Oral Ulcers: Clinical features, Causes & Treatment

Traumatic ulcers in healing stage caused by sharp teeth

An ulcer is a tissue defect which has penetrated the epithelial-connective tissue border, with its base at a deep level in the submucosa, or even within muscle or periosteum. An ulcer is a deeper breach of the epithelium than an erosion or an excoriation, and involves damage to both epithelium and lamina propria.

An erosion is a superficial breach of the epithelium, with little damage to the underlying lamina propria. A mucosal erosion is an erosion which specifically occurs on a mucous membrane. Only the superficial epithelial cells of the epidermis or of the mucosa are lost, and the lesion can reach the depth of the basement membrane. Erosions heal without scar formation. Excoriation is a term sometimes used to describe a breach of the epithelium which is deeper than an erosion but shallower than an ulcer. This type of lesion is tangential to the rete pegs and shows punctiform (small pinhead spots) bleeding, caused by exposed capillary loops.

Clinical Features

Type of Edges of an Ulcer

  1. Rolled out or Everted: Commonly seen in Squamous cell carcinoma
  2. Raised or Beaded: Commonly seen in Basal cell carcinoma or Rodent ulcer
  3. Undermined: Commonly seen in Tubercular ulcer
  4. Punched out: Commonly seen in Trophic ulcer or Decubitus ulcer or in Gummatous ulcer
  5. Sloping ulcer: Healing ulcer