Western University - Oral Ulcers

Oral ulcerations are lesions in the mouth with loss of surface epithelium. There are several causes of oral ulcers, often indicated by their name. For instance, a traumatic ulceration is an ulcer developed after an injury. Other common types of ulcers include the aphthous ulcer; non-specific ulcer; traumatic ulcer with stromal eosinophilia, or TUGSE; and herpetic ulceration. Across all types, there is no difference in prevalence by gender. But, the general prevalence, location, and age vary by etiology.

Typically, an oral ulceration appears as a well-defined, slightly depressed lesion with an erythematous or reddish to yellow center. Sometimes, the yellowish center represents a thick fibrinopurulent membrane that is a mix of acute inflammation and fibrin. This membrane can be removed by applying pressure. The ulcer may also have an irregular white halo with rolled borders. Although these features are common, other clinical features vary by type.

Aphthous ulcers or canker sores are the most common mucosal pathosis, found in 20% of adults with about 80% experiencing these ulcers before age 30. Aphthous ulcers only occur on the unattached oral mucosa, unlike herpetic ulcers or cold sores which occur on the attached oral mucosa. Most aphthous ulcers are related to stress, as often reported by patients. Yet, some individuals will suffer recurrences, termed recurrent aphthous stomatitis. Researchers believe it may be caused by T cell dysfunction leading to mucosal breakdown or the presence of microorganisms.

A traumatic ulceration is caused by an injury that cuts the epithelial surface below the basal cell layer. Sources of trauma include ill-fitting dentures, hard foods like crusty bread and chips, biting injury, irritation from chemicals in toothpastes or rinses, and burns from hot foods or drinks. It is often associated with an underlying inflammatory response. TUGSE is a subtype defined by the presence of many eosinophils. Although its etiology is presumed to be traumatic, the etiology is most likely multifactorial and has not been entirely elucidated. TUGSEs are typically long-standing ulcerations mimicking oral cancer. Clinically, TUGSEs may present as raised ulcerations with rolled margins that can either be asymptomatic or associated with pain.

Ulcers may also be caused by infectious agents, particularly viruses like the herpes simplex virus and fungal infections. Often oral herpes involves cold sores and ulcers in the face or mouth.