1. common benign oral lesions barry ladizinski darya luchinskaya

2. table of contents

3. aphthous stomatitis: clinical presentation aka canker sores, aphthae up to 60% population most common cause of recurrent oral ulcers a/w trauma, stress, HIV, nutritional deficiencies painful ‘punched-out’ ulcers w/ yellow necrotic surface & peripheral erythema on buccal and labial mucosa

4. aphthous stomatitis: treatment options usually heals spontaneously, but recurrences common topical therapy: amlexanox paste [Aphthasol] chlorhexidine [Peridex] fluocinonide gel [Lidex] systemic therapy: thalidomide colchicine

5. cheilitis: clinical presentation aka chapped lips d/t retinoids [isotretinoin], lithium, isoniazid, dehydration, cold environments, nutritional deficiencies [iron/folate/b12], high dose vitamin A, lip-licking erythematous, edematous, dry, scaly, fissured lips

6. cheilitis: treatment options usually heals spontaneously avoid predisposing factors avoid lip-licking petroleum jelly as needed

7. hairy tongue: clinical presentation aka black hairy tongue, lingua villosa a/w cigarette smoking, ETOH, poor oral hygeine, c. albicans d/t elongation & hypertrophy of filiform papillae

8. hairy tongue: treatment options usually heals spontaneously avoid predisposing factors maintain good oral hygeine tongue brushing or scraping

9. herpes labialis: clinical presentation aka cold sores, fever blisters up to 45% population primary infxn is usually asx, HSV remains latent in trigeminal ganglion, later reactivates reactivation a/w UV light, trauma, menstruation, stress painful clustered vesicles on erythematous base along vermillion border of lip, which rupture, ulcerate & crust

10. herpes labialis: treatment options usually heals spontaneously, but recurrences common topical antivirals: penciclovir cream [Denavir] docosanol [Abreva] systemic antivirals: acyclovir [Zovirax] valacyclovir [Valtrex] famciclovir [Famvir]

11. lichen planus: clinical presentation up to 2% population reticular: asx white, lacy striations [Wickham's striae] or papules on buccal mucosa erosive: painful erythema & ulcers w/ peripheral striae or desquamative gingivitis

12. lichen planus: treatment options no tx required for asx cases avoid exacerbating factors chlorhexidine [Peridex] fluocinonide gel [Lidex]

13. oral candidiasis: clinical presentation normal flora in up to 60% adults, up to 40% newborns overgrowth a/w dentures, steroids, immunodeficiency erythematous [median rhomboid glossitis]: burning midline macules on dorsal tongue perlèche [angular cheilitis]: scaling fissures at mouth corners thrush [pseudomembranous]: white plaques, can be wiped off

14. oral candidiasis: treatment options topical antifungals: nystatin [Mycostatin] fluconazole [Diflucan] clotrimazole [Mycelex] systemic antifungals: Ketoconazole [Nizoral] Itraconazole [Sporanox] fluconazole [Diflucan]

15. references Eisenberg E. Oral lichen planus: a benign lesion. J Oral Maxillofac Surg. Nov 2000;58(11):1278-85. Fatahzadeh M. Human herpes simplex virus infections: epidemiology, pathogenesis, symptomatology, diagnosis, and management. J Am Acad Dermatol. 2007;57(5):737- 763. Gonsalves WC, et al. Common oral lesions: Part I. Superficial mucosal lesions. American Family Physician. 2007;75:501. Rodu B, Mattingly G. Oral mucosal ulcers: diagnosis and management. J Am Dent Assoc. 1992 Oct;123(10):83-86. Rowen JL. Mucocutaneous candidiasis. Semin Perinatol. Oct 2003;27(5):406-13. Schneider LC, Schneider AE. Diagnosis of oral ulcers. Mt Sinai J Med. 1998 Oct- Nov;65(5-6):383-387. Silverman S Jr, Bahl S. Oral lichen planus update: clinical characteristics, treatment responses, and malignant transformation. Am J Dent 1997;10:259–63 Vañó-Galván S, Jaén P. Black hairy tongue. Cleve Clin J Med. Dec 2008;75(12):847-8.