| Candidiasis4–9 | Pseudomembranous: adherent white plaques that may be wiped off | Topical antifungals (e.g., nystatin [Mycostatin] suspension or troches, clotrimazole [Mycelex] troches, fluconazole [Diflucan] suspension, or systemic antifungals (e.g., fluconazole, ketoconazole [Nizoral], itraconazole [Sporanox]) | Can confirm diagnosis with oral exfoliative cytology (stained with periodic acid-Schiff or potassium hydroxide), biopsy, or culture |
| Erythematous: red macular lesions, often with a burning sensation |
| Perlèche (angular cheilitis): erythematous, scaling fissures at the corners of the mouth |
| Recurrent herpes labialis10–14 | Prodrome (itching, burning, tingling) lasts approximately 12 to 36 hours, followed by eruption of clustered vesicles along the vermilion border that subsequently rupture, ulcerate, and crust | Immunocompetent patients usually do not require treatment | Reactivation triggers: ultraviolet light, trauma, fatigue, stress, menstruation |
| Topical agents include 1% penciclovir cream (Denavir) |
| Systemic agents (e.g., acyclovir [Zovirax], valacyclovir [Valtrex], famciclovir [Famvir]) are most effective if initiated during prodrome or as prophylaxis |
| Recurrent aphthous stomatitis15–17 | Ulcers surfaced by a yellowish-white pseudomembrane surrounded by erythematous halo | Mild cases do not require treatment | — |
| Fluocinonide gel (Lidex) or triamcinolone acetonide (Kenalog in Orabase), amlexanox paste (Aphthasol), chlorhexidine gluconate (Peridex) mouthwash |
| Erythema migrans18 | Migrating lesions with central erythema surrounded by white-to-yellow elevated borders; typically on tongue | Asymptomatic cases do not require treatment | — |
| Symptomatic cases may be treated with topical corticosteroids, zinc supplements, or topical anesthetic rinses |
| Hairy tongue19–21 | Elongated filiform papillae | Regular tongue brushing or scraping; avoidance of predisposing factors | Predisposing factors include smoking and poor oral hygiene as well as antibiotics and psychotropics |
| Lichen planus22 | Reticular: white, lacy striae | Asymptomatic cases do not require treatment | Buccal lesions typical in reticular form; other sites (e.g., tongue, gingiva) may be involved |
| Erosive: erythema and ulcers with peripheral radiating striae, erythematous and ulcerated gingiva | Symptomatic cases may be treated with a topical corticosteroid gel or mouth rinse |