Difficult and complicated oral ulceration: an expert consensus guideline for diagnosis

Abstract

The complexity of oral ulcerations poses considerable diagnostic and therapeutic challenges to oral specialists. The expert consensus was conducted to summarize the diagnostic work-up for difficult and complicated oral ulcers, based on factors such as detailed clinical medical history inquiry, histopathological examination, and ulceration-related systemic diseases screening. Not only it can provide a standardized procedure of oral ulceration, but also it can improve the diagnostic efficiency, in order to avoid misdiagnosis and missed diagnosis.

Use of artificial intelligence in the classification of elementary orallesions from clinical images

“…This proposal is based on the fact that this is the rst criterion applied in a ow of diagnostic reasoning by a specialist in his daily practice. At the moment when it is de ned that an injury is characterised as an ulcer, a considerable number of diseases that presents characteristically with plaques can be excluded [30,31]. Based on this assumption, the training of the architecture focused on the recognition of the elementary lesion as a way to organise a set of lesions into 6 distinct groups.…”

“…Similarly, diseases that presented as vesicles or blisters in the oral cavity tend to rupture in a short period of time, starting to present as ulcerated lesions. Cases such as these show that AI resources that propose to classify diseases from clinical images should contemplate the possibility of inserting relevant clinical data that cannot be obtained from images, such as evolution, duration or presence of symptoms [30,31].…”

Follicular lymphoma manifests as multiple erosive and proliferative lesions of the oral mucosa: case report and brief literature review

“…Erosions or ulcers are common manifestations and basic lesions of oral mucosal diseases, with erosions histologically presenting as partial defects of the mucosal epithelium and ulcers as defects of the entire epithelial layer. Oral mucosal diseases such as oral lymphoma may manifest as erosions and ulcers [ 3 ]. Long-lasting erosions or ulcers may lead to severe distress and a significant decrease in quality of life, and in some cases, may even be life-threatening.…”

“…Third, besides the detection of biopsied lesions, some adjuvant examinations are recommended to identify systemic factors responsible for the oral erosions, encompassing computed tomography (CT), ultrasonography, blood testing, whole exome sequencing, and so forth. Finally, for refractory oral erosions that cannot be diagnosed through the aforementioned measures, multi-disciplinary team consultation, diagnostic treatment, and further biopsy may be required to achieve an adequate diagnosis [ 3 , 7 – 9 ].…”

“…A large number of oral mucosal diseases can be characterised by oral mucosal erosion, including oral allergic diseases [ 10 ], oral infectious diseases such as tuberculosis (TB) [ 3 ], pemphigus/pemphigoid [ 11 ], paraneoplastic autoimmune multiorgan syndrome (PAMS) [ 12 ], oral potentially-malignant disorders (OPMD) represented by OLP [ 13 ], oral malignancies including oral squamous cell carcinoma (OSCC) [ 14 ], and genetic diseases such as dyskeratosis congenita [ 8 ] (Table 1 ). These diseases may be distinguished from each other based on various features, such as the clinical duration and medical history, and by engaging diagnostic approaches, including examination of biopsied tissue and systemic adjuvant examination.…”