Our patient presented with an oral ulcer and was referred by her dentist, who was worried about the possibility of oral cancer. Oral cavity usually is involved as part of a widespread disease. Gp guide to diagnosis and treatment stephen flintma, phd, mb bs, bds, fdsrcs, ffdrcsi, ficd simple mouth ulcers are usually selflimiting and rarely present in general practice. In the uk, 20% of the population are believed to be affected by recurrent aphthous ulceration. Peptic ulcers may present with dyspeptic or other gastrointestinal symptoms, or may be initially asymptomatic and then present with complications such as. The differential diagnosis of tuberculous ulcer includes traumatic ulcer, syphilitic ulcer, and oral scc 24. These idiopathic ulcerations are oval lesions of different sizes with clean edges surrounded by an erythematous halo. Acute necrotising ulcerative gingivitis acute necrotising ulcerative gingivitis is less common than gingivitis or periodontitis but often more severe. The diagnosis of the more common oral ulcerations, in an otherwise healthy patient, is straightforward and determined from the medical history and clinical exam. Differential diagnosis short term ulcers shallow and not raised persistent ulcers extensive borders and bases 50.
While many oral ulcers are the result of chronic trauma, some may indicate an underlying systemic condition such as a gastrointestinal dysfunction, malignancy, immunologic abnormality, or cutaneous disease. Intragastric ph with oral vs intravenous bolus plus infusion protonpump inhibitor therapy in patients with bleeding ulcers. Peptic ulcer disease must be differentiated from other diseases that presents with epigastric pain such as gastritis, gastroesophageal reflux disease,acute pancreatitis,prmary biliary cirrhosis,cholelithiasis,gastric outlet syndrome,myocardial infaraction. Peptic ulcer is diagnosed using blood and stool tests, breath tests, endoscopy and rarely now barium radiography. Note location of lesion attached vs unattached mucosa recurrent hsv occurs on attached keratinized mucosa while minor rau occurs on movable mucosa note depth and shape of ulcer e. Ce 110 a guide to clinical differential diagnosis of. Ulcer of the stomach and duodenum, if attended with typical symptoms of pain, vomiting and hemorrhage of ascertainable degree and accuracy of occurrence, is a very definite and easy diagnosis. Each ulcer lasts from two weeks to several months but will heal leaving a scar. Diagnosis of oral ulcers at times may be challenging and therefore it is important to consider the differential diagnosis. This text provides students and practitioners with the essential diagnostic info for clinical issues yet as a system for differentiation of diseases that have similar signs, symptoms, and photography look. The pattern of lesions, constitutional signs and symptoms, and presence of systemic features narrow the differential diagnosis. Pdf differential diagnosis of long term tongue ulcers researchgate. Apr 28, 2001 the differential diagnosis of a tuberculous ulcer of the oral cavity includes aphthous ulcers, traumatic ulcers, syphilitic ulcers and malignancy, including primary squamous cell carcinoma.
Ulcer can be defined as a deeper crater that extends through the entire thickness of surface epithelium and involves the underlying connective tissue. At the center of the ulceration, the necrotic fundus is covered with a yellowwhite fibrinous exudate 20. Pdf on apr 1, 2016, mayra schemelsuarez and others published oral ulcers. It is essential to take a thorough medical history and to examine the patient carefully, looking for local and systemic clues to the diagnosis. The ulcers typically present in the nonmasticatory mucosa of the cheeks, lips, ventral and lateral surfaces of the tongue. Differential diagnosis 1 its chronic appearance differentiate it from h. Differential diagnosis of oral and maxillofacial lesions. Pdf oral ulcers is a very common disorder of the oral mucosa. A lesion of the skin or of a mucous membrane, that is accompanied. A mouth ulcer is an ulcer that occurs on the mucous membrane of the oral cavity. Various general search engines and specialized databases including pubmed, pubmed central, medline plus, ebsco, science direct, scopus, embase, and authenticated textbooks were. Common causes of oral ulceration the four most common presentations are trauma, recurrent aphthous stomatitis, herpes virus group infections and dermatoses, although the differential diagnosis. The diagnosis of the more common oral ulcerations, in an otherwise healthy patient, is straightforward and determined from the medical history and clinical examination.
Next, it is necessary to assess which areas of the mouth are affected, because this permits further refinement of the differential diagnosis. Differential diagnosis of vesiculoerosive and ulcerative. Oral medicine and oral pathologyoral ulceration wikiversity. Several diseases can be associated with crusting of the muzzle, and erosion, ulceration, necrosis and, occasionally, vesiculation of the oral mucosa. Major aphthous ulcers occur in about 1 in 10 cases. Ulcer occurring as a result of odontogenic infection. The diagnosis of genital ulcer disease can be made.
