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

Table 3 Systemic and adjunctive oral conditions: Diagnostic pathways and medical management

Condition	Diagnostic approach	First-line treatment	Dosage and frequency	Follow-up plan	Ref.	Evidence level (GRADE)
Oral candidiasis, including angular cheilitis	Oral swab for culture, assess risk factors (e.g., dentures, diabetes)	Nystatin oral suspension 100000 units/mL (Nystan®) or miconazole 2% oral gel (Daktarin®)	1 mL QID (hold in mouth then swallow)	Continue 48 h after resolution; reassess if unresponsive	[12-15]	A
Burning mouth syndrome (stage 1)	Swab to rule out Candida; blood test for vitamin B12, ferritin, folic acid	Correct underlying deficiency: Ferrous fumarate 200 mg (Fersaday®), Cyanocobalamin 1 mg (Cytacon®), folic acid 5 mg	Iron TID; vitamin B12 daily; folic acid daily	Repeat blood work in 3-4 weeks; escalate to stage 2 if unresolved	[12-15]	A
Burning mouth syndrome (stage 2)	Diagnosis of exclusion	Amitriptyline hydrochloride (generic)1; titrate cautiously	10-25 mg nocte; titrate slowly over 2-4 weeks	Review every 2-4 weeks; refer if no response by 8 weeks	[12-15]	A
Geographic tongue (migrating glossitis)	Clinical diagnosis: Assess for fungal co-infection	Miconazole 2% + hydrocortisone 1% cream (Daktacort®)	Apply BID for up to 7 days	Stop after 7 days or symptom relief; review at 2 weeks	[12-15]	A
Xerostomia	Medication history, salivary flow rate	Artificial saliva (Glandosane®) or Pilocarpine hydrochloride	Pilocarpine 5 mg TID (specialist only)	Manage oral hygiene, identify the underlying cause. Review salivary flow at 4 weeks; discontinue if no benefit	[12-15]	A

¹Off-label for neuropathic oral pain. Evidence level (GRADE): A: High; B: Moderate; C: Low. BID: Twice a day; TID: Three times a day; QID: Four times a day; Nocte: At night.