Ulcerative Diseases
Oral Tuberculosis
aka Tuberculous Ulcer · TB Ulcer
Rare oral manifestation of TB, typically presenting as a chronic, painful, non-healing ulcer.
§ figuresFigures (2)
Fig. 1Mycobacterium tuberculosis in Ziehl-Neelsen stained smear of sputum
“Mycobacterium tuberculosis in Ziehl-Neelsen stained smear of sputum” · Ajay Kumar Chaurasiya · CC BY-SA 4.0 · Wikimedia Commons
Verified open-access images only, reproduced for education under their stated licences · no AI-generated or illustrative artwork · Oral Tuberculosis figures pending faculty review.
§ overviewOverview
Oral lesion caused by Mycobacterium tuberculosis, usually secondary to pulmonary TB.
§ icdICD Classification
A18.8
§ etiologyEtiology
- 01Mycobacterium tuberculosis
- 02Secondary (sputum inoculation) > primary
§ epidemiologyEpidemiology
Rare; more common in immunocompromised and TB-endemic regions. Tongue most common site.
§ pathogenesisPathogenesis
Bacilli from sputum implant in minor mucosal trauma → granulomatous inflammation → ulceration.
§ clinicalClinical Features
- 01Chronic, painful, irregular ulcer
- 02Undermined edges
- 03Granular floor
- 04Tongue > palate > gingiva
- 05Regional lymphadenopathy
§ differentialDifferential Diagnosis
- 01SCC
- 02Traumatic ulcer
- 03Syphilitic ulcer
- 04Actinomycosis
- 05Deep fungal infection
§ histopathHistopathology
- 01Caseating granulomas
- 02Langhans giant cells
- 03AFB on ZN stain
§ investigationsInvestigations
- 01Chest X-ray
- 02Sputum AFB/culture
- 03Biopsy with ZN stain / TB PCR
- 04Mantoux test / IGRA
§ treatmentTreatment
- 01Standard ATT (RIPE regimen): Rifampicin, Isoniazid, Pyrazinamide, Ethambutol × 2 months, then RI × 4 months
§ complicationsComplications
- 01Spread to other sites
- 02Destruction of local tissue
§ prognosisPrognosis
Good with ATT.
§ examKey Examination Points
- 01Chronic painful ulcer with undermined edges
- 02Tongue most common
- 03Always screen for pulmonary TB
§ revisionQuick Revision Summary
- 01Secondary TB > primary
- 02Caseating granulomas + AFB
- 03RIPE regimen
§ vivaBDS Viva Questions
- 01How do you differentiate TB ulcer from SCC?
- 02Describe the histology.
- 03What is the ATT regimen?
§ mcqsMCQs — Assessment (3)
Question 1
Most common site for oral TB:
Question 2
Characteristic histology of TB:
Question 3
Oral TB is usually:
§ evidenceReferences & Evidence
Current Classification
WHO Classification of Tumours Online — Head and Neck
IARC / WHO · 2022
Continuously updated online edition of the WHO head and neck tumour classification.
Evidence summary
Highest level of evidence linked to this page: WHO / Official Classification.
- L1 · Classification — 1
- L6 · Textbook — 3
1 linked source was published from 2024 onwards. Where guidance is limited or contested, rely on the higher-level sources above rather than this summary. Educational use only — not a substitute for clinical judgement.
Content last reviewed
September 2026
Evidence last reviewed
September 2026
Next scheduled review
September 2027
Review status
EVIDENCE REVIEWED
Search latest PubMed evidence
Last literature search: 7 September 2026
Current Classification
IARC / WHO. IARC · 2022
Continuously updated online edition of the WHO head and neck tumour classification.
Histopathology References
Barnes L. CRC Press · 2008
Detailed histopathological reference for head and neck diagnostic criteria.
Textbook References
Neville BW, Damm DD, Allen CM et al.. Elsevier · 2024
Standard reference textbook of oral and maxillofacial pathology used throughout this atlas.
Rajendran R, Sivapathasundharam B. Elsevier · 2020
Undergraduate and postgraduate oral pathology textbook widely used in BDS and FCPS curricula.
Additional sources cited on this page
- Neville BW. Oral & Maxillofacial Pathology, 4e
- Kakisi OK. Int J Oral Maxillofac Surg 2010
Draft — pending faculty review. Educational use only; verify against current guidelines and primary sources before clinical application.