Oral Ulcerative Lesions

Ulcers are the most common lesions affecting the oral mucosa, and they can be ascribed to a plethora of local or systemic conditions, making differential diagnosis pivotal and often difficult. As oral ulcers, they can be a manifestation of local or systemic conditions of very different nature and severity, including trauma (mechanical, chemical, thermal), drug reactions, immune-mediated diseases, infections, and neoplasms; a careful differential diagnosis is mandatory. Recurrent aphthous stomatitis (RAS) is the most frequent ulcerative disorder of the oral cavity, affecting 10–20% of the general population. RAS lesions typically present as round or oval shallow ulcers of the nonkeratinized mucosa, with a yellow-grayish fibrin pseudomembrane and a characteristic erythematous halo. They usually appear first in childhood or adolescence, in subjects without other systemic signs. RAS may present in four main forms based on its clinical appearance (minor, major, herpetiform, and severe), and its management depends on the frequency and severity of the lesions. RAS episodes are self-limiting and in most cases do not need treatment. For severe and painful cases, the aim of therapy is to control pain and to reduce the frequency of episodes. Topical corticosteroids are typically first-line treatment, but they do not affect the rate of recurrence. Less frequently, aphthous stomatitis can be associated with a number of systemic conditions, including gastrointestinal disorders, in particular inflammatory bowel diseases and celiac disease, Behçet syndrome, food allergy, and deficiencies of micronutrients, mainly vitamin B12, folate, ferritin, and iron. In all these cases, the detection of oral lesions can lead to an early diagnosis of the underlying condition, which management requires a multi-specialist approach.