Differential Diagnosis for Ulcers on the Tongue

• Single most likely diagnosis
  • Aphthous ulcers: These are the most common cause of tongue ulcers, characterized by recurrent, painful, shallow ulcers that can appear on the tongue and other parts of the mouth. They are often triggered by stress, trauma, or certain foods.
• Other Likely diagnoses
  • Traumatic ulcers: These can occur due to accidental biting of the tongue, sharp teeth, or dental appliances, leading to ulcers.
  • Oral lichen planus: An autoimmune condition that can cause white patches and ulcers in the mouth, including on the tongue.
  • Infectious causes (e.g., herpes simplex virus, syphilis): Certain infections can lead to the development of ulcers on the tongue.
• Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
  • Oral cancer: Although less common, ulcers on the tongue can be a sign of oral cancer, especially if they are persistent, grow in size, or are associated with other symptoms like difficulty swallowing or a lump in the neck.
  • Tuberculosis: In rare cases, tuberculosis can manifest with oral ulcers, including on the tongue, especially in immunocompromised individuals.
• Rare diagnoses
  • Erythema multiforme: A rare skin condition that can also affect the mucous membranes, leading to ulcers, including on the tongue.
  • Pemphigus vulgaris: An autoimmune disease that causes blistering of the skin and mucous membranes, which can lead to ulcers on the tongue.
  • Behçet's disease: A rare disorder that causes blood vessel inflammation throughout the body, leading to symptoms including oral ulcers.