These are painful, single or multiple shallow ulcers that may be round or ovoid. They may begin in childhood and be a recurrent problem for some people. They may be caused by a number of different factors, including local trauma, stress, certain foods, such as cheese, strawberries, peanuts, chocolate or tomatoes, or hormonal changes related to the menses. They may be classed as minor if they are small lesions (2-8mm) that heal within 10 to 14 days. They are classed as major if greater than 1cm, they leave a scar and take several weeks to heal. Herpetiform ulcers, as seen here, are multiple ulcers that fuse to form larger ulcers. Although so named they are not caused by infection and usually heal within two weeks. Management involves avoiding precipitating causes; an antimicrobial mouthwash such as chlorhexidine; a course of a low-potency topical steroid, such as hydrocortisome oromucosal tablets, dissolved next to the ulcer(s); beclometasone inhaler sprayed twice daily onto the oral mucosa; and/or a local analgesic, such as lidocaine 5% ointment or benzydamine mouthwash or spray.
Oral ulcers associated with systemic disease