Chronic multifocal oral ulceration in a middle-aged man: Diagnostic work-up and debridement-based supportive care

Chronic oral ulceration often signals a wide spectrum of disorders, so management must begin with a structured differential diagnosis after malignant and infectious causes have been excluded. A 50-year-old man presented with six months of painful multifocal ulcers involving the left lateral tongue, labial mucosa and bilateral buccal mucosa, accompanied by a 5 kg weight loss. Brush cytology showed chronic suppurative inflammation without dysplasia, complete blood count revealed mild normocytic anaemia, and dual syphilis serology (VDRL + TPHA) was non-reactive. Management comprised weekly debridement using 1 hydrogen-peroxide swabs followed by saline irrigation, twice-daily 0.2 chlorhexidine mouthrinse, and dietary counselling. Supra- and sub-gingival scaling was done once pain allowed. All lesions resolved by week 7; pain improved from 8/10 to 0. This case illustrates that after reasonable exclusion of malignancy and key infections, regular debridement combined with chlorhexidine and plaque control can accelerate healing of chronic multifocal ulcers. The protocol described may be readily applied in general dental practice, including settings with limited resources. © 2025 New Zealand Dental Association. All rights reserved.