DIAGNOSIS OF ORAL ULCERS

Ulcers commonly occur in the mouth. Their causes range from minor irri tation to malignancies and systemic diseases. Innocent solitary ulcera tions, which result from trauma and infections, must be distinguished from squamous cell carcinomas, which also typically present as solitar y ulcers. Multiple oral ulcers may be classified as acute, recurrent a nd/or chronic. The most common causes of rapid-onset oral ulcers inclu de acute necrotizing ulcerative gingivitis, allergies and erythema mul tiforme. The two common forms of acute (short-term) recurrent oral ulc ers, ''cold sores'' or ''fever blisters,'' which are caused by the her pes simplex virus, and recurrent aphthous ulcers (''canker sores''), m ay be distinguished largely on the basis of their location. Most types of multiple chronic oral ulcers are associated with disturbances of t he immune system. They include erosive lichen planus, mucous membrane pemphigoid and pemphigus vulgaris. Clinical criteria which are most us eful in identifying the cause of oral ulcers are vesicles or bullae, w hich may not be seen because they rupture rapidly in the oral environm ent; constitutional signs and symptoms; and lesions on the skin and/or other mucosa. In some cases, diagnosis depends upon culture or biopsy , particularly with the application of immunofluorescence to the surgi cal specimen.