eMedicine Specialties > Dermatology > Diseases of the Oral Mucosa

Traumatic Ulcers: Differential Diagnoses & Workup

Author: Glen Houston, DDS, MSD, Chair, Professor, Department of Oral and Maxillofacial Pathology, University of Oklahoma Health Sciences Center
Contributor Information and Disclosures

Updated: Jun 17, 2009

Differential Diagnoses

Squamous Cell Carcinoma

Other Problems to Be Considered

Granulomatous ulcers (eg, deep fungal infections, tuberculosis)10
Crohn disease11

Workup

Procedures

  • Ulcerations without an etiology or those that persist despite therapy may need to be examined microscopically to exclude malignancy and other causes.
  • Some ulcers caused by trauma may resemble squamous cell carcinoma or granulomatous ulcers (eg, those resulting from deep fungal infections or tuberculosis). If the cause of the ulceration is not obvious at clinical examination or if no response to local therapy is noted, biopsy may be indicated to exclude these conditions. Also see Oral Manifestations of Systemic Diseases.

Histologic Findings

Microscopic features include an area of surface ulceration covered by a fibrinopurulent membrane consisting of acute inflammatory cells intermixed with fibrin. The stratified squamous epithelium from the adjacent surface may be hyperplastic and exhibit areas of reactive squamous atypia. The ulcer bed is composed of a proliferation of granulation tissue with areas of edema and an infiltrate of acute and chronic inflammatory cells.

More on Traumatic Ulcers

Overview: Traumatic Ulcers
Differential Diagnoses & Workup: Traumatic Ulcers
Treatment & Medication: Traumatic Ulcers
Follow-up: Traumatic Ulcers
References
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References

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  2. Bouquot JE. Common oral lesions found during a mass screening examination. J Am Dent Assoc. Jan 1986;112(1):50-7. [Medline].

  3. Baroni A, Capristo C, Rossiello L, Faccenda F, Satriano RA. Lingual traumatic ulceration (Riga-Fede disease). Int J Dermatol. Sep 2006;45(9):1096-7. [Medline].

  4. Ceyhan AM, Yildirim M, Basak PY, Akkaya VB, Ayata A. Traumatic lingual ulcer in a child: Riga-Fede disease. Clin Exp Dermatol. Mar 2009;34(2):186-8. [Medline].

  5. Maron FS. Mucosal burn resulting from chewable aspirin: report of case. J Am Dent Assoc. Aug 1989;119(2):279-80. [Medline].

  6. Rees TD, Orth CF. Oral ulcerations with use of hydrogen peroxide. J Periodontol. Nov 1986;57(11):689-92. [Medline].

  7. Shetty K. Hydrogen peroxide burn of the oral mucosa. Ann Pharmacother. Feb 2006;40(2):351. [Medline].

  8. Rawal SY, Claman LJ, Kalmar JR, Tatakis DN. Traumatic lesions of the gingiva: a case series. J Periodontol. May 2004;75(5):762-9. [Medline].

  9. Ozcelik O, Haytac MC, Akkaya M. Iatrogenic trauma to oral tissues. J Periodontol. Oct 2005;76(10):1793-7. [Medline].

  10. Hirshberg A, Amariglio N, Akrish S, et al. Traumatic ulcerative granuloma with stromal eosinophilia: a reactive lesion of the oral mucosa. Am J Clin Pathol. Oct 2006;126(4):522-9. [Medline].

  11. Ganesh R, Suresh N, Ezhilarasi S, Rajajee S, Sathiyasekaran M. Crohn's disease presenting as palatal ulcer. Indian J Pediatr. Mar 2006;73(3):229-31. [Medline].

  12. Edlich RF, Farinholt HM, Winters KL, Britt LD, Long WB 3rd. Modern concepts of treatment and prevention of electrical burns. J Long Term Eff Med Implants. 2005;15(5):511-32. [Medline].

  13. Hashem FK, Al Khayal Z. Oral burn contractures in children. Ann Plast Surg. Nov 2003;51(5):468-71. [Medline].

  14. Hitchings A, Murray A. Traumatic ulceration mimicking oral squamous cell carcinoma recurrence in an insensate flap. Ear Nose Throat J. Mar 2004;83(3):192, 194. [Medline].

  15. Gallego L, Junquera L, Llorente S. Oral carcinoma associated with implant-supported overdenture trauma: a case report. Dent Traumatol. Feb 2009;25(1):e3-4. [Medline].

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Further Reading

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Keywords

traumatic oral ulcers, oral ulcers, oral ulcerations, sublingual ulcerations, Riga-Fede disease, electrical burns, thermal burns, bruxism, food sensitivity

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Contributor Information and Disclosures

Author

Glen Houston, DDS, MSD, Chair, Professor, Department of Oral and Maxillofacial Pathology, University of Oklahoma Health Sciences Center
Glen Houston, DDS, MSD is a member of the following medical societies: American Academy of Oral and Maxillofacial Pathology, American Academy of Oral Medicine, and American Dental Association
Disclosure: Nothing to disclose.

Medical Editor

Daniel Mark Siegel, MD, MS, Director, Procedural Dermatology Fellowship Program, Clinical Professor of Dermatology, Department of Dermatology, State University of New York Downstate
Daniel Mark Siegel, MD, MS is a member of the following medical societies: American Academy of Dermatology, American Academy of Facial Plastic and Reconstructive Surgery, American College of Mohs Micrographic Surgery and Cutaneous Oncology, American College of Physician Executives, American Society for Dermatologic Surgery, American Society for Laser Medicine and Surgery, American Society for MOHS Surgery, and International Society for Dermatologic Surgery
Disclosure: Nothing to disclose.

Pharmacy Editor

Michael J Wells, MD, Associate Professor, Department of Dermatology, Texas Tech University Health Sciences Center
Michael J Wells, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, and Texas Medical Association
Disclosure: Nothing to disclose.

Managing Editor

Drore Eisen, MD, DDS, Consulting Staff, Department of Dermatology, Dermatology Research Associates of Cincinnati
Drore Eisen, MD, DDS is a member of the following medical societies: American Academy of Dermatology, American Academy of Oral Medicine, and American Dental Association
Disclosure: Nothing to disclose.

CME Editor

Glen H Crawford, MD, Assistant Clinical Professor, Department of Dermatology, University of Pennsylvania School of Medicine; Chief, Division of Dermatology, The Pennsylvania Hospital
Glen H Crawford, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, Phi Beta Kappa, and Society of USAF Flight Surgeons
Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD, Director, Department of Dermatology, Geisinger Medical Center
Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology
Disclosure: Nothing to disclose.

 
 
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