_______________________________________________________________________________________________________________________________ Open Access Maced J Med Sci. 2019 Oct 15; 7(19):3341-3347. 3341 ID Design Press, Skopje, Republic of Macedonia Open Access Macedonian Journal of Medical Sciences. 2019 Oct 15; 7(19):3341-3347. https://doi.org/10.3889/oamjms.2019.689 eISSN: 1857-9655 Review Article Oral Ulcers Presentation in Systemic Diseases: An Update Sadia Minhas 1 , Aneequa Sajjad 1 , Muhammad Kashif 2 , Farooq Taj 3 , Hamed Al Waddani 4 , Zohaib Khurshid 5* 1 Department of Oral Pathology, Akhtar Saeed Dental College, Lahore, Pakistan; 2 Department of Oral Pathology, Bakhtawar Amin Medical & Dental College, Multan, Pakistan; 3 Department of Prosthetic, Khyber Medical University Institute of Dental Sciences, Kohat, Pakistan; 4 Department of Medicine and Surgery, College of Dentistry, King Faisal University, Hofuf, Al- Ahsa Governorate, Saudi Arabia; 5 Department of Prosthodontics and Dental Implantology, College of Dentistry, King Faisal University, Hofuf, Al-Ahsa Governorate, Saudi Arabia Citation: Minhas S, Sajjad A, Kashif M, Taj F, Al Waddani H, Khurshid Z. Open Access Maced J Med Sci. 2019 Oct 15; 7(19):3341-3347. https://doi.org/10.3889/oamjms.2019.689 Keywords: Oral ulcer; Infections; Vesiculobullous lesion; Traumatic ulcer; Systematic disease *Correspondence: Zohaib Khurshid. Department of Prosthodontics and Dental Implantology, College of Dentistry, King Faisal University, Hofuf, Al-Ahsa Governorate, Saudi Arabia. E-mail: drzohaibkhurshid@gmail.com Received: 24-Apr-2019; Revised: 12-Sep-2019; Accepted: 13-Sep-2019; Online first: 10-Oct-2019 Copyright: © 2019 Sadia Minhas, Aneequa Sajjad, Muhammad Kashif, Farooq Taj, Hamed Al Waddani, Zohaib Khurshid. This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (CC BY-NC 4.0) Funding: This research did not receive any financial support Competing Interests: The authors have declared that no competing interests exist Abstract BACKGROUND: Diagnosis of oral ulceration is always challenging and has been the source of difficulty because of the remarkable overlap in their clinical presentations. AIM: The objective of this review article is to provide updated knowledge and systemic approach regarding oral ulcers diagnosis depending upon clinical picture while excluding the other causative causes. METHODS: For this, specialised databases and search engines involving Science Direct, Medline Plus, Scopus, PubMed and authentic textbooks were used to search topics related to the keywords such as oral ulcer, oral infections, vesiculobullous lesion, traumatic ulcer, systematic disease and stomatitis. Associated articles published from 1995 to 2019 in both dental and medical journals including the case reports, case series, original articles and reviews were considered. RESULTS: The compilation of the significant data reveals that ulcers can be classified according to (i) duration of onset, (ii) number of ulcers and (iii) etiological factors. Causation of oral ulcers varies from slight trauma to underlying systemic diseases and malignancies. CONCLUSION: Oral manifestations must be acknowledged for precise diagnosis and appropriate treatment. Introduction The breach describes ulcerations in the epithelium, underlying connective tissue or both [1]. The most frequent oral mucosal lesion that comes across is oral ulceration [2], [3], [4]. Patients having ulceration of oral cavity might report primarily to a dental consultant or a general physician. Ulcerations can be classified based on (i) duration of onset (ii) number of ulcers and (iii) etiological factors; ulcerative lesion lasts for two weeks, is considered as the chronic ulcer. Acute ulcer lasts for no longer than two weeks and is typically painful [1], [5], whereas recurrent ulcers present with a history of comparable episodes with irregular healing and chronic ulcer may last for more than two weeks [6]. The solitary ulcer is the occurrence of a single ulcerative lesion, while the term multiple explains the incidence of numerous ulcerative lesions [6]. Because of the variety of presenting features and causative factors, identification of oral ulcerative lesions may be relatively challenging. Local or systemic factors can be contributing to developing ulcers [1], [6]. Ulcers have different parts: the floor (uncovered ulcer surface), the base (ulcer rest seat), the margin (interface among the wall of ulcer and normal epithelium) and the edge (the part of the