Oral Ulcers: Causes, Types and Treatment Overview

Secondary Oral Ulcers

Secondary Infectious Ulcers

Secondary Infectious Ulcers: Infection:

1) Primary Herpetic Stomatitis

• Prodrome: fever, malaise, headache, vomiting
• Latency: K&NK
• Gingival swelling
• Excess saliva
• Lipschitz bodies
• Treatment: supportive measures, acyclovir

2) Recurrent Herpes Labialis

• Symptoms: paresthesia, burning sensation
• Scarring: none
• Treatment: sunblock, acyclovir cream

3) Recurrent Intraoral Herpes

• Presentation: clusters of small vesicles
• Diagnosis (K): Key diagnostic features
• Treatment: tetracycline mouthwash

4) Chronic Herpes

• Associated with: immune compromise, HIV
• Presentation: large, deep ulcers
• Treatment: acyclovir 400 mg, healing

5) Chickenpox

• Rashes in repeated waves
• Viremia

6) Herpes Zoster

• Presentation: unilateral, shooting pain, paresthesia
• Pathology: posterior root ganglion involvement
• Complications: postherpetic neuralgia, fetal risk, scarring secondary to infection, ophthalmic division blindness
• Treatment: acyclovir 800 mg, IV acyclovir, analgesics, prednisolone

7) Ramsay Hunt Syndrome

• Complications: permanent facial paralysis, postherpetic neuralgia, deafness
• Treatment: corticosteroids, ACTH, acyclovir

8) Hand, Foot and Mouth Disease

• Coxsackievirus A, epidemics

9) Herpangina

• Coxsackievirus A, epidemics
• Posterior oral aspect involvement
• Fever and malaise

Secondary Non-Infectious Ulcers

1) Pemphigus Vulgaris

• Nature: autoimmune disease, potentially fatal
• Pathology: destruction of desmosomal junctions between prickle and basal cells, against desmoglein 3
• Diagnostic signs: Tzanck smear, tombstone appearance, Nikolsky sign, bloody crusted lips
• Demographics: more common in females
• Treatment: direct immunofluorescence (IgG), prednisolone, azathioprine, intralesional therapy

2) Mucous Membrane Pemphigoid

• Cicatricial, subepithelial
• Nikolsky sign positive
• Desquamative gingivitis
• Treatment: corticosteroids, dapsone, ophthalmology referral

3) Erythema Multiforme

• Minor: maculopapular lesions, target (iris) lesions, Koebner phenomenon
• Major: Stevens-Johnson syndrome, toxic epidermal necrolysis (TEN)
• Treatment: levamisole, acyclovir, corticosteroids, antibiotics

Primary Oral Ulcers

Primary Infectious Ulcers

1) Tuberculosis

• Location: mid dorsum of tongue, angular
• Appearance: stellate, deep
• Pathology: TB granuloma, floor ulcer
• Treatment: biopsy, chest X-ray, PCR, multidrug chemotherapy

2) Syphilis (Treponema pallidum)

• Primary: rounded, raised, indurated edges, no scarring, negative serology
• Secondary: pinkish-coppery macules, snail-track ulcers, mucous patches
• Tertiary: gummas, severe scarring, distorted soft palate, tongue involvement, perforated hard palate, uvula destruction
• Treatment: serology (VDRL positive), penicillin, tetracycline

Primary Non-Infectious Ulcers

1) Traumatic Ulcer

• Single lesion, acute onset
• Obvious cause

2) Recurrent Aphthous Stomatitis

• Etiology: bacteria, stress, gastrointestinal disorders, trauma, allergy, vitamin deficiency
• Treatment:
• Minor: mild: Orabase, topical anesthetics, NSAIDs, benzydamine hydrochloride mouthwash; severe: triamcinolone paste
• Major: systemic and intralesional therapy, azathioprine, dapsone
• Herpetiform: tetracycline mouthwash, chlorhexidine mouthwash

3) Behçet Syndrome

• Diagnostic test: pathergy test
• Diagnosis:
• Major criteria: recurrent aphthous ulcers, genital ulcers, eye involvement, skin lesions
• Minor criteria: arthralgia, arthritis, gastrointestinal involvement, CNS involvement
• Treatment: corticosteroids, topical anesthetics, prednisone, azathioprine

4) Reiter Syndrome

• Oral manifestations: aphthous ulcers, geographic tongue, purpuric rash on palate

Mucocutaneous Ocular Syndromes: Behçet’s syndrome, Reiter’s syndrome, Stevens-Johnson syndrome