Management of Oral Ulcers in Elderly Denture Wearers

Assessment and Identification of Traumatic Ulcers

In elderly denture wearers, clinicians must first evaluate whether oral ulcers are caused by denture‑related trauma before assuming aphthous disease 1, 2.
Mechanical irritation from ill‑fitting dentures, sharp denture edges, or residual tooth roots is a frequent cause of ulcerations that mimic aphthous lesions 1, 3.
Traumatic ulceration can be diagnosed by correlating the ulcer’s location and shape with the site of mechanical irritation 4, 1.
A systematic examination of denture fit, including identification of sharp edges or pressure points that align with the ulcer, is essential 2, 3.

When denture trauma is identified, the definitive treatment is denture adjustment or replacement rather than pharmacologic therapy 1.
After removal of the offending mechanical factor, traumatic ulcers are expected to heal within 1–2 weeks 4.

If an ulcer persists beyond 2 weeks or fails to improve after 1–2 weeks of appropriate management, a biopsy should be performed to exclude serious pathology 4, 1.
Biopsy is particularly important in the elderly to rule out malignancy 1, 5.
Additional conditions to consider when ulcers are refractory include autoimmune bullous diseases 4, systemic disorders such as anemia or vitamin B12/folate deficiency 4, 3, and fungal infections—especially in diabetic patients 4, 3.

For elderly patients with recurrent oral ulcers, baseline laboratory testing should include a complete blood count, fasting glucose, vitamin B12, folate, and iron studies to identify underlying systemic contributors 4, 3.

Do not assume that all oral ulcers in denture wearers are aphthous; traumatic ulceration is more common and requires mechanical correction, not medication 1, 2.
Do not delay biopsy in elderly patients with atypical or persistent ulcers (> 2 weeks), as the risk of malignancy increases with age 4, 1.
Always assess for nutritional deficiencies (vitamin B12, folate, iron) that may predispose to recurrent ulceration in older adults 4.