Orofacial granulomatosis: recognition, management, and referral by dental providers

Orofacial granulomatosis (OFG) is a chronic inflammatory condition manifesting with erythema and granulomatous enlargement of the orofacial soft tissues with predilection for children and young adults. The clinical spectrum and severity are highly variable, ranging from subtle to disfiguring swelling, ulceration, and/or neurological manifestations in the orofacial region. The precise cause of OFG is unclear and its diagnosis is one of exclusion relying on thorough history and physical and clinicopathologic correlation. Management of OFG remains challenging, and may require retreatment for control of recurrences. Orofacial granulomatosis is a rare clinical entity and likely unfamiliar to dental practitioners, but orofacial localization of this disorder may lead patients to consult dental providers. Not only could the clinical presentation of OFG be confused with an infection of dental or periodontal origin but also granulomatous inflammation may arise from a long-standing oral infection. Exclusion of oral infection as a potential etiologic culprit and the ruling out of hypersensitivity to oral hygiene products and dental materials are routine steps in diagnostic workup of cases involving oral cavity and well within the scope of dentistry. Both delayed diagnosis and misdiagnosis of OFG could lead to permanent, unsightly sequelae that are distressing to patients. This article aims to raise awareness of OFG and its diagnostic algorithm in the dental community, facilitate early recognition, and guide appropriate interventions and timely referral which are essential for optimal outcome. Sometimes, this enhanced vigilance could also lead to detection of serious systemic conditions with similar orofacial presentations.