vesicular, bullous or ulcerative lesions of the oral mucosa

Etiology

• viral infection
  • herpes simplex
    • primary acute herpes gingivostomatitis
      • herpes simplex (type 1, rarely type 2)
        • lips & oral mucosa
        • vesicles, painful
        • spontaneous resolution in 10-14 days, unless secondary infection
    • recurrent herpes labialis
      • mucocutaneous junction of lip
      • groups of vesicles, may be painful
      • spontaneous resolution in 1 week, unless secondary infection
    • recurrent intraoral herpes simplex
      • palate & gingiva
      • vesicles, painful
      • spontaneous resolution in 1 week
  • Varicella zoster
    • chickenpox
      • gingiva & oral mucosa
      • skin lesions, mucosal vesicles
      • spontaneous resolution in 2 weeks
    • shingles
      • cheek, tongue, gingiva, palate
      • unilateral vesicles &/or ulcers
      • gradual resolution without scarring
  • Epstein-Barr virus (infectious mononucleosis)
    • oral mucosa
    • small oral ulcers precede lymphadenopathy, gingival bleeding, petechiae at junction of hard & soft palate
    • oral lesions disappear during convalescence
  • papillomavirus (warts)
    • anywhere on oral mucosa
    • single or multiple papillary lesions
    • lesions grow rapidly & spread
  • coxsackievirus
    • herpangina
      • oral mucosa, pharynx, tongue
      • vesicles, fever, sore throat
      • generally in children < 4 years of age
    • hand, foot & mouth disease
      • oral mucosa, pharynx
      • oropharyngeal vesicles, painful, fever
      • spontaneous resolution in 2-4 weeks
  • primary HIV infection
    • gingiva, palate, pharynx
    • acute gingivitis, oropharyngeal ulceration
• bacterial infection
  • acute necrotizing ulcerative gingivostomatitis
    • ulceration & necrosis of gingival papillae
    • painful, bleeding gingiva, foul breath
  • syphilis
    • congenital syphilis
      • palate, jaws, tongue, teeth
      • mucous patches, fissures in corners of mouth
    • primary syphilis (chancre)
      • lesions appear where organism enter body
      • small papule developing into large, painless ulcer
    • secondary syphilis
      • oral mucosa, palate, comissures of mouth
      • maculopapular lesions 5-10 mm with central ulceration
    • tertiary syphilis
      • palate & tongue
      • gummatous infiltration, ulceration & fibrosis
  • gonorrhea
    • dryness, burning of mouth followed by pharyngitis
    • dry mouth, foul odor
  • tuberculosis
    • tongue, tonsillar area, soft palate
    • solitary irregular ulcer with perisistent exudate
• fungal infection
  • cervicofacial actinomycosis
    • floor of mouth, face & neck
    • resembles pyogenic abscess
  • histoplasmosis
    • any area of mouth esp. tongue, gingiva, palate
    • numerous small nodules, may ulcerate, fever
  • candidiasis
    • any area of oral mucosa
    • pseudomembranous form with white patches easily wiped off leaving red, bleeding, sore surface
    • erythematous form is flat & red
    • rarely candidal leukoplakia (does NOT rub off)
    • angular cheilitis
• dermatologic disease
  • mucous membrane pemphigoid
    • mucous membrane of oral cavity
    • painful, grayish-white collapsed vesicles or bullae
    • gingival lesions desquamate, leaving ulcerated area
  • erythema multiforme (Stevens-Johnson syndrome)
    • intraoral bullae surrounded by inflammatory area
    • may be signs of severe systemic toxicity
  • pemphigus vulgaris
    • ruptured bullae & ulcerated oral areas
    • mostly in older adults
  • lichen planus
    • white striae in mouth
    • oral mucosal ulcers & erosive gingivitis (uncommon)
• neoplasm
  • squamous cell carcinoma
    • most commonly on lower lip, tongue, floor of mouth
    • ulcer, failure to heal, pain not prominent
    • tend to arise from areas of leukoplakia or in smooth or atrophic tongue
  • acute leukemia
    • gingiva
    • swelling, ulceration, hyperplasia, necrosis, hemorrhage
    • deep ulcers may occur elsewhere on mucosa complicated by secondary infection
  • lymphoma
    • gingiva, palate, tongue & tonsillar area
    • elevated, ulcerated area, may proliferate rapidly
    • swelling of regional lymph nodes
  • metastatic tumors
    • generally in premolar-molar area of mandible
    • destructive progression, pain & numbness of lower lip
    • evidence of malignancy apparent in other organ system
• other conditions
  • recurrent aphthous ulcers
    • anywhere on non-keratinized oral mucosa
    • painful ulcers (single or clusters) with surrounding erythema, 1-15 mm in diameter
    • lesions heal in 1-2 weeks, but may recur monthly or several times/year
  • Behcet's syndrome
    • multiple ulcers
    • ulcers may persist for several weeks & heal without scarring
    • manifestations of disease in other organ systems
  • traumatic ulcers

More general terms

• mouth lesions, mucosa (oral lesion)