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Traumatic oral ulcer - Oral Mucosal Lesion
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Traumatic oral ulcer - Oral Mucosal Lesion

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Contributors: Carl Allen DDS, MSD, Sook-Bin Woo MS, DMD, MMSc
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Synopsis

The traumatic oral ulcer is very common and can be caused by acute or chronic trauma from sharp objects, accidental or intentional biting, or overzealous brushing. The ulcer is usually solitary and can range from less than 1 mm to more than 1 cm in diameter. Typically the patient complains of mild pain during the first few days following the episode of trauma. With removal of the cause, healing takes place within 2-7 days. A superimposed candidal infection can impede healing, even in healthy patients. Sites commonly injured by the teeth include the tongue, lips, and buccal mucosa. Ulcers on the gingiva, palate and mucobuccal fold are usually related to hard, sharp edges of food or to toothbrush-induced injury. Thorough questioning of the patient may suggest the diagnosis.

The lesion appears as a round, ovoid or irregularly shaped removable, creamy-white fibrinopurulent membrane surrounded by a variable amount of erythema. For more chronic lesions, a white border of hyperkeratosis, the margins of which blend with the surrounding mucosa, is adjacent to the area of ulceration.

Codes

ICD10CM:
K12.0 – Recurrent oral aphthae

SNOMEDCT:
50882004 – Traumatic ulcer of oral mucosa

Look For

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

  • Aphthous ulcer – This condition only affects non-keratinized mucosa and generally has a history of recurrence. Aphthae cause pain that seems to be out of proportion to the size of the lesion.
  • Squamous cell carcinoma – Once any presumed contributing traumatic factors have been eliminated, an ulcer (especially on the lateral border of tongue) that persists for more than 2 weeks requires biopsy.
  • Traumatic eosinophilic granuloma – This ulcer may lack a preceding history of trauma, is slow to heal (sometimes lasting weeks to months), and may resolve with incisional biopsy.
  • Primary syphilis (chancre) – This can present with a painless intraoral ulcer affecting the lip, tongue, or tonsillar area. Regional lymphadenopathy is normally present.
  • Tuberculosis – Oral lesions of tuberculosis are rare but may present as a chronic, painless ulcer.
  • Histoplasmosis – Deep fungal infections, such as histoplasmosis, are an uncommon cause of oral ulceration.

Best Tests

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Management Pearls

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Therapy

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References

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Last Updated: 01/21/2015
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Traumatic oral ulcer - Oral Mucosal Lesion
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Traumatic oral ulcer : Oral ulcers, Oral erosions, Oral mucosa, Painful oral ulcers
Clinical image of Traumatic oral ulcer
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