Common Oral Lesions: Part I. Superficial Mucosal Lesions
WANDA C. GONSALVES, M.D., ANGELA C. CHI, D.M.D., and BRAD W. NEVILLE, D.D.S. Medical University of South Carolina, Charleston, South Carolina
Common superficial oral lesions include candidiasis, recurrent herpes labialis, recurrent aphthous stomatitis, erythema migrans, hairy tongue, and lichen planus. Recognition and diagnosis requiretaking a thorough history and performing a complete oral examination. Knowledge of clinical characteristics such as size, location, surface morphology, color, pain, and duration is helpful in establishing a diagnosis. Oral candidiasis may present as pseudomembranous candidiasis, glossitis, or perlèche (angular cheilitis). Oral candidiasis is common in infants, but in adults it may signify immunedeficiency or other illness. Herpes labialis typically is a mild, self-limited condition. Recurrent aphthous stomatitis most often is a mild condition; however, severe cases may be caused by nutritional deficiencies, autoimmune disorders, or human immunodeficiency virus infection. Erythema migrans is a waxing and waning disorder of unknown etiology. Hairy tongue represents elongation andhypertrophy of the filiform papillae and most often occurs in persons who smoke heavily. Oral lichen planus is a chronic inflammatory condition that may be reticular or erosive. Certain risk factors have been associated with each of these lesions, such as poor oral hygiene, age, tobacco use, and alcohol consumption, and some systemic conditions may have oral manifestations. Many recommended therapies fororal lesions are unsupported by randomized controlled trials. (Am Fam Physician 2007;75:501-7. Copyright © 2007 American Academy of Family Physicians.)
This is part I of a two-part article on oral lesions. Part II, “Masses and Neoplasia,” appears in this issue of AFP on page 509. Patient information: A patient education handout on canker sores is available at http://familydoctor.org/613.xml. Seerelated editorial on page 475.
he Surgeon General’s report on oral health highlights the relationship between oral and overall health, emphasizing that oral health involves more than dentition.1 Physicians regularly encounter oral health issues in practice. For recognition and diagnosis of common oral lesions, a thorough history and a complete oral examination are required; knowledge of clinicalcharacteristics such as size, location, surface morphology, color, pain, and duration also is helpful. Large-scale, population-based screening studies have identified the most common oral lesions as candidiasis, recurrent herpes labialis, recurrent aphthous stomatitis, mucocele, fibroma, mandibular and palatal tori, pyogenic granuloma, erythema migrans, hairy tongue, lichen planus, andleukoplakia.2,3 This article, part I of a two-part series, reviews superficial mucosal lesions: candidiasis, herpes labialis, aphthous stomatitis, erythema migrans, hairy tongue, and lichen
planus (Table 1).4-22 Part II covers masses and neoplasia.23 Oral Candidiasis As many as 60 percent of healthy adults carry Candida species as a component of their normal oral flora. However, certain local andsystemic factors may favor overgrowth. These include use of dentures, use of a steroid inhaler, xerostomia, endocrine disorders, human immunodeficiency virus (HIV) infection, leukemia, malnutrition, reduced immunity based on age, radiation therapy, systemic chemotherapy, and use of broad-spectrum antibiotics or corticosteroids.4-6,24,25 Oral candidiasis typically is a localized infection; however,rarely it may progress to or occur in patients with systemic candidiasis. Clinical patterns of oral candidiasis are variable and include pseudomembranous candidiasis, or thrush (Figure 1); median rhomboid glossitis and other forms of erythematous candidiasis (Figure 2); and
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