Differential Diagnosis for New Onset Canker Sore in a 70-Year-Old
- Single Most Likely Diagnosis
- Aphthous ulcer: This is the most common cause of canker sores, and they can occur at any age. The fact that it's a new onset in a 70-year-old doesn't necessarily point towards a more serious condition, as aphthous ulcers can be triggered by various factors such as stress, minor mouth injury, or certain foods.
- Other Likely Diagnoses
- Traumatic ulcer: Given the age, the possibility of accidental trauma to the mucosa (e.g., from dentures, sharp teeth, or eating) is plausible.
- Denture-related irritation: If the patient wears dentures, irritation or poor fit could lead to canker sores.
- Nutritional deficiencies (e.g., vitamin B12, iron, or folate deficiency): These can cause oral mucosal changes, including canker sores, especially in elderly individuals with poor dietary intake or malabsorption issues.
- Do Not Miss Diagnoses
- Oral cancer: Although less likely, it's crucial not to miss oral cancer, especially in elderly patients who may have a history of smoking or other risk factors. A canker sore that doesn't heal within 2 weeks should raise suspicion.
- Infections (e.g., herpes simplex virus, hand-foot-and-mouth disease): While less common in this age group for some of these infections, they can still occur and need to be considered, especially if the patient is immunocompromised.
- Rare Diagnoses
- Behçet's disease: A rare condition characterized by recurrent aphthous ulcers, among other symptoms. It's less likely but should be considered if the patient has recurrent or unusually severe canker sores.
- Pemphigus or pemphigoid: Autoimmune diseases that can cause blistering of the skin and mucous membranes, including the oral cavity. These conditions are rare but can be serious.
- Eosinophilic ulcer: A rare condition that can present with oral ulcers, often associated with eosinophilia. It's an uncommon diagnosis but should be considered in the differential for unexplained or recurrent oral ulcers.