Oral Lesions You Can’t Afford to Miss

Rheumatologic conditions. Systemic or discoid lupus erythematosus may present with oral findings that largely resemble those of oral lichen planus (see Figure 16).¹⁵ Sjögren’s syndrome is an autoimmune disease with characteristic xerostomia, which can lead to oral discomfort, dysphagia, recurrent candidiasis, and rampant dental caries.

Other conditions to watch for. Erosion of the enamel on the lingual surface of the teeth may be a sign of gastroesophageal reflux disease or bulimia (see Figure 17). Examination of the oral mucosa can reveal typical white plaques of oral candidiasis (see Figure 18), which may be associated with systemic immune suppression as well as salivary gland dysfunction.

SIGNS OF SYSTEMIC DISEASE (cont'd)

Oral conditions that have been associated with HIV infection include ANUG/ANUP, recurrent candidiasis, and oral hairy leukoplakia (see Figure 19). In the absence of known HIV infection, patients who present with any of these oral conditions should be evaluated for HIV infection.¹³

Atrophic glossitis may indicate a vitamin B deficiency. Thrombocytopenia and leukemia may pre­sent with oral petechiae, purpura, oral hematomas, or hemorrhagic bullae (see Figure 20).¹³ Painless pseudomembranous mucosal erosions may be a presentation for secondary syphilis.¹⁶

SIGNS OF SYSTEMIC DISEASE (cont'd)

Continue for signs that suggest malignancy >>