Oral sarcoidosis: A systematic review of dental implications

Sarcoidosis is a multisystem granulomatous disease of unknown etiology. While pulmonary and dermatological manifestations are well documented, oral involvement is rare and presents significant diagnostic challenges for dental practitioners. This systematic review synthesizes current literature on oral sarcoidosis, focusing on clinical presentations, diagnostic pathways, treatment outcomes, and dental implications.

A comprehensive literature search was conducted in PubMed, Scopus, and Web of Science (January 2021 - January 2026) using terms related to sarcoidosis and oral manifestations. English-language case reports, case series, and observational studies reporting oral or maxillofacial involvement were included. A narrative synthesis was performed, and study quality was assessed using a modified JBI checklist for case reports and case series. Study selection and data extraction were performed by a single reviewer; a second independent reviewer was not available (acknowledged as a limitation).

From 243 initially identified records, 13 studies met the inclusion criteria, comprising 13 patients with oral sarcoidosis (primary analysis). A previously published systematic review (Jaber et al., 2025) reported pooled data from 77 patients, which we discuss for context but not as a primary data source. Two distinct clinical entities emerged: soft-tissue lesions (submucosal nodules, gingival swelling, salivary gland enlargement) often presenting as early signs of systemic disease, and bony involvement (jaw lesions with tooth mobility and bone loss) indicative of later, more destructive stages. Gingiva and salivary glands were the most frequently involved sites. Diagnosis relied on histopathological confirmation of non-caseating granulomas and exclusion of other granulomatous diseases. Corticosteroids (topical or systemic) were the mainstay of treatment, with methotrexate and hydroxychloroquine used as steroid-sparing agents. Outcomes were generally favorable with early diagnosis.

Oral sarcoidosis, though rare, can be the first manifestation of systemic disease. Dental professionals should maintain a high index of suspicion for persistent oral swellings or unexplained granulomatous lesions. Biopsy with histopathological examination is essential. Multidisciplinary management and long-term follow-up are recommended.