Review of oral ulcers: A diagnostic dilemma

Oral ulcers have long been a source of diagnostic difficulty. This has been attributed to the tremendous overlap in their clinical appearances. The problem is compounded by the fact that a number of oral ulcers may be superimposed by infections owing to their easy access to the oral cavity and thin nature of the oral mucous membrane which may get traumatized locally adding additional challenge to their diagnosis. While the diagnosis of some types of oral ulcers is facilitated by their association with constitutional signs and symptoms or lesions on the skin and/or mucous membranes in other areas, ulcers which are localized to the oral cavity may be more difficult to identify. Most of the oral ulcers are, therefore, biopsied because they are less readily recognizable on the basis of their clinical features. The similarity in histologic features by virtue of contamination by the oral liquids and microflora also on occasions makes differentiation difficult by masking the basic pathology. This review aims at a systematic approach toward the diagnosis of oral ulcers based on their clinical and histopathological features while ruling out unrelated causal factors.