Mouth ulcers and diseases of the oral cavity

Abstract

Diseases of the oral cavity present with varying degrees of mucosal changes, ranging from erythema, atrophy or ulceration to white or hyperkeratotic areas or pigmentation. These are frequently chronic and can occur because of underlying systemic disease. Diagnosis can be challenging because of similarities in clinical presentation between different conditions. The most common presentations include mucosal ulceration and abnormalities of the lips and tongue. Ulceration represents a full-thickness breach in the epithelium. This can result in pain and difficulty with eating, drinking, speech and maintaining oral hygiene. The wide range of causes of oral ulceration includes trauma, recurrent aphthous stomatitis, lichen planus, immunobullous disease, drugs and erythema multiforme. Lesions on the tongue can be caused by primary oral disease or secondary to systemic disease. Abnormalities include nutrient-deficient glossitis, geographic tongue, burning mouth syndrome and, more rarely, amyloidosis. The lips can be affected by skin diseases such as eczema (exfoliative cheilitis) and actinic damage or conditions with potential systemic involvement such as orofacial granulomatosis. The priority with mucosal lesions is to exclude carcinoma, as early detection and treatment significantly decreases morbidity and mortality. This article reviews these disorders and their distinguishing features and highlights the importance of history-taking, clinical examination and further investigation in making a definitive diagnosis.