WOUNDS IN THE ORAL MUCOSA
Wounds fare requent in the oral mucosa, and traumatic ulcers comprise the majority. The term vulnus is used for wounds triggered by exogenous factors, e.g. trauma from biting, sharp food substances or a sharp, fractured tooth. This type of wound is characterized by acute onset and typically heals within 7 to 10 days. An ulcer, on the other hand, may heal more slowly, and this type of wound occurs due to endogenous factors, i.e. local or systemic diseases. The most frequent causes of oral mucosal ulcers are infection (especially viral infections), immune-mediated disease (e.g. lichen planus and inflammatory bowel disease), immune-related reactions (e.g. medication-induced reactions), autoimmune diseases (e.g. pemphigoid or lupus erythematosus) or malignant neoplasia. It is obvious that a detailed patient history and a thorough clinical examination are crucial for the identification of a possible triggering cause for one or more ulcers in the oral mucosa, and for deciding on further investigation, including biopsy and supplementary paraclinical tests, if the cause is unclear, and especially with accompanying systemic symptoms. Malignant neoplasms with ulceration can sometimes be difficult to distinguish from conditions with benign ulcerations. A patient with an ulcer that does not show clear signs of healing within 2-3 weeks must therefore always be referred urgently for suspicion of malignancy. In addition, severe cases of recurrent aphthous stomatitis should lead to differential diagnostic considerations and referral for investigation for underlying systemic immune-related disease. This article reviews the most common diseases associated with ulcerations and differential diagnostic considerations in related to those conditions.