The diagnosis and management of chronic nonspecific mucosal lesions

Chronic lichenoid or leukoplakic oral mucosal lesions are a common cause of morbidity and concern. Many of these are reactive or inflammatory lesions; but they can also represent other disorders, including dysplasia. These lesions are caused by a variety of irritants and allergens such as systemic drugs, dental restorations and prostheses, oral health care products, foods, habits, and candida. Indiscriminate use of steroids to treat these lesions empirically is contraindicated; management should be aimed at discovery and removal of the cause. The proposed sequence of investigation is intended initially to eliminate any obvious etiology and, if that is unsuccessful, to rule out candida or determine a histologically diagnosable disease. If a biopsy shows nonspecific or lichenoid mucositis and the lesions are symptomatic, the investigation is directed to the more obscure and speculative causes that require expensive and time-consuming trial-and-error elimination of various agents.