September 2012 265 original article Keywords: Oral medicine, autoimmune diseases, aphthous stomatitis, Sjogren’s syndrome, systemic lupus erythematosus Corresponding Author: Niki Moutsopoulos, DDS, PhD, National Institutes of Health/ Nidcr Building 30, Room 327, 30 Convent Dr Msc 4320, Bethesda, MD 20892-4320; E-mail: nmoutsop@mail.nih.gov J Evid Base Dent Pract 2012:S1: [265-282] 1532-3382/$36.00 © 2012 Elsevier Inc. All rights reserved. Clinical Research Core, National Institute of Dental and Craniofacial Research, National Institutes of Health, Bethesda, MD 20892 ORAl MANIfEStAtIONS Of SyStEMIC AutOIMMuNE AND INflAMMAtORy DISEASES: DIAgNOSIS AND ClINICAl MANAgEMENt Jacqueline W. Mays, DDS, PhD, Mojgan Sarmadi, DDS, MD, Niki M. Moutsopoulos DDS, PhD AbStrAct context: Systemic autoimmune and infammatory diseases often manifest oral le- sions in their earliest stages, and early diagnosis, which may be spurred by a dental examination, is key for improved outcomes. After systemic diagnosis, oral lesions beneft from specialized care by dentists in collaboration with the medical team. this review aims to educate dental clinicians about the most relevant systemic autoimmune and infammatory conditions with accompanying oral lesions, their implications for health, and management strategies supported by the biomedi- cal literature and clinical experience. ulcerative conditions including Behcet and Crohn diseases are discussed, along with rheumatic conditions including Sjögren syndrome, lupus erythematosus, and rheumatoid arthritis. Evidence Acquisition: Evidence was accumulated through PubMed searches using pertinent keywords for each subsection. References were reviewed and original publications examined to verify the accuracy of the information. We focused on evidence included in current reviews and randomized trials. Recommendations were supported by multiple studies and consensus expert opinion. Evidence Synthesis: Disease phenotypes described and clinical recommendations were synthesized from best-quality evidence available for each disease. Efforts were made to describe evidence selection within each disease section. conclusions: Dentists play an important role in the early detection and multidis- ciplinary medical management of complex autoimmune diseases. It is important to recognize prevalent medical and dental issues and special needs of patients with autoimmune conditions. The management of many infammatory conditions is similar, and often begins with the use of topical steroids, analgesics, and antimi- crobial treatments, in addition to careful attention to oral hygiene and appropriate fuoride usage. In this brief review, we aim to discuss the presentation/prevalence, diagnosis, and treatment of oral manifestations encountered in autoimmune, autoinfammatory and systemic chronic infammatory diseases. Systemic autoimmune conditions are estimated to affect 5% to 8% of Americans. 1 Oral manifestations are encountered with high frequency, and are often the frst clinical signs or symptoms of the general disease. Optimal management of complex autoimmune diseases requires a multi- disciplinary medical team including dentists to care for lesions of the oral cavity. the dental practitioner may be asked to play a primary role in the diagnosis of such