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.
ICD10CM: K12.0 – Recurrent oral aphthae
SNOMEDCT: 50882004 – Traumatic ulcer of oral mucosa
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.
A common mouth ulcer caused by an injury. This may be from biting the inside of the mouth, brushing too briskly, or a cut from the edge of a broken tooth, dental appliance, or even food.
The ulcer may be on the roof or sides of the mouth, the gums, the tongue, or the lips. The mouth wound becomes sore and may become painful and infected.
Who’s At Risk
Injuries inside the mouth, especially from sharp objects, may progress to oral ulcers.
Persons with dental hardware or braces are at risk to develop mouth ulcers due to injury.
Signs & Symptoms
Traumatic mouth ulcers are usually single, but sometimes multiple, wounds in the mouth that may be painful and sore. They may have the appearance of a whitish, round or oval blister, surrounded by redness of the mucous membrane. Ulcers may bleed.
Mouth hygiene is essential. Brush your teeth gently so not to further injure the ulcer site. Rinsing with salt water may help soothe and heal mouth sores.
When to Seek Medical Care
Report to your doctor or dentist if the ulcer fails to heal within a week or two or if you notice signs of infection (warmth, pus, increased pain).
Your physician or dental care provider may instruct you in proper cleaning and care of the ulcer. You may be need to have a sharp or broken tooth or dental appliance removed or repaired.
A biopsy may be done if certain types of infection are suspected, particularly candidiasis.