Management protocols for patients with oral diseases treated in primary care settings
This chapter tabulates the typical management in primary dental care of patients with the more common complaints.
| Condition | Typical main clinical features | Investigations that may be indicated for diagnosis in addition to history and examination | Therapeutic protocols | High levels of available evidence for treatment* |
| Aphthous stomatitis | Recurrent oral ulcers only | Full blood picture. Exclude underlying systemic disease (e.g. ESR for autoinflammatory disease; transglutaminase for coeliac disease; haematinic assays for deficiencies) | Vitamin B12, aqueous chlorhexidine, corticosteroids topically (e.g. hydrocortisone, betamethasone), amlexanox or, only in adults, topical tetracycline (doxycycline) | Yes (for all) |
| Allergic reactions | Swelling, erythema or erosions | Allergy testing | Avoid precipitant. Consider antihistamines (e.g. loratidine) | Yes |
| Burning mouth syndrome | Glossodynia | Full blood picture, haematirics, glucose, thyroid function, electrolytes | Reassurance, CBT. GMPs or specialists may use tricyclic antidepressants or SSRIs | Yes |
| Candidosis (including angular stomatitis and denture-related stomatitis) | White or red persistent lesions | Consider smear, or biopsy. Consider immune defect | Antifungals, leave out dental appliances, allowing the mouth to heal. Disinfect the appliance (as per additional instructions). Use antifungal creams or gels (e.g. miconazole) or tablets (e.g. nystatin or fluconazole), regularly for up to 4 weeks | Yes |
| Chapped lips | Dry, flaking lips | May be dry mouth | Topical petrolatum gel or bland creams | No |
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