Differential Diagnosis for Tongue Ulcer
- Single most likely diagnosis
- Aphthous ulcer: This is the most common cause of tongue ulcers, characterized by small, painful, and recurrent lesions. The high prevalence and typical presentation make it the single most likely diagnosis.
- Other Likely diagnoses
- Traumatic ulcer: Accidental bites, sharp edges of teeth or dental work, or other mechanical injuries can cause ulcers on the tongue. The history of trauma and the location of the ulcer often support this diagnosis.
- Infectious ulcers (e.g., herpes simplex, syphilis): These can present with ulcers on the tongue, among other symptoms. The presence of systemic symptoms or a history of exposure may suggest an infectious cause.
- Oral lichen planus: This chronic inflammatory condition can cause ulcers, especially in the context of other oral lesions or skin involvement.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed)
- Squamous cell carcinoma: Although less common, any non-healing ulcer, especially in smokers or those with a history of alcohol abuse, should raise suspicion for oral cancer. Early detection is crucial for treatment outcomes.
- Tuberculosis: Oral tuberculosis can present with ulcers, and given its potential severity and the importance of early treatment, it should not be missed, especially in endemic areas or in immunocompromised patients.
- Rare diagnoses
- Eosinophilic ulcer: A rare condition characterized by an eosinophilic infiltration of the oral mucosa, presenting as an ulcer. It's more common in children but can occur in adults.
- Behçet's disease: A form of vasculitis that can cause oral ulcers, among other systemic symptoms. It's rare but important to consider in patients with recurrent oral ulcers and other systemic symptoms.
- Autoimmune disorders (e.g., pemphigus, pemphigoid): These conditions can cause oral ulcers and blisters. While rare, they are important to diagnose due to their potential for significant morbidity and the need for specific treatment.