Evidence-based review and clinical practice recommendations for the diagnosis and management of common oral mucosal lesions

Table 2 Evidence-based first-line treatments and adjunct therapies for common oral mucosal conditions

Condition	First-line treatment	Dosage and frequency	Treatment duration	Adjunct therapy	Ref.	Evidence level (GRADE)
Aphthous ulcers	Betamethasone sodium phosphate 0.5 mg tablets dissolved in water (Betnesol® mouthwash)	Rinse 4 times/day QID	7-10 days or until complete symptom resolution; reassess at 10 days if persistent	Chlorhexidine gluconate 0.2% (Corsodyl®), Benzydamine hydrochloride 0.15% (Difflam®), topical lidocaine (Acuvisc®)	[1,12-15]	A
Oral lichen planus	Clobetasol propionate 0.05% ointment (Dermovate®). If not working: Tacrolimus 0.03% ointment (Protopic®)1	Apply a thin layer BID after meals. Apply 4 times daily	2-4 weeks, then mandatory reassessment; discontinue if no improvement after 4 weeks	Benzydamine hydrochloride 0.15% (Difflam®), nystatin suspension if fungal co-infection	[1,12-15]	A
Oral candidiasis including (angular cheilitis)	Nystatin oral suspension 100000 units/mL (Nystan®) or miconazole 2% oral gel (Daktarin®)	1 mL QID (hold in mouth, then swallow; dietary support)	7-14 days; continue 48 hours after clinical resolution; reassess at day 16 if ongoing	Vitamin B12 or iron supplementation; because nutritional deficiencies (iron, vitamin B12) provoke Candida albicans infection	[1,12-15]	A
Traumatic ulcers	Remove traumatic source (e.g., denture adjustment)	NA	Reassess at 10-14 days; biopsy if not fully healed by day 14	Lidocaine 2% gel (Acuvisc®), Chlorhexidine gluconate (Corsodyl®), Benzydamine hydrochloride (Difflam®)	[1,12-15]	A
Herpetic stomatitis	Aciclovir 200 mg tablets	Five times daily for 5 days	Complete 5-day course; review at day 7 if lesions persist	Benzydamine hydrochloride rinse (Difflam®), hydration, analgesics	[1,12-15]	A

¹Off-label use on oral mucosa; specialist initiation recommended. Evidence level (GRADE): A: High; B: Moderate; C: Low. BID: Twice a day; QID: Four times a day; NA: Not available.