“Not every oral ulcer is dangerous,
But an ulcer which is non-healing cannot be ignored.”
There are different kinds of ulcers in the oral cavity.
Broadly they can be divided into single & multiple.
Again these ulcers can be recurrent also.
Single Ulcer can be caused by:
- Traumatic – Physical/ Thermal/ Chemical
- Infective – Bacterial/ Fungal
- Malignant/ Cancerous
Multiple Ulcers can be caused by:
- Herpes Stomatitis associated with fever
- Autoimmune diseases: Apthous ulcer, Lichen Planus, Pemphigus
- Systemic conditions : Nutritional Deficiency, Necrotic ulcers
Traumatic Ulcer:
Traumatic ulcers take the shape of the physical object causing trauma. For example an ulcer caused by a sharp tooth will appear as a depression and it is of the same size & shape as that of the sharp tooth. Their treatment is also very simple. Just removal of the cause can lead to cure of the ulcer. If in case the ulcer doesn’t heal after removal of the cause then other causes should be ruled out & an oral medicine specialist consultation can be considered.
Thermal burns these days are very common due to consumption of hot microwaved food.
Usually they occur on the palatal mucosa and heal within 5-7 days depending on the area & intensity of the burn.
Chemical burns usually occur from sucking on or chewing medications formulated to be swallowed like Aspirin or sometimes due to mouthwashes with high alcoholic content or hydrogen peroxide etc. Smaller lesions heal on their own once the irritant is removed. Topical anesthetics can be helpful during the healing period.
Apthous ulcer:
Apthous ulcers are the most common among the multiple recurrent ulcers.
They can be either small or large widespread painful described as minor & major varieties respectively.
Apthous ulcers are usually associated with immunological disorders.
Other predisposing factors include stress, gastro-intestinal factors or nutritional deficiency. These ulcers are usually self limiting. However in major cases, anti-inflammatory or steroids are given under supervision of an oral physician/ Oral medicine specialist.
Lichen Planus:
Lichen planus is mainly a chronic inflammatory condition of skin & mucosa. It has periods of relapses & remissions. It can present as vesicles/bullae/ulcers with white striae. These conditions need to be treated with a multi-dimensional approach.
Infective Ulcers:
Ulcers associated with viral fevers are usually multiple & are usually associated with cold blisters.
Bacterial & fungal ulcers are usually found in patients with compromised immune status & the ulcers are usually non-healing by nature. They are to be excised widely and attention should be paid in removing the cause & improving the immunity.
Malignant Ulcers:
These ulcers are more commonly associated with tobacco use. They are commonly located in relation to tongue, floor of mouth or inner surfaces of lips/cheeks. Clinically the ulcer is painless, wide spreading with bleeding tendency & indurated base as well as margins. These ulcers require urgent biopsy & treatment.
Summary:
Usually oral ulcers are self-healing.
If the cause is persisting like in cases of traumatic ulcer, attention should be paid to the removal of cause.
In cases with Apthous ulcers or Lichen Planus, patients should be informed about the recurrent nature of the condition. This helps in relieving the anxiety of the patient thereby leading to reduction in the number of episodes of the ulcerative condition.
Ulcers due to low immunity or infection needs certain blood tests. This helps in evaluating the cause & treating the condition more specifically.
In tobacco consumers, malignant changes should be ruled out.
Biopsy should be performed in cases where no cause can be identified & the ulcer is non-healing in nature under the guidance of an Oral Medicine Specialist.
Traumatic ulcer
By: DR. ALKA BULCHANDANI
ORAL MEDICINE & RADIOLOGY