Ulcers are the most common oral soft
Viral infections of oral mucosa: Herpes
simplex, herpangina, herpes zoster
Erosive lichen planus
Bacterial infections: T.B ulcer, syphilitic
Caused by local trauma
Either by ill fitted dentures
Sharp edges of brocken tooth
Lip or tongue biting after heavy
Most common oral mucosal lesion
Possible etiological factors:
Genetic predisposition: HLA family
Hormonal influences: Female, menstrual period
Infectious agents: AIDS,HSV,VZV
Of all the types of nontraumatic
ulceration that affect oral
mucosa, aphthous ulcers (canker sores)
are probably the most common.
incidence ranges from 20% to 60%.
Prevalence tends to be higher in
professional persons, in those in upper
socioeconomic groups, and in those
who do not smoke.
Onset frequently in childhood but
peak in adolescence or early adult
Attacks at variable but sometimes
relatively regular intervals
Most patients are non-smokers
Usually self-limiting eventually
Three forms of aphthous ulcers have
minor, major, and herpetiform
All are believed to be part of the same
disease spectrum, and all are believed
to have a common etiology.
Differences are essentially clinical and
correspond to the degree of severity.
Minor Aphthous stomatitis
The most common type
Non-keratinized mucosa affected
Ulcers are shallow, rounded, 5-7mm with
erythematous margins and yellowish
One or several ulcers may be present
Minor aphthous ulcers usually appears as a
single, painful, oval ulcer that is less than 0.5 cm
in diameter, covered by a yellow fibrinous
membrane and surrounded by an erythematous
halo. Multiple oral aphthae may be seen.
Minor aphthous ulcers generally last 7 to 10 days
and heal without scar formation. Recurrences vary
from one individual to another. Periods of
freedom from disease may range from a matter of
weeks to as long as years.
Ulcers frequently several cms mimic
Ulcers persist for several months
Masticatory mucosa, dorsum of tongue
or gingiva may be involved
Scar follow healing
painful recurrent ulcers.
prodromal symptoms of tingling or burning before
the appearance of lesions.
The ulcers are not preceded by vesicles and
characteristically appear on the vestibular and
buccal mucosa, tongue, soft palate, fauces, and floor
Only rarely do these lesions occur on the attached
gingiva and hard palate, thus providing an
important clinical sign for the separation of
aphthous ulcers from secondary herpetic ulcers.
discomfort, systemic health may be
compromised because of difficulty
in eating and psychological stress.
The predilection for movable oral
mucosa is as typical for major
aphthous ulcers as it is for minor
HIV-positive patients may have
aphthous lesions at any intraoral
Non-keratinized mucosa affected
Ulcers are 1-2 cm
Dozens or hundreds may be present
May coalesce to form irrigular ulcers
Widespread bright erythemous
Herpetiform Aphthous Ulcers.
recurrent crops of small ulcers.
movable mucosa is predominantly affected,
palatal and gingival mucosa may also be
involved. Pain may be considerable,
healing generally occurs in 1 to 2 weeks.
Unlike herpes infection, herpetiform
aphthous ulcers are not preceded by vesicles
and exhibit no virus-infected cells.
the diagnosis of these ulcers is usually
evident clinically, biopsies usually are
unnecessary and therefore are rarely
Aphthous ulcers have nonspecific
microscopic findings, and no histologic
features are diagnostic.
Studies have shown that mononuclear cells
are found in submucosa and perivascular
tissues in the preulcerative stage. These cells
are predominantly CD4 lymphocytes,
Diagnosis of aphthous ulcers is generally based
on the history and clinical appearance.
Lesions of secondary (recurrent) oral herpes are
often confused with ulcers.
A history of vesicles preceding ulcers, location on
the attached gingiva and hard palate, and crops of
lesions indicate herpetic rather than aphthous
Other painful oral ulcerative conditions include
trauma, pemphigus vulgaris, mucous membrane
pemphigoid, and neutropenia.
occasional or few minor aphthous
ulcers, usually no treatment is
needed apart from a bland mouth
rinse such as sodium bicarbonate in
warm water to keep the mouth
patients more severely
affected, some forms of treatment
can provide significant control (but
not necessarily a cure) of this
Behçet’s syndrome is a rare multisystem
(gastrointestinal, cardiovascular, ocular, CNS, a
rticular, pulmonary, dermal) in which
recurrent oral aphthae are a consistent feature.
Although the oral manifestations are usually
relatively minor, involvement of other
sites, especially the eyes and CNS, can be
Disease comprised oral aphthae, genital
ulcerations and ocular diseases and
Major and minor criteria
Affect mostly young adult males
Strong genetic component
- Rare disease of middle age
- Initial presentation:
sinusitis, rhinorrhea, nasal stuffiness &
- Majority of cases, nasal & maxillary sinus
- Necrosis & perforation of the nasal septum
or palate are occasionally seen.
- Intra-oral lesions consist of
red, hyperplastic, granular lesion on attached
- Classical triad : upper respiratory
Allergic contact stomatitis: many agents cause
reactions in the oral cavity as: numerous
food, chewing gums, food additives, mouth
washes dental materials, oral anasthesia.
Acute or chronic, female predominance
Appearance, mild redness- bright erythematous
lesions or vesicls rapture to form areas of
Anaphylactic stomatitis either alone or in
conjunction with urticarial skin lesions.
The affected mucosa show multiple zones of
erythema or many aphthous-like ulceration.
Mucosal fixed drug eruptions develop into
vesiculo-erosive lesions mostly on the labial
Most common drugs penicillin, barbiturates
and sulfa drugs
Lichenoid drug reactions
Pemphigus-like drug reactions