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This paper discusses the range of recurrent oral ulceration which affects the oral mucosa. Types of ulceration covered in this paper include traumatic, infective, aphthous, ulceration related to the oral dermatoses, drug-induced, ulceration as a manifestation of systemic disease and ulceration indicating malignancy. Aspects of the aetiology, diagnosis and management of common oral recurrent ulcerative conditions are reviewed from a clinical perspective as an aid to practising dentists.

Hyperparathyroidism-jaw tumor syndrome (HPT-JT) is an important diagnosis because of the possible involvement of other family members and risk of malignant disease. We report clinical and genetic studies in a previously undocumented Australian family with HPT-JT. The proband and his sister presented with bilateral or recurrent mandibular radiolucencies diagnosed histopathologically as cemento-ossifying fibromas. Mutation screening of the recently identified disease gene HRPT2 was performed by direct sequencing in 3 affected members. This revealed a novel mutation in exon 1 of HRPT2 (nt 20AGGACG --> GGGAG), which is predicted to inactivate the parafibromin protein through protein truncation and premature termination of translation. The terminology used for the jaw lesions in this syndrome warrants review to become more consistent. Cemento-ossifying fibroma is the preferred term to better reflect the pathologies found in most individuals and families,and to emphasize the significance of the jaw lesions in the diagnosis of the syndrome.

A 34-year-old female presented with ‘a most bizarre presenting problem’. The patient had a history of polycystic ovary syndrome, epilepsy as a child and occasional asthma. She had allergies to sulphur and was lactose intolerant. In March 2008 she had a tooth extraction. Several weeks later she became aware of particles of material emerging from the gingivae when she brushed her teeth. Initially this began in the extraction quadrant but subsequently affected all quadrants. The material was not produced every time she brushed her teeth; a course of antibiotics resolved the problem for about a week. The material produced appeared as glassy, elongated particles of varying size ‘like clear plastic, but brittle’ and larger ones could be Y-shaped. Clinical examination showed no obvious abnormalities to explain her story. Laboratory analysis established that the crystals were most likely to be magnesium carbonate, presumably precipitated out from toothpaste. The speed at which these crystals formed appeared to be quite remarkable.