Causes of Recurrent Mouth Ulcers

Etiologic Categories and Diagnostic Considerations

Mechanical trauma from sharp food, dental appliances, or accidental biting creates ulcers that correspond in location and shape to the inciting factor, typically resolving within 2 weeks once the trauma source is eliminated 1
Inflammatory bowel disease commonly causes oral ulceration, requiring specific investigation when ulcers are recurrent and unexplained 3
Behçet's disease manifests as recurrent bipolar aphthosis (oral and genital ulcers), with a significant impact on patient quality of life 4
Deep fungal infections occur particularly in immunosuppressed or hyperglycemic patients, and can be diagnosed with appropriate laboratory tests 2
NSAIDs can cause gastrointestinal complications including oral ulceration, highlighting the importance of medication review 5
Any solitary chronic ulcer >2 weeks must be biopsied to exclude malignancy, with atypical features suggesting malignancy 1
Blood tests should include full blood count, fasting glucose, HIV antibody, syphilis serology, and nutritional markers (B vitamins, iron, folate) to establish a definitive diagnosis 1
Relying solely on topical treatments for persistent ulcers without establishing definitive diagnosis delays identification of malignancy or systemic disease, emphasizing the need for a comprehensive diagnostic approach 1