34 Oral Pain The symptom of oral pain, although nonspecific, can be an indicator of localized or systemic dysfunction. Oral pain can be associated with a myriad of disorders and diseases. Thorough history taking and evaluation of the oral cavity during the otolaryngological examination can often aid the clinician in establishing a definitive diagnosis. Many times, however, laboratory testing is required to confirm the clinical suspicion. In evaluating the etiologies of oral pain, it is convenient to consider the various conditions by the areas or systems affected, which is the approach taken in this chapter. Oral pain can be a result of diseases affecting the tongue (glossitis), lips (cheilitis), or any other region of oral mucosa (stomatitis). Dental disorders can be an alternative source of oral pain. Similarly, it may be secondary to a salivary gland, pharyngeal, neurological, or psychological disorder. Individual descriptions of the disorders are beyond the scope of this text. The differential diagnosis of etiologies affecting the lips, tongue, or oral cavity mucosa causing pain is vast. Certain infectious causes of oral pain may result in fever or leukocytosis. Systemic diseases with oral manifestations will often have symptoms and signs of disease outside the oral cavity that can be elicited with a thorough history, physical examination, and laboratory testing. Although many of the conditions following here are benign, the cause of oral pain secondary to precancerous or malignant lesions must always be considered. Suspicious lesions should always be considered neoplastic until otherwise determined. Biopsy with histopathological analysis is often necessary. Most infectious lesions listed here will have other findings, such as ulceration, blistering, or mucosal change, which are covered in detail in Chapter 36.
Infectious Disease
Viral
Herpetic gingivostomatitis
Varicella
Herpangina (Coxsackie A or B)
Hand, foot, and mouth disease (Coxsackie A)
Human papilloma virus
Human immunodeficiency virus (HIV)
Bacterial
Staphylococcus/Streptococcus
Tuberculosis
Diphtheria
Gonorrhea
Rhinoscleroma
Leprosy
Fungal
Candidiasis
Actinomycosis
Blastomycosis
Histoplasmosis
Sporotrichiosis
Inflammatory Disease
Aphthous ulcers
Lichen planus: Lichen planus (LP) is a cell-mediated immune response that causes pruritic, papular eruptions. Lesions are most commonly found on the tongue and the buccal mucosa; they are characterized by white or gray streaks forming a linear or reticular pattern on a violaceous background.
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