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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

• Migratory glossitis – Associated with a linear white raised rim and usually located on the lateral aspect of the dorsal tongue. Lesions resolve and develop in another site. Infrequently, this process will occur on other oral mucosal surfaces (ectopic geographic tongue), but nearly always in conjunction with tongue lesions.
• Lichen planus – Usually painful and associated with peripheral white striations.
• Desquamative gingivitis – Appears as a painful erosion and sloughing of the gingiva and should be biopsied for a definitive diagnosis.
• Denture stomatitis – Occurs beneath a maxillary denture and is confined to the area that the denture covers. It is typically asymptomatic. Disinfecting the denture and leaving it out of the mouth at night should resolve the lesion.
• Contact stomatitis and chemical burns – Usually painful and associated with placement of a noxious agent against the mucosa.
• Erythematous / atrophic candidiasis – May be asymptomatic ("central papillary atrophy of the tongue") or have a burning sensation if diffuse involvement of the dorsal tongue is present. Typically, this resolves with anti-fungal agents.

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