ABC of oral health: Mouth ulcers and other causes of orofacial soreness and pain

Mouth ulcers are common and are usually due to trauma such as from ill fitting dentures, fractured teeth, or fillings. However, patients with an ulcer of over three weeks' duration should be referred for biopsy or other investigations to exclude malignancy (see previous article) or other serious conditions such as chronic infections. Main systemic and iatrogenic causes of oral ulcersMicrobial disease Cutaneous disease Malignant neoplasms Blood disorders Gastrointestinal disease Rheumatoid diseases Drugs Radiotherapy Ulcers related to trauma usually resolve in about a week after removal of the cause and use of benzydamine hydrochloride 0.15% mouthwash or spray (Difflam) to provide symptomatic relief and chlorhexidine 0.2% aqueous mouthwash to maintain good oral hygiene. Recurrent aphthous stomatitis (aphthae, canker sores)Recurrent aphthous stomatitis typically starts in childhood or adolescence with recurrent small, round, or ovoid ulcers with circumscribed margins, erythematous haloes, and yellow or grey floors. It affects at least 20% of the population, and its natural course is one of eventual remission. There are three main clinical types:Minor aphthous ulceration (top) and major aphthous ulceration (bottom)Some cases …