth cancer. It’s best to get it checked.

• #40 Ulcers (Mouth/Oral), Differential Diagnosis | Time of Care

  https://www.timeofcare.com/ulcers-mouth-oral-differential-diagnosis/

  Aphthous ulcer (i.e. canker sore or ulcerative stomatitis) Herpes simplex Oral candidiasis Hand, foot, and mouth disease (Coxsackievirus) Herpangina (Coxsackievirus) Acute HIV infection Chickenpox (Varicella Zoster) Syphilis Parvovirus (fifth disease) Squamous cell carcinoma Trauma Drug reaction Behcets disease Erythema multiforme Stevens-Johnson syndrome Lichen planus Pemphigus, Bullous pemphigoid Reactive arthritis Necrotizing ulcerative gingivostomatitis (Vincents fusospirochetal disease) Inflammatory bowel disease Systemic lupus erythematosus (SLE) […] The differential diagnosis above can be categorized into Infectious, Neoplastic, Trauma, Drugs, Autoimmune.

• #41 Diagnostic Features of Common Oral Ulcerative Lesions: An Updated Decision Tree

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5066016/

  Diagnosis of oral ulcerative lesions might be quite challenging. […] This narrative review article aims to introduce an updated decision tree for diagnosing oral ulcerative lesions on the basis of their diagnostic features. […] In order to arrive at a definitive diagnosis, it is imperative to consider differential diagnoses. […] According to the literature, many cases of oral malignant ulcerations were misdiagnosed as nonneoplastic lesions up to several months before the definite diagnosis was established. […] A decision tree is a flowchart that organizes features of lesions so that the clinician can make a series of orderly decisions to reach a logical conclusion. […] The first decision to be made is whether the ulcerative lesion is of an acute, chronic, or recurrent nature; thereafter, the lesion(s) should be placed in one of the five subgroups. […] The newly updated decision tree includes 29 oral ulcerative lesions based on duration and number of lesions, which helps clinicians establish a stepwise method to rule out improbable conditions to arrive at a logical diagnosis.

• #42 Difficult and complicated oral ulceration: an expert consensus guideline for diagnosis | International Journal of Oral Science

  https://www.nature.com/articles/s41368-022-00178-0

  The complexity of oral ulcerations poses considerable diagnostic and therapeutic challenges to oral specialists. The expert consensus was conducted to summarize the diagnostic work-up for difficult and complicated oral ulcers, based on factors such as detailed clinical medical history inquiry, histopathological examination, and ulceration-related systemic diseases screening. Not only it can provide a standardized procedure of oral ulceration, but also it can improve the diagnostic efficiency, in order to avoid misdiagnosis and missed diagnosis. […] For oral ulceration that cannot be diagnosed after collection of clinical medical history and oral examination, especially those with the course over 2 weeks, or cases which do not respond to 12 weeks of treatments, a biopsy should be considered. Note that blood test is necessary before the biopsy, aiming to exclude contraindications. More importantly, blood test can also provide clues of further clinical examination and diagnosis.

• #43 A Simple Approach for the Diagnosis of Oral Ulcers: A Novel Algorithm

  https://ajdr.umsha.ac.ir/Article/ajdr-1741

  Ulcers are one of the most common lesions in the oral cavity and are caused by injuries to the oral mucosa for different reasons. These ulcers are clinically characterized by the loss of the whole thickness of the epithelium and the denuding of the underlying lamina propria in the presence of a white/yellow layer called the fibrinoleukocytic layer and are usually accompanied by pain. Due to the wide array of etiologic agents for oral ulcers, pinpointing the etiologic agent can be highly challenging, and the availability of a good diagnostic guide assists in the diagnosis and selection of proper treatment modalities because a fast and accurate diagnosis of some ulcers (e.g., the early stages of squamous cell carcinoma) is crucial for the early initiation of treatment. The present study attempts to present a proper and comprehensive diagnostic guide to facilitate the classification and diagnosis of different oral ulcers.

• #44 Oral ulcers in children- a clinical narrative overview | Italian Journal of Pediatrics | Full Text

  https://ijponline.biomedcentral.com/articles/10.1186/s13052-021-01097-2

  The prevalence of oral ulcers in children is reported to be 9%, however diagnosis of oral lesions can be challenging, being an unspecific symptom of several diseases. […] A systematic literature search and a narrative literature review about the potential 48 diseases connected to oral ulcers were performed. According to the duration of symptoms and size of the lesions, a tabular overview was created to support the clinician in making a correct diagnosis, additionally different treatment options are presented. […] Although oral ulcers are common in childhood, there is only sparse literature published describing the diagnostic approach. Our aim was to introduce a narrative review and create a decision flowchart for diagnosing children with oral ulcers, supporting clinicians in the diagnostic pathway.

