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Painful oral vesiculoerosive diseases (OVD) include lichen planus, pemphigus vulgaris, mucous membrane pemphigoid, erythema multiforme, and recurrent aphthous stomatitis. OVD lesions have an immunopathic cause. Treatment is aimed at reducing the immunologic and the following inflammatory response. The mainstay of OVD management is topical or systemic corticosteroids to include topical triamcinolone, fluocinonide, and clobetasol, whereas systemic medications used in practice can include dexamethasone, prednisone, and prednisolone. Oral herpetic lesions can be primary or recurrent. If management is desired, they can be treated by topical or systemic antiviral drugs. Topical antiviral creams include prescription acyclovir, penciclovir and over-the-counter docosanol., (Published by Elsevier Inc.)

This article discusses the classic autoimmune diseases: pemphigus vulgaris, mucosal pemphigoid, and oral lichen planus. These are generally considered of autoimmune origin or, at a minimum, immune system mediated. Cause, diagnosis, and treatment are discussed. As management of these diseases progresses, continued advances in molecular pathogenesis will allow insight into which strategies can be employed in interfering with the complex cascade of events leading to mucosal impairment and clinical morbidity., (Copyright © 2011 Elsevier Inc. All rights reserved.)

The conditions discussed in this article are those most likely to cause a patient to seek emergency care, primarily for pain. All the characteristics given for the conditions to aid in the diagnosis do not necessarily need to be present and other characteristics not mentioned may in fact be present. A complete differential diagnosis, especially of more obscure lesions, was also not attempted. An attempt was made to provide the practitioner with enough information to develop a working diagnosis from which to alleviate the patient's discomfort. A definitive diagnosis may not be available in an emergency setting. However, it must be emphasized that the final responsibility of the dentist is to make a definitive diagnosis at a later time if one cannot be made when emergency treatment is sought. Alleviating pain without dealing with the underlying cause may be more detrimental to the patient's health in the long run, as palliative therapy may mask a more severe condition.