Despite a declining trend in tb incidence in recent years, it is still a major public health problem with high. Differential diagnosis of superficial ulcerations of the oral mucosa. Primary syphilitic ulceration usually occurs as a result of orogenital or oroanal contact with an infectious lesion. Differential diagnosis, complications and diagnosis of. Tuberculosis tb is a serious infectious disease with considerable fatality, typically affecting the pulmonary system and, rarely, other body organs including the oral cavity. Diseases such as pemphigus and pemphigoid may also impair differential diagnosis with nonspecific secondary ulcers after rupture of the. A case report of a tongue ulcer presented as the first. Oral ulceration aetiopathogenesis, clinical diagnosis. Diagnostic features of common oral ulcerative lesions.
The two most common causes of oral ulceration are local trauma e. While many oral ulcers are the result of chronic trauma, some may indicate an underlying systemic condition. Ulcers are a common form of pathol ogy in the mouth because many oral lesions, initially distinctive, tend to ulcer ate from the constant trauma of chewing and. An outspoken attack of severe biliary colic, so characteristic of gallstones, is. Oral ulcers can be the first manifestation of systemic diseases of immunogenetic origin, such as behcets disease and others. The diagnosis and treatment of oral lesions is often challenging due to the clinicians limited exposure to the conditions that may cause the lesions and their similar appearances. What are the differential diagnoses for peptic ulcer disease. Rationale for differential diagnosis developing an accurate diagnosis for herpes and aphthous is critical to the treatment plan because the recommended treatment approaches are very different for herpetic lesions and aphthous ulcerations. Clinical differential diagnosis is the cognitive process of applying logic and knowledge, in a series of stepbystep decisions, to create a list of possible diagnoses. The differential diagnosis of chronic leg ulcers may be straightforward, but at times will require time, effort, and patience by both physician and patient.
Few signs or lesions associated with oral infection are pathognomonic and an aetiological diagnosis based solely on clinical. Oral ulceration aetiopathogenesis, clinical diagnosis and. However, patients with impaired immunological function e. However, patients with impaired immunologic function e. Few signs or lesions associated with oral infection are pathognomonic and an aetiological diagnosis based solely on.
Differential diagnosis viral stomatitis erythema multiforme pemphigus, pemphigoid drug reactions. Differential diagnosis for isolated single ulcerations examination hints. Due to the similar clinical appearance of many oral ulcers, the differential diagnosis is extensive. Treating a herpetic lesion with topical steroids as appropriate for an aphthous ulcer can have serious. Differential diagnosis of diseases causing oral lesions in. Evaluation of oral ulceration differential diagnosis of. Differential diagnosis of oral lesions and developmental. Therefore, if the lesions are seen on the lateral border of the. Approximately 90% of oral cancers are squamous cell carcinoma scc, which is seen typically on the lip or lateral part of the tongue usually as a lump or ulcer that is white, red, or mixed white and red. Differential diagnosis of oral ulcers according to duration. May 14, 2018 aphthous stomatitis, or recurrent aphthous ulcers raus or canker sores, are among the most common oral mucosal lesions physicians and dentists observe. Ulcers mouthoral, differential diagnosis time of care.
Oral ulceration is a common complaint of patients attending out. Mouth ulcers are very common, occurring in association with many diseases and by many different mechanisms, but usually there is no serious underlying cause. The diagnosis of ofg includes histopathology presence of noncaseating granulomas and clinical presentation. The principal causes of oral ulceration are trauma, recurrent aphthous stomatitis, microbial infections. Aug 31, 2016 oral ulceration is a common condition. Differential diagnosis short term ulcers shallow and not. Differential diagnosis, complications and diagnosis of acid peptic disease.
In particular, it is important to develop a clear picture of whether the process. Assessment of oral ulceration differential diagnosis of. At times, it can be difficult to determine the correct diagnosis of a leg ulcer. Differential diagnosis and treatment find, read and cite all the research you need on researchgate. Oral candidiasis may present as pseudomembranous candidiasis, glossitis, or perleche angular cheilitis.
One of the keys to improve accuracy in diagnosing oral lesions is forming an appropriate differential diagnosis. Oral ulceration is a break in the oral epithelium, exposing nerve endings in the underlying connective tissue. Pressure ulcers occur, as expected, from sustained or prolonged pressure on the skin. Oral candidiasis is common in infants, but in adults it may signify immune defi. Oral mucosal ulceration a clinicians guide to diagnosis and treatment. Differential diagnosis of oral and maxillofacial lesions, 5th edition pdf author. Recurrent aphthous ulcer is a disorder of unknown etiology that can cause clinically significant morbidity. S that its lesions are recurrent and heals rapidly, but pemphigous lesions extends peripherally and takes a period of weeks to months.
