Aphthous Ulcers: Diagnosis and Management

Clinical Presentation and Diagnostic Features

Aphthous ulcers are well-demarcated, oval or round ulcers with a white or yellow pseudomembrane and an erythematous halo, representing the most common type of oral ulcerative disease affecting 10-20% of the population 1
Typical aphthous ulcers have a yellow or white base with a well-defined erythematous border 1
They are usually located on non-keratinized, movable oral mucosa (buccal mucosa, labial mucosa, floor of mouth) 1
Traumatic ulceration (related to sharp teeth edges or appliances) should be considered in the differential diagnosis 1
Infectious causes (bacterial, fungal, viral) should also be considered in the differential diagnosis 1, 2

For ulcers persisting beyond 2 weeks or not responding to treatment, further investigation is warranted, including first-line testing such as full blood count, fasting blood glucose, HIV antibody testing, and syphilis serology testing 3
Second-line testing may include nutritional deficiency screening (iron, folate, vitamin B12) and autoimmune markers if autoimmune conditions are suspected 3
Biopsy for persistent ulcers to rule out malignancy is recommended 1, 3

Relying solely on clinical appearance without appropriate testing for persistent ulcers is a common pitfall 3
Overlooking systemic causes of recurrent oral ulcers is another common pitfall 3
Treating symptoms without establishing a definitive diagnosis for persistent ulcers is not recommended 3