Table 1 Clinical characteristics
From: Oral ulcers in children- a clinical narrative overview
Disease | Number of ulcers | Location and description of ulcers | Other hints and symptoms |
|---|---|---|---|
Traumatic ulcer | Depends on trauma | - Can affect all sites of oral cavity - Raised ulcers with reddish borders, necrotic pseudomembrane. | |
Herpetic gingivostomatitis | Multiple | - Keratinized and nonkeratinized mucosa - Superficial fluid-filled vesicles, form into ulcers with scalloped borders and erythematous halo | 6 months to 5 years Pyrexia, anorexia, submandibular lymphadenitis, dysphagia. |
Herpangina | Multiple | - Oropharynx and soft palate - Small vesicular lesions on the. | < 5 years Pyrexia, headache, drooling, peaks in the summer. |
Hand-foot-and-mouth-disease | Multiple | - Affecting front of the mouth (tongue, buccal mucosa, hard palate) - Small blisters | < 5 years Pyrexia, rash on hands and feet. |
Infectious Mononucleosis | Multiple | - Affects the lateral border of the tongue - Hairy leukoplakia: White, hyperkeratotic lesion with a flat surface | Asymptomatic in early childhood, teenagers and immune-compromised. Pyrexia, halitosis, cervical lymphadenopathy, tonsillitis, hepatosplenomegaly. |
Diptheria | Multiple | - Upper respiratory tract, -Formation of pseudomembrane. | Pyrexia, lymphadenopathy. Lack of vaccination. |
Fungal infection | Multiple | - Buccal mucosa - White patches, ‘plaques’ | Any age in immune-compromised. |
Erythema multiforme | Multiple | - Lips, tongue and buccal mucosa - Large and confluent lesions, bullae and ulcerations with irregular border, inflammatory halo and pseudomembrane | Cutaneous ‘target’ lesions. Acute and self-limiting. |
Reiter’s syndrome | Multiple | - On the palate, tongue, lips - Superficial, small ulcers or opaque vesicles | A history of bacterial gastroenteritis. Urethritis, conjunctivitis, arthritis. Association with HLA-B27. |
Stevens-Johnson-Syndrome | Multiple | - Lips, buccal mucosa, tongue - Large and confluent lesions, same oral presentation as in Erythema multiforme. | Prodromal illness, severe erythematous papules, bullae and skin erosions, ‘target’ lesions (same as in erythema multiforme) mainly on the trunk. Potentially life-threatening, high fever, signs of systemic toxicity. |
GvHD | Multiple | - Any site intraorally as well as lips can be involved. - Ulcers can be shallow or deep and confluent. | Skin, gastrointestinal tract, liver, joints might be affected as well. |
Plasma cell stomatitis | Multiple | Gingiva presents with desquamative gingivitis. | Angular cheilitis, fissured lips, epithelial desquamation, self-limiting. |
CMV-associated ulcer | Single | - Hard and soft palate - Shallow ulcer with rolled margins and yellow slough. | Pyrexia, myalgia, hepatitis, lymphadenopathy, mainly in immunocompromised children. |
Tuberculous ulcer | Single | - Gingiva, mucobuccal folds - Single lesion with undermined borders. | Submandibular lymphadenopathy. |
Syphilitic ulceration | Single | - Punched-out lesion, 2-3 cm in diameter, covered by a yellow serous discharge. | Lesion lasts for 2–4 weeks, cervical lymphadenopathy. |
Necrotizing sialometaplasia | Multiple | - Affecting papillary and marginal gingivae - Crater like ulcer | Fever, halitosis, bleeding gingiva, necrosis of interdental papilla. |
Sarcoidosis | Single | Superficial ulcer, sometimes combined with nodules. | Swelling of buccal mucosa. |
Necrotizing ulcerative gingivitis | Multiple | - Gingiva - Crater like ulcers with interdental bleeding. | Fever, malaise. Risk factors: Smoking, trauma, preexisting gingivitis or immunosuppression. |
Granulomatosis with polyangiitis | Multiple | Strawberry-like gingivitis. | Petechial haemorrhages in the gingivae, hyperplastic gingival lesions. |
Bullous pemphigoid | Multiple | - Gingiva - Small vesicles | Desquamative gingivitis. |
Mucous membrane pemphigoid | Multiple | - Gingiva and palate - Small blisters | Oesophageal and nasal mucosa can be affected. Bleeding into bullae. |
Pemphigus vulgaris | Multiple | - Buccal mucosa and gingivae - Blisters, whose ruptures form erosions | Positive Nikolsky sign, desquamative gingivitis. |
Lichen planus | Multiple | - affects buccal mucosa and gingiva - Reticular, erosive and atrophic forms can affect | Inflammatory dermatosis involving wrists, lower limbs and genital mucosa. Desquamative gingivitis. |
Linear IgA disease | Multiple | - Mainly buccal - Many blisters with an erythematous base | Same ulcers can appear anogenital. |
Melkersson-Rosenthal Syndrome | Multiple | Small, multiple ulcers. | Oro-facial edema, facial nerve palsy, furrowing of the tongue. |
Behcet’s disease | Multiple | - Affecting oral or pharyngeal mucosa - Recurrent ulcers covered with sharp erythematous border | Genital ulcers, skin lesions (erythema nodosum- like), ocular inflammation. |
Crohn’s and Coeliac disease | Single | - Buccal mucosa - Tag-like lesions | Cobblestoning and mucogingivitis. |
Pyoderma gangrenosum | Single or Multiple | - Affecting the tongue - Large, deep ulcers | Necrotic ulcers with a ragged violaceous border and surrounding erythema affecting any anatomical site. |
Deficiencies | Multiple | Multiple small ulcers. | Anorexia. Vitamin B, folic acid and zinc deficiencies can be the reason. |
Systemic Lupus erythematodes | Multiple | White plaques, raised keratotic plaques, petechiae, cheilitis. | Butterfly-shaped rash, fatigue, fever, joint pain. |
PFAPA-Syndrome | Multiple | - Affecting lips and buccal mucosa, not the tongue - Small ulcers | Pharyngitis, cervical lymphadenopathy, joint pain, fever, high CRP. |
Cyclic neutropenia | Multiple | - Any oral mucosa - Multiple small ulcers with erythematous halo | Episodic with concomitant fever, periodontitis, gingival recession. |
Familial Mediterranean fever | Multiple | Multiple small ulcers | Family history of FMF; High CRP, ESR and fever during the episode, which lasts 1–4 days. Arthritis, serositis. |
Oral hypersensitivity reaction | Multiple | Many different forms, which can affect all sites intraorally. | Swelling of the lips, signs of oral allergy. |