Last reviewed: 25 Apr 2022
Last updated: 18 Oct 2019
Summary
Definition
History and exam
Key diagnostic factors
- creamy white or yellowish plaques, fairly adherent to oral mucosa
- cracks, ulcers, or crusted fissures radiating from angles of the mouth
More key diagnostic factors
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
Other diagnostic factors
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
More risk factors
Diagnostic investigations
1st investigations to order
- superficial smear of lesion for microscopy
More 1st investigations to order
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
More investigations to consider
Treatment algorithm
ACUTE
oral candidiasis
angular cheilitis
ONGOING
severely immunocompromised: prophylactic-therapy
Contributors
Authors
Fariba S. Younai, DDS

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 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
NY
Disclosures
JAP declares that she has no competing interests.
Giuseppina Campisi, DDS, PhD
Professor of Oral Medicine
Department of Oral Sciences
University of Palermo
Palermo
Italy
Disclosures
GC declares that she has no competing interests.
Differentials
- Chemical burns
- Reactive keratosis
- Hairy leukoplakia
More DifferentialsGuidelines
- Prevention and treatment of opportunistic infections in HIV-infected adults and adolescents
- Clinical practice guideline for the management of candidiasis
More GuidelinesPatient leaflets
Oral thrush: what is it?
Oral thrush: what treatments work?
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