Long-standing oral ulcers: proposal for a new `S-C-D classification system

• Published in: Journal of oral pathology & medicine 2009-03, Vol.38 (3), p.241-253
• Main Authors: Compilato, D., Cirillo, N., Termine, N., Kerr, A. R., Paderni, C., Ciavarella, D., Campisi, G.
• Format: Article
• Language: English
• Subjects: Biological and medical sciences; Carcinoma, Squamous Cell - diagnosis; Chronic Disease; Dentistry; Dermatology; Diagnosis, Differential; Facial Injuries - diagnosis; Humans; lichen planus; Lichen Planus, Oral - diagnosis; Medical sciences; Mouth Neoplasms - diagnosis; oral carcinoma; Oral Ulcer - classification; Oral Ulcer - pathology; oral ulcers; Otorhinolaryngology. Stomatology; Psoriasis. Parapsoriasis. Lichen; Skin Diseases, Vesiculobullous - diagnosis; traumatic ulcer; Tumors; Upper respiratory tract, upper alimentary tract, paranasal sinuses, salivary glands: diseases, semeiology; vesiculo-bullous diseases
• ISSN: 0904-2512; 1600-0714
• DOI: 10.1111/j.1600-0714.2008.00722.x

Persistent oral ulcers and erosions can be the final common manifestation, sometimes clinically indistinguishable, of a diverse spectrum of conditions ranging from traumatic lesions, infectious diseases, systemic and local immune‐mediated lesions up to neoplasms. The process of making correct diagnosis for persistent oral ulcers still represents a challenge to clinicians. Major diagnostic criteria should include the clinical appearance of both ulcer and surrounding non‐ulcerated mucosa, together with the evaluation of associated signs and symptoms, such as: number (single or multiple), shape, severity of the ulcer(s), conditions of remaining mucosa (white, red or with vesiculo‐bullous lesions) and systemic involvement (e.g. fever, lymphadenopathy or evaluation of haematological changes). The aim of this paper was to review the literature relating to persistent oral ulcers and provide a helpful, clinical‐based diagnostic tool for recognising long‐standing ulcers in clinical dental practice. The authors, therefore, suggest distinguishing SIMPLE, COMPLEX AND DESTROYING (S‐C‐D system) ulcerations, as each requires different diagnostic evaluations and management. This classification has arisen from studying the current English literature relating to this topic, performed using MEDLINE / PubMed / Ovid databases (key words: oral ulcerations, persistent oral ulcers, systemic diseases and oral ulcers, drugs and oral ulcers).