Ulceration of the oral mucosa induced by antidepressant. The first historic clue guiding the diagnosis of acute oral ulcerations is to consider whether the patient has experienced recurrent episodes or a single episode. A chronic leg ulcer is defined as full thickness skin loss for 3 months. Diagnosis of oral ulcerative lesions might be quite challenging. Peptic ulcer disease must be differentiated from other diseases that presents with epigastric pain such as gastritis, gastroesophageal reflux disease,acute pancreatitis,prmary biliary cirrhosis,cholelithiasis,gastric outlet syndrome,myocardial infaraction,pleural empyema,acute appendicitis. Differential diagnosis of chronic leg ulcers servier. Recurrent aphthous stomatitis including herpetiforme ulceration, recurrent intraoral herpetic stomatitis. Goaz this text provides students and practitioners with the essential diagnostic information for clinical problems as well as a system for differentiation of diseases that have similar signs, symptoms, and radiographic appearance.
Oral mucosal ulceration is a common clinical complaint encountered by. All lesions that cannot be excluded initially should be included in the differential diagnosis, followed by laboratory. Jun 29, 2017 mouth cancer is a major neoplasm worldwide and theoretically should be largely preventable or detectable at an early stage. Evaluation of oral ulceration differential diagnosis of symptoms. Department of oral medicine and radiology, kaminein institute of dental sciences, nagonda, india abstract pyoderma gangrenosum pg is a rare, noninfectious neutro. Due to the rarity of oral tb, it is frequently overlooked in differential diagnosis of oral lesions. Differential diagnosis diagnosing lesions of the oral mucosa is necessary for the proper management of patients. Request pdf differential diagnosis and management of oral ulcers the diagnosis and treatment of oral lesions is often challenging due to the clinicians limited exposure to the conditions that. Download pdf differential diagnosis of oral lesions.
Along with dermatologic blistering, other manifestations include oral ulceration and desquamative gingivitis. Immunemediated, traumatic and neoplastic ulcerations will be illustrated. While many oral ulcers are the result of chronic trauma, some may indicate an underlying systemic condition such as a gastrointestinal dysfunction, malignancy. The differential diagnosis of tuberculous ulcer includes traumatic ulcer, syphilitic ulcer, and oral scc. Pyoderma gangrenosum with oral involvement case report. Before the final diagnosis of ofg, other conditions with similar histopathology features e. A peptic ulcer is a defect in the gastric or duodenal mucosa that extends through the muscularis mucosa into the deeper layers of the wall. Ulcerations are characterized by defects in the epithelium, underlying connective tissue, or both. It has an estimated 4% point prevalence in the usa, and 25% of the global population are thought to be affected by aphthous ulcers, one of the most common causes of oral ulceration.
Differential diagnosis should be approached on the basis of exclusion. The differential diagnosis of diseases causing oral lesions in cattle can pose problems both clinically and at necropsy. Diseases such as pemphigus and pemphigoid may also impair differential diagnosis with nonspecific secondary ulcers after rupture of. The differential diagnosis of a tuberculous ulcer of the oral cavity includes aphthous ulcers, traumatic ulcers, syphilitic ulcers and malignancy, including primary squamous cell carcinoma. Patients with signs or symptoms of oral ulcers are sometimes referred to. Each ulcer lasts 710 days and then goes without leaving a scar. Peptic ulcers may present with dyspeptic or other gastrointestinal symptoms, or may be initially asymptomatic and then present with complications such as hemorrhage or perforation. Assessment of oral ulceration differential diagnosis of symptoms. Nov 14, 2003 oral ulceration is a common complaint of patients attending out. Mouth cancer is a major neoplasm worldwide and theoretically should be largely preventable or detectable at an early stage. Due to diversity of causative factors and presenting features, diagnosis of oral ulcerative lesions might be quite challenging 14. However, severe, recurrent or persistent oral ulceration can be extremely painful and may result from an underlying systemic pathology.
Differential diagnosis and management of oral ulcers. Differential diagnosis of oral ulcerations with special emphasis on the diagnosis, etiology and management will be presented in a casebased format. Aphthous stomatitis, or recurrent aphthous ulcers raus or canker sores, are among the most common oral mucosal lesions physicians and dentists observe. Ulcer a local defect, or excavation of the surface of an organ or tissue, produced by sloughing of necrotic inflammatory tissue. The search for the cause of a leg ulcer should include a detailed medical history, physical examination, evaluation of arterial and venous blood flow, and suitable laboratory tests table. Oct 25, 20 differential diagnosis 1 its chronic appearance differentiate it from h.
1158 633 827 1571 1528 1433 858 1231 541 1438 53 123 1363 1627 845 1195 627 1170 615 900 1011 402 992 772 1415 339 342 1028 1091 1348 339