Recurrent aphthous ulceration
Trauma (e.g. rough tooth, biting)
Acute herpes gingivostomatitis
Serious disorders not to be missed
Syphilitic: chancre or gumma
Inflammatory bowel disease (e.g. Crohn)
Is the patient trying to tell me something?
Take a history of trauma, skin problems, stress, dental problems, drugs, allergy and possible infections, including herpes simplex, Candida albicans, sexually transmitted diseases and Coxsackie virus infection. Consider an immunosuppressive disorder.
The examination should focus on the patient’s general health, dental status, characteristics of the ulcer, cervical lymphadenopathy and the skin in general
Depending on the clinical picture investigations may include:
Non-healing ulcers warrant biopsy to exclude squamous cell carcinoma.
Remember to enquire about medication such as phenytoin, cytotoxics, immunosuppressants, carbimazole.
A blood dyscrasia may be possible.
Consider inflammatory bowel disease and coeliac disease in your considerations.
Aphthous ulcers are usually 3–5 mm in diameter; minor ones have an erythematous margin.