Ulcers in the oral cavity

Basic terminology
Ulcer
• Local defect of the surface of
an organ or tissue produced
by detachment of
inflammatory necrotic tissue

• Epithelium is lost and the

connective tissue is exposed

Kumar V, Abbas AK, Fausto N. Chapter 2. Acute and Chronic Inflammation. In: Robbins and Source: CNX OpenStax [CC BY 4.0 (https://creativecommons.org/licenses/by/4.0)]
Coltran Pathologic Basis of Disease. 7th ed. ElSevier: Madrid, Spain, 2005. pp 77-78
 Phases of an ulcer
1. Prodromal stage
Local inflammation occurs. There might be pain, discomfort,
redness or even the formation of a vesicle.
2. Pre-ulcerative stage
Local necrosis in the area occurs. Surrounding the necrotic area
is an area of inflammation.
3. Ulcerative stage
Ulcer is formed. The area of the ulcer is filled by blood and
necrotic tissue and may be colonized by microbia. Surrounding the
ulcer you will find inflammatory cells in charge of the healing of the
ulcer. On the surface, a fibrin membrane is formed protecting the
area of the ulcer.
4. Healing stage
Healthy tissue is forming in the area, the fibrin membrane
detaches. Initially, there is an area of scar that soon disappears.
5. Remission stage

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Superficial ulcer
A superficial ulcer is an ulcer in which
only the superficial tissues are exposed.

Superficial ulcers usually present with an

erythematous halo surrounding the
ulcer.

Borders of the ulcer are not raised

Fibrin membrane is usually homogenous

in color (white/white-yellow)

Dr. Paola Mora, Costa Rica; Dr. Maria Luisa Gainza, Malta
Deep ulcer
In a deep ulcer, more surfaces of the
connective tissue are involved.

Borders of the ulcer are raised

Fibrin membrane is can be homogenous

in color (white/white-yellow) or non-
homogenous depending on the cause
and on the time of evolution of the ulcer

This Photo by Unknown Author is licensed under CC BY-NC

Benign Malignant
Not deep Deep
Clean background Dirty background
Slightly or not elevated borders Everted rims
Pain from the beginning Not painful at the beginning
Painful when nervous and vascular
7-15 days evolution involvement
Cause-effect relation Evolution?
Hard and infiltrating when touched

This Photo by Unknown Author is licensed under CC BY-NC