Last reviewed: 25 Sep 2021
Last updated: 18 Oct 2019



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

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

Treatment algorithm



Fariba S. Younai, DDS
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



FSY declares that she has no competing interests.

Peer reviewers

Joan A. Phelan, DDS

Chair of Department of Oral Pathology

New York University College Of Dentistry

New York



JAP declares that she has no competing interests.

Giuseppina Campisi, DDS, PhD

Professor of Oral Medicine

Department of Oral Sciences

University of Palermo




GC declares that she has no competing interests.

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