Indu et al reported an algorithm for the diagnosis of oral amyloidosis. While macroglossia is the most common presentation, it may not always be present.
Red flags for oral amyloidosis:
(1) macroglossia with restricted tongue movements and slurred speech
(2) crenations of the teeth on lateral tongue border
(3) multiple well-circumscribed, hard, painless nodules on lips, gingiva, and/or buccal mucosa
(4) oral ulcers on tongue and palate (Nawata et al)
(5) hard painless nodules in the parotid gland
Supportive systemic findings:
(1) weight loss despite good appetite
(2) proteinuria
(3) hepatomegaly
(4) abnormal cardiac function
(5) neuropathy, including carpal tunnel syndrome
If red flags and supportive systemic findings are present, then an oral biopsy should be taken.
Histologic findings:
(1) acellular amorphous material in the submucosa
(2) reddish color of amorphous material on Congo red stain with apple green birefringence