• #45 Mouth Ulcers: Types, Causes & Treatment

  https://my.clevelandclinic.org/health/diseases/21766-mouth-ulcer

  Mouth ulcers can be alarming. However, theyre not a sexually transmitted infection (STI) and you cant get or spread them from kissing or sharing food and drinks. […] But some types of mouth sores could point to underlying health conditions like viruses, autoimmune diseases or gastrointestinal issues. […] A healthcare provider can diagnose a mouth ulcer with a visual examination. If you have a severe breakout, or if they suspect a specific health condition, they may order blood tests. […] If you have a mouth ulcer that hasnt gone away after three weeks, tell your healthcare provider. […] Anyone can get mouth ulcers. But you should call your healthcare provider if you have: Mouth sores that last for three weeks or longer. […] Anytime you have a mouth sore that lasts longer than three weeks, schedule a visit with your provider. Mouth ulcers that dont go away could point to other underlying health conditions.

• #46 Mouth ulcers – Diagnosing mouth ulcers

  https://www.ibdrelief.com/learn/symptoms/mouth-ulcers-introduction/mouth-ulcers-diagnosing-mouth-ulcers

  If you have a mild mouth ulcer, there is usually no need for you to see your GP or dentist because these ulcers will usually heal within a week or two. […] You only need to visit your GP or dentist if you have a mouth ulcer that is very painful or has lasted for more than three weeks, or if you are getting mouth ulcers regularly. […] If you see your GP or dentist with a mouth ulcer, they will usually look inside your mouth to examine the ulcer first. […] In some cases, your GP or dentist might consider carrying out or referring you for a blood test. A sample of your blood can be tested to check for signs of infection or inflammation and to check your levels of iron and vitamin B12, which can sometimes help identify an underlying condition that could be responsible for your mouth ulcers.

• #47 Mouth ulcers

  https://www.nhs.uk/conditions/mouth-ulcers/

  Mouth ulcers are common and should clear up on their own within a week or 2. But see a GP or dentist if you have a mouth ulcer that lasts longer than 3 weeks. […] A pharmacist can recommend a treatment to speed up healing, prevent infection or reduce pain, such as: antimicrobial mouthwash, a painkilling tablet, mouthwash, gel or spray, corticosteroid lozenges, a salt (saline) mouthwash. […] Non-urgent advice: See a dentist or GP if your mouth ulcer: lasts longer than 3 weeks, is different to other mouth ulcers you’ve had before, for example if it’s bigger than usual or near the back of your throat, bleeds or becomes more painful and red this may be a sign of an infection. […] Although most mouth ulcers are harmless, a long-lasting mouth ulcer is sometimes a sign of mouth cancer. It’s best to get it checked.

• #48 Mouth ulcers | Lima Memorial Health System

  https://www.limamemorial.org/health-library/HIE%20Multimedia-TextOnly/1/001448

  Mouth ulcers are sores or open lesions in the mouth. […] Most of the time, a health care provider or dentist will look at the ulcer and where it is in the mouth to make the diagnosis. You may need blood tests or a biopsy of the ulcer may be needed to confirm the cause. […] Contact your provider if: A mouth ulcer does not go away after 3 weeks. You have mouth ulcers return often, or if new symptoms develop.

• #49 Mouth ulcers – Diagnosing mouth ulcers

  https://www.ibdrelief.com/learn/symptoms/mouth-ulcers-introduction/mouth-ulcers-diagnosing-mouth-ulcers

  If you have had a severe mouth ulcer for more than three weeks, your GP or dentist may refer you to a hospital specialist. […] The hospital specialist may decide to carry out a biopsy to help determine what may be causing your symptoms. This is a procedure in which a small tissue sample is taken from your mouth for further examination.

• #50 Persistent Mouth Sores? Working with Your Oral Health Care Provider to Reach a Diagnosis – IPPF

  https://www.pemphigus.org/persistent-mouth-sores-working-with-your-oral-health-care-provider-to-reach-a-diagnosis/

  The saying diagnosis dictates treatment is particularly relevant when it comes to treating oral ulcerative conditions. […] Therefore, the best advice I can offer is threefold: Your dentist or physician needs to take your complaint seriously and needs to thoroughly investigate your symptoms. A diagnostic tissue biopsy is essential before your dentist or physician treats you empirically with antifungal, anti-viral, or corticosteroid medication. If the clinician assessing you does not insist on performing a diagnostic biopsy, insist on being referred to a clinician with extensive experience in the diagnosis and management of oral lesions.

• #51 Difficult and complicated oral ulceration: an expert consensus guideline for diagnosis | International Journal of Oral Science

  https://www.nature.com/articles/s41368-022-00178-0

  The complexity of oral ulcerations poses considerable diagnostic and therapeutic challenges to oral specialists. The expert consensus was conducted to summarize the diagnostic work-up for difficult and complicated oral ulcers, based on factors such as detailed clinical medical history inquiry, histopathological examination, and ulceration-related systemic diseases screening. Not only it can provide a standardized procedure of oral ulceration, but also it can improve the diagnostic efficiency, in order to avoid misdiagnosis and missed diagnosis. […] For oral ulceration that cannot be diagnosed after collection of clinical medical history and oral examination, especially those with the course over 2 weeks, or cases which do not respond to 12 weeks of treatments, a biopsy should be considered. Note that blood test is necessary before the biopsy, aiming to exclude contraindications. More importantly, blood test can also provide clues of further clinical examination and diagnosis.

