Diagnostic delay in autoimmune oral diseases

Objectives: Autoimmune diseases affect about 5% of the general population, causing various systemic and/or topical clinical manifestations. The oral mucosa is often affected, sometimes as the only involved site. The misdiagnosis of oral autoimmune diseases is and underreported issue. Methods: This narrative review focuses on diagnostic delay in oral autoimmune diseases (oral lichen planus, oral pemphigus vulgaris, mucous membrane pemphigoid, oral lupus erythematosus, orofacial granulomatosis, oral erythema multiforme and Sjogren syndrome). An extensive literature research was conducted via MEDLINE, Embase and Google Scholar databases for articles reporting the time spent to achieve the correct diagnosis of oral autoimmune diseases. Results: Only 16 studies reported diagnostic delay in oral autoimmune diseases. Oral autoimmune vesiculobullous diseases are usually diagnosed after 8 months from the initial signs/symptoms, the Sjogren Syndrome diagnosis usually requires about 73 months. No data exist about the diagnostic delay in oral lichen planus, oral lupus erythematosus, orofacial granulomatosis, and oral erythema multiforme. Conclusions: The diagnosis of oral autoimmune diseases can be difficult due to the non-specificity of their manifestations and the unawareness of dentists, physicians, and dental and medical specialists about these diseases. This can lead to a professional diagnostic delay and a consequential treatment delay. The delay can be attributed to the physicians or/and the healthcare system (Professional Delay) or the patient (Patient's Delay).