Oral Diseases

Multiple 1–2 mm yellow papules on buccal mucosa and upper lip vermilion

Ectopic sebaceous glands, normal variation of anatomy

Torus
(Figure 3.55A)

Bony outgrowth along hard palate or mandibular area (palatal/mandibular tori)

5–10% of the population

Geographic tongue
(Figure 3.55F)

Well-demarcated erythema with whitish rim typically involving dorsal tongue

↑ Frequency with psoriasis

Fissured tongue
(Scrotal tongue)

Nonpainful furrows on dorsum of tongue with ‘corrugated’ appearance

May be associated with Melkersson-Rosenthal syndrome

Hairy tongue
(Black hairy tongue)
(Figure 3.55B)

Yellow to brown-black elongated and hypertrophic papillae with hair-like projections on dorsum of tongue

Due to keratin accumulation; association with smoking, poor hygiene, or antibiotic use

Diffuse grey-white surface along buccal mucosa

Benign, disappears with stretching of affected area

Diffuse gingival erythema with erosions, ± mucosal sloughing

General term for findings in many vesiculoerosive diseases

Shaggy white plaque on buccal mucosa

Chronic irritation from biting

White wrinkled necrotic plaque at site of contact with subsequent desquamation

Self-limited; often due to aspirin

Shaggy white hyperkeratotic areas on buccal mucosa resembling oral LP

Dental amalgam and cinnamon may cause lichenoid changes

Black or bluish-black pigmented macule typically over buccal vestibule

After tooth extraction, amalgam may incorporate in wound

Nicotine stomatitis
(Figure 3.55D)

Umbilicated papules with central red depression over hard palate/soft palate

Inflamed palatal mucous salivary glands due to nicotine

Orofacial granulomatosis
(Cheilitis granulomatosa)

Persistent, non-tender enlargement of lips (upper or lower lip) and/or face

Associated with Melkersson- Rosenthal syndrome

{Melkersson-Rosenthal: facial nerve palsy, fissured tongue, granulomatous cheilitis}

Round to oval painful shallow ulcers with creamy-white base and red halo

Three forms: minor, major and herpetiform

Mucocele
(Figure 3.55E)

Soft, blue, translucent cyst (superficial) or mucosa-colored firm nodule (deep)

Due to obstruction or rupture of minor salivary glands

Pinpint red macules on lower lip mucosa, ± enlargement of lower lip

Dilated/inflamed minor salivary glands; treat w/ vermilionectomy

Absent/reduced salivary secretion causing dryness of mouth

Side effect of medications, autoimmune disease, XRT, etc.

Hemorrhagic painful gingiva with punched out lesions and foul odor

Associated with many oral bacterial pathogens

Median rhomboid glossitis
(Figure 3.55C)

Diamond or oval-shaped erythematous smooth plaque on posterior dorsal tongue

Asymptomatic, may resolve on own; likely due to C. albicans

Angular cheilitis (Perleche)
(Figure 3.56B)

Erythema, maceration and fissuring at the lip commissures

Vitamin deficiency, candidal infection, irritant dermatitis

Atrophic, smooth red glistening tongue

Candidiasis or vitamin deficiency

Loosely adherent white patches or plaques on mucosal surfaces

Due to candidal infection

Heck’s disease
(Focal epithelial hyperplasia)

Pink to white soft papules/plaques with cobblestone appearance over lips, buccal mucosa and/or lateral sides of tongue

Infection of mucosa by HPV types 13 and 32

Painful vesicles and ulcers; typically with diffuse gingival involvement

Primary HSV infection

White, thickened spongy plaques typically over buccal mucosa bilaterally, ± labial mucosa, tongue, floor of mouth

Rare, autosomal dominant, present at birth or shortly after; mutation in keratin 4 and 13

Soft, sessile plaques typically over gingiva, alveolar mucosa and hard palate

No associated lipid abnormality

{Foamy lipid-laden cells req’d for diagnosis}

Painless soft or rubbery papules/nodules affecting mainly lips and tongue

Solitary firm, sessile nodule typically on tongue; asymptomatic

30% confined to tongue (rest arising on head and neck)

Oral fibrous histiocytoma
(Figure 3.56C)

Solitary, pink smooth nodule typically on buccal mucosa, tongue, gingiva or lip

Asymptomatic

White plaque on floor of the mouth and lateral/ventral tongue, soft palate

Most common premalignant oral lesion

Flat or slightly erythematous sharply marginated patch or plaque

90% carcinoma in situ or invasive at time of biopsy

Actinic cheilitis
(Figure 3.56D)

Blurring of vermilion border, change in texture/color of lip, ± scale, ulceration

Precancerous; typically diffuse

SCC
(Figure 3.56E, F)

Ulcer, indurated plaque or exophytic mass typically over lateral/ventral tongue and floor of mouth

Strongly associated with tobacco, alcohol, HPV infection, and chewing betel nut

Slow growing exophytic verrucous or papillary white plaque

Distinct subtype of SCC, locally
aggressive; HPV type 16 and 18

Linear fissures and ulcers of vestibule, cobblestone lesions on buccal mucosa

Oral lesions respond to therapy for bowel disease

Pyostomatitis vegetans
(Figure 3.56A)

‘Snail-track’ creamy-yellow tiny pustules arranged in linear, serpentine fashion against erythematous background

Associated with IBD (Crohn’s, UC), similarities to oral variant of pyoderma gangrenosum

Hyperplasia of gingiva with interdental papillae being affected first

Seen in phenytoin, calcium channel blockers, cyclosporine