Oral Diseases

Oral medicine is the clinical and academic specialty dedicated to the diagnosis, management, and research of oral cavity diseases that require medical treatment, as well as systemic diseases with oral and facial manifestations.

The mouth is a window into the body’s general state of health. Systemic diseases such as diabetes, lupus, or Crohn’s disease often present oral manifestations before the condition is even diagnosed systemically. An oral medicine specialist trained to recognize these signs can be the first to alert the patient that something else is happening in their body.

At Asensio Dental Clinic, Dr. Lucía Asensio Romero (Registration No. 46002287) coordinates the oral medicine area in Valencia, with specific training in oral pathology. The first visit is completely free and includes a full clinical examination and digital X-ray.

Which patients should see an oral medicine specialist?

Any patient with an oral cavity ailment that cannot be directly attributed to the teeth can benefit from an oral medicine assessment. This is especially relevant for immunocompromised patients —due to HIV, transplants, or immunosuppressive treatments—, those receiving chemotherapy, radiation therapy, or bisphosphonates, and anyone with systemic diseases manifesting orally. It also includes patients with mucosal lesions of uncertain diagnosis, severe recurrent canker sores, or changes in mucosal color and texture that have no dental explanation.

Oral Mucosal Alterations

The oral mucosa is part of the upper digestive tract and can be affected by diseases of local or systemic origin. Any alteration requires a thorough examination of the entire oral cavity: mucosa, gums, palate, and tongue. Visual inspection is always complemented by bimanual palpation and, when indicated, an anatomopathological biopsy study for definitive diagnostic confirmation.

Common variations of normal structure include Fordyce spots —yellowish spots on the lip mucosa caused by ectopic sebaceous glands, without clinical significance—, fissured tongue —increased grooves on the dorsum of the tongue, generally asymptomatic—, median rhomboid glossitis —an erythematous plaque in the center of the tongue’s dorsum, often colonized by candida—, lingual varicosities —dilated vessels on the ventral surface of the tongue, without pathological meaning— and torus palatinus —a bony exostosis in the midline of the hard palate that requires no treatment unless it interferes with a prosthesis.

Viral Infections of the Oral Mucosa

Viral infections are a frequent cause of oral lesions, especially in immunocompromised patients. Acute herpetic gingivostomatitis —caused by herpes simplex virus type 1— is more common in children and presents with edematous mucosa, coalescing ulcers, fever, and neck lymphadenopathy. It heals in 1-2 weeks without scarring. Recurrent herpes labialis, present in 30% of the population, produces recurring vesicles on the outer third of the lip that last 3-7 days and heal without scarring.

Hand-foot-and-mouth disease —caused by Coxsackie type A— presents with vesicular lesions in the oropharynx, hands, feet, and gluteal region, healing within two weeks. Oral herpes zoster —caused by the varicella-zoster virus— produces vesicles that ulcerate along a unilateral dermatome and cause intense neuralgia. In patients with HIV or transplants, these infections may have atypical presentations and greater severity.

Bacterial and Fungal Infections

The most common bacterial infections of the oral mucosa include acute necrotizing ulcerative gingivitis —with painful ulcers on the interdental papilla, fever, and halitosis— and oral manifestations of systemic diseases like syphilis, gonorrhea, tuberculosis, and actinomycosis. The latter are rare but important because their oral lesions can be mistaken for malignant ones.

Among fungal infections, the most relevant is oral candidiasis. Candida albicans is present in 50% of healthy individuals and causes infection when defenses are low. It can present in different clinical forms: pseudomembranous with white plaques, erythematous with painful red areas, or angular cheilitis with fissures at the corners of the mouth. For detailed information on symptoms and treatment, consult our guide on oral candidiasis.

Dermatological Diseases with Oral Manifestations

Several autoimmune or idiopathic dermatological diseases have characteristic oral manifestations. Pemphigus vulgaris is an autoimmune blistering disease affecting the skin and mucosa, with vesicles that rupture to leave painful ulcers. Oral lichen planus is very common —affecting 1-2% of the population— and presents as reticular white streaks on the buccal mucosa, though it can also take erosive forms with painful ulceration. It requires monitoring due to its malignant potential in erosive forms.

Erythema multiforme presents as “target” lesions on the skin accompanied by extensive, crusty oral ulcers on the lips, often triggered by herpes simplex or medications. Contact stomatitis can be irritative —caused by heat, peroxide, or chlorhexidine— or allergic —caused by toothpastes, antiseptics, or orthodontic materials.

Premalignant and Malignant Lesions of the Oral Mucosa

The early detection of premalignant lesions is one of the most important goals of oral medicine. Leukoplakia —a white plaque that cannot be scraped off— has a malignancy rate of 5-17% over ten years depending on its location, size, and histological characteristics. It requires a confirmatory biopsy and close follow-up. Erythroplakia —a well-circumscribed erythematous plaque with a velvety surface— has a much higher malignant potential, near 50%, and always requires an urgent biopsy.

Squamous cell carcinoma is the most common oral malignant tumor —representing 90% of oral tumors— and primarily affects people aged 50-70 with a history of smoking and alcohol consumption. The most frequent location is the lateral border of the tongue and the floor of the mouth. Its prognosis depends fundamentally on the stage at which it is diagnosed: five-year survival exceeds 80% in stage I and falls below 30% in stage IV. Regular oral check-ups —annual for people with risk factors— are the only available early diagnosis strategy.

Frequently Asked Questions about Oral Medicine

What is the difference between oral medicine and stomatology?

They are essentially equivalent terms. In many regions, “stomatology” (medicina bucal) is the official clinical designation, while “oral medicine” is more common in international academic circles. Both refer to the same specialty: the medical diagnosis and treatment of oral cavity diseases.

Which doctor treats diseases of the mouth and tongue?

An oral medicine specialist is the appropriate professional for mucosal lesions, ulcers, oral infections, or premalignant lesions. For lesions requiring major surgery, the patient is referred to a maxillofacial surgeon. At Asensio Dental Clinic, we coordinate both specialties to ensure continuity of care.

When is it urgent to consult about an oral lesion?

When an ulcer does not heal within two weeks, when it grows progressively, when it is painless, when it is accompanied by difficulty swallowing or speaking, or when it appears in people with risk factors —such as smoking or alcohol consumption. When in doubt, a specialized examination is the only way to rule out serious pathology.

Is oral candidiasis contagious?

The risk of contagion is low in healthy people, as Candida is part of the normal flora. It can be transmitted between babies and mothers during breastfeeding and in immunocompromised individuals. Visit our page on oral candidiasis for more information.

Read our full guide on what is a stomatologist and our article on the free first dental consultation.