Oral ulceration
Consider trauma, aphthae, infection, immune disease and malignancy. An unexplained persistent ulcer, especially if indurated, requires urgent assessment.
Understand
An oral ulcer is a description, not a diagnosis. Trauma, aphthous disease, infection, systemic inflammation and malignancy can overlap in appearance.
Assess
Record number, site, duration, recurrence, size, edge, base and induration, plus systemic symptoms and medicines. Remove an obvious traumatic source and set a short review.
Apply
Persistent, unexplained or indurated ulceration needs prompt specialist assessment and possible biopsy. Avoid repeatedly prescribing topical agents without verifying healing.
Key distinctions
Recurrent aphthous ulcers have a different pattern from a solitary persistent indurated ulcer. Ask about gastrointestinal, skin, genital and systemic symptoms when ulcers recur or are severe. Medicines and immunosuppression can predispose to infection or atypical healing. A short planned review after removing trauma is safer than an indefinite assumption that it will settle.
Think through a case
A lateral tongue ulcer is attributed to a sharp cusp, which is smoothed. It remains firm and unhealed at review, so the working diagnosis must change.
The distinction to remember
Do not repeatedly renew topical treatment when an unexplained ulcer persists; set and honour a review date.
Test your recall
What should trigger reconsideration of a presumed traumatic ulcer?
Show answer
Failure to resolve after the cause is removed.