Clinical Overview of Common Oral Disorders

Inflammatory and Autoimmune Conditions

Oral Lichen Planus

Oral lichen planus is a chronic autoimmune condition characterized by "lacy" white patches on the oral mucosa, known as Wickham striae. It may also be associated with Hepatitis C. While the rate of progression to SCC is low (approximately 1%), diagnosis is typically confirmed via biopsy or exfoliative cytology. The primary goal of treatment is managing pain and discomfort, often using topical steroids such as Clobetasol.

Aphthous Ulcers (Canker Sores)

Aphthous ulcers are very common, painful, and recurrent round ulcers featuring a grey, yellow, or white center surrounded by a red halo. While the exact cause is uncertain, associations exist with HHV-6, Crohn’s disease, and celiac disease. Most ulcers heal within 14 days; if they persist beyond this window, a biopsy is required to rule out malignancy. Treatment includes avoiding irritants and using topical steroids (e.g., triamcinolone in an Orabase) for symptomatic relief.

Infectious Disorders

Herpes Simplex / Herpes Stomatitis

Over 85% of adults carry Herpes Simplex Type 1 (HSV-1). Primary infections can manifest as gingivostomatitis, while recurrent outbreaks may be triggered by sun exposure, fever, or immunosuppression. Clinically, these present as small, grouped vesicles on an erythematous base, most commonly on the vermilion border of the lips.

Antiviral therapy (such as Acyclovir or Valacyclovir) is most effective when initiated within 24–48 hours of the onset of symptoms. For patients with frequent or severe recurrences, suppressive therapy can reduce outbreaks by 85%.

Oral Candidiasis (Thrush)

Oral candidiasis, or thrush, is caused by Candida albicans and presents as creamy-white, curd-like plaques that can be easily scraped off, often leaving an erythematous mucosa underneath. It is most common in immunosuppressed individuals, those with diabetes, or those using long-term steroids or antibiotics. Diagnosis is clinical or confirmed via a KOH wet prep showing budding yeast and pseudohyphae. Treatment involves azole antifungals (e.g., Fluconazole or Nystatin) for 7–14 days.

Summary Table of Common Oral Lesions

Exam Tip: If a question describes a white patch that cannot be scraped off, think Leukoplakia or SCC. If it can be scraped off, think Oral Candidiasis.