DIAGNOSIS CHECKLIST
for Mouth ulcers

Why: to determine if acute or chronic.

Why: e.g. if on the lip may suggest herpes simplex labialis (cold sore), syphilis or lip cancer.

Why: Aphthous ulcers in the mouth are extremely common and the majority of adults will experience aphthous ulcers at some time during their lives however some medical conditions may cause recurrent mouth ulceration such as Crohn's disease, pernicious anemia, Behcet's disease and HIV infection.

Why: minor mouth injury is the most common cause of mouth ulceration e.g. injury from a toothbrush whilst brushing teeth, biting of the cheek.

Why: when last saw a dentist?, dental care routine? Known dental caries? - Poor oral hygiene may be associated with Vincent's infection and oral cancer which may both cause mouth ulceration.

Why: Poorly fitting dentures may cause oral ulcers.

Why: e.g. cigarette smoking, poor dental hygiene, spirits, recurrent mouth infections or syphilis.

Why: e.g. recurrent mouth ulcers may occur in people with leukemia, immunocompromise, malnutrition and diabetes mellitus; aphthous mouth ulcers may be associated with Behcet's disease, Crohn's disease, celiac disease, HIV disease; angular cheilitis may occur due to Candida infection in people with HIV disease, general debilitation or diabetes mellitus.

Why: some medications may cause aphthous ulceration such as gold and steroids; some medications are associated with erythema multiforme including barbiturates, penicillin, sulphonamides, phenothiazines and phenytoin.

Why: malnutrition can increase the risk of Acute ulcerative gingivitis (Vincent's infection); may indicate risk of dietary deficiencies (such as Vitamin B6, B12, folate and iron) that may cause angular stomatitis or glossitis.

Why: increases risk of gingivitis, lip and oral cavity cancers.

Why: may indicate the risk of HIV which may be associated with angular cheilitis (due to Candida infection), aphthous mouth ulceration, tongue ulceration and an increased risk of oral cancer; Primary syphilis may also feature chancres (ulcer) in the mouth.

Why: aphthous mouth ulcers seem to run in families.

Why: may suggest acute ulcerative gingivitis (Vincent's disease).

Why: would suggest herpes simplex labialis, syphilis and carcinoma.

Why: must consider Behcet's syndrome, Herpes simplex or Reiter's syndrome.

Why: may suggest Crohn's disease, Ulcerative colitis and Celiac disease.

Why: may suggest Herpes zoster (shingles) or Chicken pox.

Why: may suggest Behcet's syndrome, Reiter's syndrome, Ulcerative colitis or Crohn's disease.

Why: may suggest malignancy such as leukemia which may also be associated with swollen and bleeding gums and also recurrent mouth infections.

Why: e.g. smooth appearance of the tongue, tongue may be red. In later stages there may be shallow ulceration. May be due to nutritional deficiency in iron, folate, Vitamin B12.

Why: e.g. lesions occurring on the inside of the lips or mouth which begin as a small painful vesicle which later breaks down to form a painful shallow ulcer. The ulcers heal without scarring. Cause is unknown, but may occur in Crohn's disease, Celiac disease, AIDS, Behcet's disease and cyclic neutropenia.

Why: e.g. tender, red, swollen, bleeding and ulcerated gums - occurs in the malnourished person with poor dentition and also in the immunocompromised person.

Why: e.g. fever, headache, sore mouth, shallow ulcers on the lining of the mouth, gums and tongue, blisters on hands, palms and soles.

Why: e.g. prodrome of tingling, itching or burning sensation on the lips which usually precede any visible skin changes by 24 hrs. Prodrome is followed by development of fluid filled vesicles which erode to become ulcers on the lips.

Why: e.g. cracks at the corners of the mouth. Possible causes may include Vitamin B6, B12, folate and iron deficiency.

Why: e.g. recurrent and persistent oral aphthous ulcers, recurrent genital aphthous ulcers, features of posterior uveitis (blurred vision and floaters), erythema nodosum (painful nodules on the arms and legs).

Why: e.g. acute eruption involving the skin and mouth mainly in children, adolescents and young adults. Lesions are raised patches of concentric rings (iris or target lesions). The mouth lesions are tender and painful erosions. It may be associated with herpes simplex type 1, systemic lupus erythematosus, Hodgkin's disease, myeloma, tuberculosis and some medications.

Why: e.g. fissuring at the corners of the mouth, red inflamed tongue, seborrheic dermatitis on face, scrotum or vagina.

Why: e.g. urethritis (painful urination with penile discharge), conjunctivitis (red painful eyes) and painful peripheral joints. Lesions on palms, soles, penis and mouth. 90% of those affected are male.