Traumatic Ulcer — ORE Part 1 MCQ

Correct answer: C — Traumatic ulcer (thermal burn)

Explanation lettering: C = shown as A · D = shown as B · A = shown as C · B = shown as D

The diagnosis is thermal burn (option A). The key discriminators are the clear temporal and mechanical history (hot pizza ingestion 3 days ago), the classic site (hard palate), and the smooth surface consistent with early-stage thermal injury with slough formation. Most oral thermal burns arise from ingestion of hot foods and typically affect the hard palate. Although the ulcer is described as painless—atypical for acute thermal injury—this may reflect keratinized palatal mucosa response, underlying neuropathy, or normal healing progression at day 3. The 3-day timeline and explicit trauma mechanism decisively exclude squamous cell carcinoma (B: malignancy typically presents without clear acute trauma and requires unexplained ulceration >3 weeks for urgent investigation). Necrotising sialometaplasia (C) is a rare salivary gland infarction unrelated to thermal injury. Minor aphthous ulcers (D) are recurrent immune-mediated lesions without mechanical causation. Traumatic ulcerative granuloma with stromal eosinophilia (E) is exceedingly rare on the palate and requires histology; it is not a first-line diagnosis for acute post-traumatic ulceration.

Reference: PubMed 24797620 (Thermal burn of palate in an elderly diabetic patient) and PubMed 33747516 (Successful GaAlAs laser therapy of thermal burns of palate); SDCEP Management of Acute Dental Problems (www.acutedentalproblems.sdcep.org.uk); Neville BW et al., Oral and Maxillofacial Pathology (standard UK dental school curriculum text on oral pathology), https://pubmed.ncbi.nlm.nih.gov/33747516/