Symptoms and Signs - ​Differential Diagnosis of Aphthous Stomatitis (Canker Sores)
• White sponge nevus: thick, white corrugated folds involving the buccal mucosa; appears in childhood as an autosomal dominant trait; benign condition
• Varices
• Nicotine stomatitis: whitened palate with red papules
• Melanotic lesions: freckles, lentigines, lentigo, melanoma, Peutz- Jeghers syndrome, Addison’s disease
• Lichen planus: linear, reticular, slightly raised striae on buccal mucosa; skin is involved by pruritic violaceous papules on forearms and inner thighs
• Leukoplakia: white lesions that cannot be scraped off; 20% are premalignant epithelial dysplasia or squamous cell carcinoma
• Leukoedema: filmy opalescent-appearing mucosa, which can be reverted to normal appearance by stretching. This condition is benign.
• Kaposi’s sarcoma: red or purple macules that enlarge to form tumors; seen in patients with AIDS
• Histoplasmosis: ill-defined irregular patch with a granulomatous surface, sometimes ulcerated
• Hemangiomas
• Hairy leukoplakia: shaggy white surface that cannot be wiped off; seen in HIV infection, caused by Epstein-Barr virus
• Erythroplakia: red patch usually caused by epithelial dysplasia or squamous cell carcinoma
• Discoid lupus erythematosus: lesion resembles lichen planus
• Darier’s disease (keratosis follicularis): white papules on the gingivae, alveolar mucosa, and dorsal tongue; skin lesions also present (erythematous papules); inherited as an autosomal
• Coated tongue: accumulation of keratin; harmless condition that can be treated by scraping
• Chemical injury: white sloughing mucosa
• Candidiasis may present with red instead of the more frequent white lesion (see White Lesions). Median rhomboid glossitis is a chronic variant.
• Candidiasis
• Burning tongue (glossopyrosis): normal examination; sometimes associated with denture trauma, anemia, diabetes, vitamin B12 deficiency, psychogenic problems
• Benign migratory glossitis (geographic tongue): area of atrophic depapillated mucosa surrounded by a keratotic border
• Anemia: atrophic reddened glossal mucosa seen with pernicious anemia
• Allergy
• Papilloma
• Verruca vulgaris
• Condyloma acuminatum
• Fibroma
• Epulis
• Pyogenic granuloma
• Mucocele
• Retention cyst
• Primary herpetic gingivostomatitis
• Pemphigus and pemphigoid
• Hand-foot-mouth disease: caused by coxsackievirus group A
• Erythema multiforme
• Herpangina: caused by echovirus
• Traumatic ulcer
• Primary syphilis
• Perlèche (angular cheilitis)
• Recurrent aphthous stomatitis (canker sores)
• Behçet’s syndrome (aphthous ulcers, uveitis, genital ulcerations,
arthritis, and aseptic meningitis)
• Reiter’s syndrome (conjunctivitis, urethritis, and arthritis with
occasional oral ulcerations)