[Oral ulcerations]

Oral ulcerations are frequent lesions resulting from numerous different causes. A precise anamnesis is mandatory to direct towards the diagnosis. It includes the type of the earliest lesion (blister/vesicle or ulceration), the number of lesions (isolated or numerous), the complaints (painful or asymptomatic), the disease evolution (acute, chronic, recurrent), the duration of the ulceration (a few hours, days, weeks, months, years...), the presence of adenopathies and/or the association with clinical lesions on other mucous membranes, on skin, on nails or on scalp. A traumatism or a drug reaction are the first aetiologies to be excluded. Chronic enteropathies or lupus erythematosus or other systemic diseases, especially those leading to immunosuppression, can be responsible for oral ulcerations. These diseases must be diagnosed and treated to obtain an improvement of the oral lesions. Laboratory studies such as microbiological isolation, serology or biopsy, are performed in accordance with the suspected diagnosis resulting from anamnesis and physical examination. Aphthous stomatitis and oral herpes infection present similar features such as symptomatology, recurrences, trigger factors, etc. Differential diagnosis is mandatory to treat correctly the disease. It is easier if the primary lesion (vesicle or ulceration) is observed or if herpes simplex virus is yielded. Oral blisters are uncommon; they especially concern erythema multiforme and bullous auto-immune diseases. A single ulceration directs towards a diagnosis of cancer or chancre. Lichen planus is a frequent disease of the oral mucous membrane with numerous clinical features: erosive and ulcerated lesions are often observed. In all cases, a symptomatic treatment is necessary against pain to permit nutrition, hydratation and good speech. An etiologic treatment is associated as soon as possible.