DIAGNOSIS CHECKLIST
for Oral pain

Why: to determine if acute or chronic.

Why: e.g. lips, tongue, mucosa (lining of the oral cavity), tooth, gums, jaw.

Why: when last saw a dentist?, dental care routine? Known dental caries? - Poor oral hygiene may be associated with gingivitis, periodontitis, Vincent's infection, oral cancer and oral Candida infection.

Why: Poorly fitting dentures may cause oral ulcers.

Why: e.g. cigarette smoking, poor dental hygiene, spirits, recurrent mouth infections or syphilis.

Why: e.g. May be associated with poor oral hygiene, alcoholism, AIDS, leukemia, lymphoma, diabetes mellitus, iron deficiency, steroids, tumor chemotherapy or broad spectrum antibiotics.

Why: e.g. recurrent mouth ulcers may occur in people with leukemia, immunocompromise, malnutrition and diabetes mellitus; aphthous mouth ulcers may be associated with Behcet's disease, Crohn's disease, celiac disease, HIV disease; angular cheilitis may occur due to Candida infection in people with HIV disease, general debilitation or diabetes mellitus; Chronic mucocutaneous candidiasis is a distinct syndrome that may be associated with diseases such as hypoparathyroidism, hypothyroidism and Addison's disease.

Why: some medications may cause aphthous ulceration such as gold and steroids; some medications increase the risk of oral Candida infection including steroids, broad spectrum antibiotics and tumor chemotherapy; some medications are associated with erythema multiforme including barbiturates, penicillin, sulphonamides, phenothiazines and phenytoin.

Why: malnutrition can increase the risk of Acute ulcerative gingivitis (Vincent's infection); may indicate the risk of dietary deficiencies (such as Vitamin B6, B12, folate and iron) that may cause angular stomatitis or glossitis; recent ingestion of fish such as tuna, mackerel and skipjack, especially if fish is allowed to spoil may cause a poisoning with symptoms including burning mouth.

Why: increases risk of gingivitis, lip and oral cavity cancers.

Why: may indicate the risk of HIV which may be associated with angular cheilitis due to Candida infection or aphthous mouth ulceration.

Why: e.g. scrombotoxic fish poisoning which can cause burning of the mouth.

Why: may suggest malignancy such as leukemia which may also be associated with swollen and bleeding gums and also recurrent mouth infections.

Why: may suggest acute ulcerative gingivitis (Vincent's disease).

Why: may be due to diabetes, certain drugs , Sjogren's syndrome, dehydration, anemia, HIV infection or irradiation - can increase the risk of dental caries and thus gingivitis.

Why: would suggest herpes simplex labialis, syphilis and carcinoma.

Why: may suggest tooth socket (alveolar) abscess.

Why: e.g. tender, red, swollen and bleeding gums - Gingivitis is an inflammatory process caused by failure to remove bacteria in the form of plaque from the tooth-gum junction.

Why: e.g. creamy white curd-like patches in the mouth which are removed only with difficulty and leave a bleeding surface. If the infection spreads to the esophagus it may cause pain with swallowing.

Why: e.g. smooth appearance of the tongue, tongue may be red. In later stages there may be shallow ulceration. May be due to nutritional deficiency in iron, folate or Vitamin B12.

Why: e.g. lesions occurring on the inside of the lips or mouth which begin as a small painful vesicle which later breaks down to form the painful shallow ulcer. The ulcers heal without scarring. Cause is unknown, but may occur in Crohn's disease, Celiac disease or AIDS.

Why: e.g. tender, red, swollen, bleeding and ulcerated gums - occurs in the malnourished person with poor dentition and also in the immunocompromised person.

Why: e.g. fever, headache, sore mouth, shallow ulcers on the lining of the mouth, gums and tongue, blisters on hands, palms and soles.

Why: e.g. prodrome of tingling, itching or burning sensation on the lips which usually precede any visible skin changes by 24 hrs. Prodrome is followed by development of fluid filled vesicles which erode to become ulcers on the lips.

Why: e.g. cracks at the corners of the mouth. Possible causes may include Vitamin B6, B12, folate and iron deficiency.

Why: e.g. recurrent oral aphthous ulcers, recurrent genital aphthous ulcers, features of posterior uveitis (blurred vision and floaters), erythema nodosum (painful nodules on the arms and legs).

Why: e.g. acute eruption involving the skin and mouth mainly in children, adolescents and young adults. Lesions are raised patches of concentric rings (iris or target lesions). The mouth lesions are tender and painful. It may be associated with herpes simplex type 1, systemic lupus erythematosus, Hodgkin's disease, myeloma, tuberculosis and some medications.

Why: e.g. frequent urination, excessive thirst, weight loss, fatigue - can cause recurrent mouth infections, dry mouth and lips.

Why: Hormonal changes occurring during menopause may be associated with burning mouth.

Why: e.g. fissuring at the corners of the mouth, red inflamed tongue, seborrheic dermatitis on face, scrotum or vagina.

Why: e.g. dry eyes, dryness of the mouth, skin or vagina. Dry mouth can predispose to recurrent mouth infections including oral candidiasis. This syndrome may be associated with many systemic conditions such as Raynaud's phenomenon, difficulty in swallowing (as seen in systemic sclerosis), painful joints (like that seen with systemic lupus erythematosus), thyroid disease, myasthenia gravis, primary biliary cirrhosis, chronic active hepatitis, renal diabetes insipidus, renal tubular acidosis and vasculitis.

Why: a distinct syndrome usually occurring in children comprising of recurrent or persistent oral thrush, finger or toe bed infection and skin infection.

Why: e.g. pain felt over the jaw joint and localized to the region of the ear but may radiate forwards to the cheek and even the neck; pain and limitation of jaw movements especially on opening the mouth, clicking and crackling in the jaw joint with movement.

Why: e.g. 2-3 hours after ingestion may experience flushing, burning of the mouth, itchiness, headache, hives, nausea, vomiting and difficulty with breathing.

Why: the cause of most cases of burning and painful mouth is unknown. There is a high prevalence of anxiety, depression and reactions to stress suggesting a psychological basis but a causal link has not been clearly established.