Table 1 Clinical, imaging and laboratory investigations to uncover existing systemic condition causing oral dysesthesia
Differential diagnoses to be ruled out | Examples | Diagnostic modality | |
|---|---|---|---|
BMS | Hyposalivation | Drug-induced hyposalivation Sjögren's syndrome | Stimulated and unstimulated sialometry Sjogren's syndrome ACR-EULAR diagnostic criteria42 American College of Rheumatology (ACR) and the European League Against Rheumatism (EULAR) |
Oral fungal infection | Oral candidiasis | Cytology smear or biopsy | |
Oral viral infections | Primary and recurrent herpes simplex or varicella zoster infections | Clinical presentation, culture and sensitivity | |
Autoimmune or immune derived oral mucosal lesions | Aphthous ulcers and oral lichen planus Mucous membrane pemphigoid and pemphigus vulgaris Lupus erythematosus | Empiric therapy Biopsy with immunohistochemistry Antinuclear antibody, anti-double-stranded DNA, anti-Smith antibody | |
Anemias | Iron, vitamin B12 and folic acid deficiencies | Complete full blood count (FBC) with haematinics (iron, ferritin, vitamin B12 and folic acid levels) | |
Metabolic disorders | Diabetes mellitus | HbA1c | |
Nutritional deficiency | Zinc deficiency | Serum zinc level | |
Endocrine disorders | Hypothyroidism Cortisol imbalance Oestrogen imbalance | Serum thyroid-stimulating hormone, triiodothyronine, thyroxine Serum cortisol Serum 17-beta oestradiol levels | |
Gastrointestinal disorders | Crohn's and ulcerative colitis | Endoscopy/colonoscopy Routine blood tests (FBC, haematinic) Inflammatory markers (erythrocyte sedimentation rate, C-reactive protein) Serum anti-neutrophil cytoplasmic antibodies and anti-saccharomyces cerevisiae antibodies | |
Gastro-esophageal reflux | Empiric therapy or endoscopy | ||
Allergies and hypersensitivity reaction | Oral contact allergic stomatitis/lichenoid reaction | Elimination of the suspicious agent and/or patch test | |
Drug-induce lichenoid reactions | Cessation of the offending medication and/or biopsy |
