Ulcers in the mouth are common. They vary in sizes, shape, and symptoms. They may represent a wide spectrum of disease, from the minor nuisance of recurrent aphthous ulcers to neoplasm, such as squamous cell carcinoma.
It is the role of dentists to find out what is the most likely diagnosis. Only with the correct diagnosis, can the correct treatment be carried out.
History of the ulcer is crucial. Was there any traumatic bite occurring prior to the onset of the ulcers? (If yes, maybe it is a traumatic ulcer.) Does it recur from time to time? (If yes, maybe it is a recurrent aphthous ulcer.) Does a vesicle formation precede the onset of the ulcer (then it could be a vesiculo-bullbous lesion such as pemphigus and pemphigoid.) Is the ulcer long standing and painless? (it’s a possible neoplasm.)
Other relevant information that you may be experiencing and should disclose during your dental visit includes any ulceration noted in different parts of your body, for example the vaginal and conjunctiva (possible Bechet’s syndrome); or any stressful events in life that coincide with the onset of the ulceration, for example menstrual periods and examinations (possible hormonal and stress induced aphthous ulcer). The same goes for any diarrhea and stomach discomfort, just to rule out any gastro-intestinal involvement such as Crohn’s disease.
Following a thorough questioning, then the dentist will inspect the patient. Extra-oral examination may include palpating the lymph nodes around the neck, whereas intra-oral examination include the general oral hygiene, the dentition, and of course the lesion. The size, base, and distribution of the ulcers matter. It will give an idea on the working diagnosis, and helps clinician to decide if further investigations are required or not. Some can be diagnosed based on the history alone; some may involve a blood investigation, such as full blood count, and nutritional status of iron, folic acid and Vitamin B12.
Most ulceration in the oral cavity is benign, and can be treated symptomatically. Some, especially the long standing (more than 2 weeks) may require a biopsy to confirm the diagnosis. Knowing that it could represent a wide variety of disease, oral ulcers should not be taken lightly and all patients are advised to seek for medical consultation regarding it.