Diagnosis of oral ulcers.

Ulcers commonly occur in the mouth. Their causes range from minor irritation to malignancies and systemic diseases. Innocent solitary ulcerations, which result from trauma and infections, must be distinguished from squamous cell carcinomas, which also typically present as solitary ulcers. Multiple oral ulcers may be classified as acute, recurrent and/or chronic. The most common causes of rapid-onset oral ulcers include acute necrotizing ulcerative gingivitis, allergies and erythema multiforme. The two common forms of acute (short-term) recurrent oral ulcers, "cold sores" or "fever blisters," which are caused by the herpes simplex virus, and recurrent aphthous ulcers ("canker sores"), may be distinguished largely on the basis of their location. Most types of multiple chronic oral ulcers are associated with disturbances of the immune system. They include erosive lichen planus, mucous membrane pemphigoid and pemphigus vulgaris. Clinical criteria which are most useful in identifying the cause of oral ulcers are vesicles or bullae, which may not be seen because they rupture rapidly in the oral environment; constitutional signs and symptoms; and lesions on the skin and/or other mucosa. In some cases, diagnosis depends upon culture or biopsy, particularly with the application of immunofluorescence to the surgical specimen.