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Necrotising sialometaplasia at multiple sites: a therapeutic challenge to oral physicians. Necrotising sialometaplasia is a rare, benign and self-limiting inflammatory lesion that commonly involves minor salivary glands. Its clinical appearance, signs and symptoms very often mimic a carcinomatous lesion, thus creating a diagnostic dilemma for the clinician. Necrotising sialometaplasia being an important differential for an apparent carcinoma should be excluded histologically prior to radical therapy. It commonly occurs on the palatal mucosa following a palatal infiltration anaesthesia. The patient reports to the dentist with a sudden onset of painful ulcerations that rapidly increase in size. This case report describes the occurrence of necrotising sialometaplasia in a 46-year-old man with an unusual clinical presentation at multiple sites in the oral cavity. The importance of history taking, thorough clinical examination and careful histopathological examination in diagnosing necrotising sialometaplasia is highlighted in this paper.