Last reviewed: October 2017
Last updated: November  2017

Summary

Definition

History and exam

Key diagnostic factors

  • presence of risk factors
  • creamy white or yellowish plaques, fairly adherent to oral mucosa
  • cracks, ulcers, or crusted fissures radiating from angles of the mouth

Other diagnostic factors

  • lesions on any part of the oral mucosa
  • atrophic, fiery red, flat lesions on the palate
  • patchy areas of loss of filiform papillae on the dorsum of the tongue
  • spotty red areas on the buccal mucosa
  • lesions confined to the outline of a dental prosthesis
  • burning oral pain
  • dysphagia or odynophagia
  • rhomboid outline on the dorsal aspect of the tongue
  • continuous or patchy band of erythema, involving the free gingival margin

Risk factors

  • hyposalivation/xerostomia
  • age >60 years
  • female sex
  • poor oral hygiene, especially among denture wearers
  • malabsorption and malnutrition
  • advanced malignancy
  • cancer chemotherapy and radiotherapy
  • HIV infection
  • endocrine disturbance (e.g., diabetes mellitus, hypoparathyroidism, pregnancy, hypoadrenalism)
  • immunosuppressive agents (e.g., systemic corticosteroid therapy)
  • inhaled corticosteroids
  • current or recent past use of broad-spectrum or multiple narrow-spectrum antibiotics

Diagnostic investigations

1st investigations to order

  • superficial smear of lesion for microscopy
Full details

Investigations to consider

  • biopsy of lesion
  • culture of mouth rinse sample
  • upper GI endoscopy with or without biopsy of lesions
  • urinalysis, random or fasting blood glucose, or glucose tolerance test to exclude diabetes
  • HIV antibody test
  • sialometry
  • electrolyte panel
Full details

Treatment algorithm

Contributors

Authors VIEW ALL

Fariba S. Younai

Professor of Clinical Dentistry

Oral Medicine and Orofacial Pain

Vice Chair

Division of Oral Biology and Medicine

UCLA School of Dentistry

Los Angeles

CA

Disclosures

FSY has contributed to lectures and other educational events relevant to this topic in the community and in continuing education courses. FSY has also developed educational material on this topic for the American Academy of HIV Medicine, which is used to issue HIV Specialist Certification.

Peer reviewers VIEW ALL

Chair of Department of Oral Pathology

New York University College Of Dentistry

New York

NY

Disclosures

JAP declares that she has no competing interests.

Professor of Oral Medicine

Department of Oral Sciences

University of Palermo

Palermo

Italy

Disclosures

GC declares that she has no competing interests.

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