• #52 Diagnostic Features of Common Oral Ulcerative Lesions: An Updated Decision Tree

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5066016/

  Diagnosis of oral ulcerative lesions might be quite challenging. […] This narrative review article aims to introduce an updated decision tree for diagnosing oral ulcerative lesions on the basis of their diagnostic features. […] In order to arrive at a definitive diagnosis, it is imperative to consider differential diagnoses. […] According to the literature, many cases of oral malignant ulcerations were misdiagnosed as nonneoplastic lesions up to several months before the definite diagnosis was established. […] A decision tree is a flowchart that organizes features of lesions so that the clinician can make a series of orderly decisions to reach a logical conclusion. […] The first decision to be made is whether the ulcerative lesion is of an acute, chronic, or recurrent nature; thereafter, the lesion(s) should be placed in one of the five subgroups. […] The newly updated decision tree includes 29 oral ulcerative lesions based on duration and number of lesions, which helps clinicians establish a stepwise method to rule out improbable conditions to arrive at a logical diagnosis.

• #53 Mouth Ulcers: Types, Causes & Treatment

  https://my.clevelandclinic.org/health/diseases/21766-mouth-ulcer

  Mouth ulcers can be alarming. However, theyre not a sexually transmitted infection (STI) and you cant get or spread them from kissing or sharing food and drinks. […] But some types of mouth sores could point to underlying health conditions like viruses, autoimmune diseases or gastrointestinal issues. […] A healthcare provider can diagnose a mouth ulcer with a visual examination. If you have a severe breakout, or if they suspect a specific health condition, they may order blood tests. […] If you have a mouth ulcer that hasnt gone away after three weeks, tell your healthcare provider. […] Anyone can get mouth ulcers. But you should call your healthcare provider if you have: Mouth sores that last for three weeks or longer. […] Anytime you have a mouth sore that lasts longer than three weeks, schedule a visit with your provider. Mouth ulcers that dont go away could point to other underlying health conditions.

• #54 Mouth ulcers | Better Health Channel

  https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/mouth-ulcers

  A mouth ulcer is the loss or erosion of the delicate lining tissue of the mouth (mucous membrane). […] If your mouth ulcers dont clear up after 14 days, or if you get them frequently, see your dentist or doctor. […] An ulcer that wont heal may be a sign of mouth cancer. […] See your dentist or doctor if your mouth ulcers dont clear up within 2 weeks, or if you get them frequently. […] If your oral health professional cannot determine the cause of your mouth ulcers, or if the ulcers do not respond to the normal treatments, you may need to have a biopsy of part of the ulcer and some of the surrounding tissue. A biopsy is a procedure where a tissue sample is taken for examination and diagnosis. […] In some cases, you may need blood tests if it is suspected that you have an underlying deficiency (such as an iron, folate or vitamin B deficiency) or an inflammatory medical condition.

• #55 17 Mouth & Tongue Problems: Pictures of Sores, Blisters, Bumps, and More

  https://www.webmd.com/oral-health/ss/slideshow-mouth-problems

  See a doctor for a firm diagnosis. […] Persistent, severe canker sores can be treated with numbing creams, prescription drugs, or dental lasers. […] Oral lichen planus can be chronic and may increase the risk for oral cancer. […] A mouth sore that doesn’t go away. Unexplained numbness in the face, mouth, or neck. Problems chewing, speaking or swallowing. These are a few symptoms of oral cancer. […] Don’t let fear keep you from the doctor — oral cancer that is caught early is treatable and curable. […] See your dentist to treat receding gums. […] If the blue-gray spot grows or changes color, there is a good possibility it may not be an amalgam tattoo. Ask your dentist to check it out. […] See your dentist as soon as possible if your tooth aches or if you have a fever, earache, or pain when you open your mouth wide.

• #56 Spotting Mouth Ulcers vs. Oral Cancer Early Signs

  https://nhcancerclinics.com/blog/how-to-spot-the-difference-between-mouth-ulcers-and-oral-cancer/

  Proper checkup at the correct time is essential in differentiating mouth ulcers from oral cancers. […] Canker sores or mouth ulcers are non-cancerous ulcerations in the oral cavity mucosa. […] Sores in the mouth that do not heal after the expected time for regular ulcers should always be seen by a healthcare provider or visited if any of the following symptoms occur because they do not come with mouth ulcers. […] Early detection of oral cancer has dramatically increased the chances of successful treatment. […] The sore must heal within two weeks; otherwise, visit a doctor or dentist for further evaluation. Ulcers that persist long beyond their expected time may need to be examined for malignancy or underlying disease.

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