White mucosal lesions are some of the more commonly biopsied lesions and both benign and dysplastic lesions often pose a diagnostic challenge, and these are discussed in this and other chapters because of their varied etiologies. The term “leukoplakia” is not any white lesion, but rather a clinical term to denote a keratotic lesion that has a high risk of developing dysplasia and carcinoma and does…

Extrinsic pigmentation Amalgam tattoos are by far the most common form of intramucosal extrinsic pigmentation seen in the oral cavity. A distant second is graphite tattoo from implanted pencil lead. Extrinsic surface pigmentation such as those caused by tea, coffee, or other foods and mouth rinses such as chlorhexidine are readily removed with dental polishing and are not discussed here. Amalgam tattoo (focal agyrosis) Clinical findings…

Granulomatous inflammation True granulomas are clusters of activated histiocytes/macrophages with an epithelioid appearance with variable inflammation and often multinucleated giant cells. They have a wide range of etiologies and range from cholesterol granulomas within odontogenic cysts to tumor-like granulomas from dermal fillers, to infectious granulomas. Necrotizing granulomas are often seen in infectious processes and diseases of collagen degradation and necrobiosis. Table 8.1 lists the common noninfectious…

Recurrent aphthous ulcers Most cases of recurrent aphthous ulcers are idiopathic and occur in 15% to 25% of the population, usually children, teenagers, and young adults. Trauma and stress, both physical and emotional, bring on episodes in susceptible individuals. However, aphthous-like lesions are seen in many systemic diseases and oral hypersensitivity reactions but unlike idiopathic aphthous ulcers that are episodic for a few decades of the…

Only the most common soft tissue tumors that one encounters with regularity in the oral cavity will be discussed here. The landscape of these tumors has changed tremendously over the last 10 years because of advances in molecular diagnostics and development of surrogate markers for genetic alterations ( Table 6.1 ). Beyond benign and malignant tumors are tumors of intermediate potential as well as benign tumors…

Fibrous lesions Fibroma (“bite” or “irritation” fibroma, fibroepithelial or fibrovascular polyp), and giant cell fibroma Clinical findings Fibroma: This occurs at any age group without sex predilection and consists of a dome-shaped nodule or papule that may be white/keratotic, mucosa-colored, or ulcerated. It is located in areas readily traumatized by biting (i.e., buccal mucosa, lateral tongue, and lower lip mucosa) or on the gingiva where plaque…

Besides the common bacterial, fungal, and viral infections of the oral cavity, any infection that occurs in any part of the body may manifest in the mouth, including mycobacterial, treponemal, and protozoal infections, although they are uncommon and rarely occur initially in the mouth. However, in many parts of the world, syphilitic and protozoal infections are on the rise. Polymicrobial bacterial infections in the mouth are…

Giant cell fibroma This lesion may occur as a smooth-surfaced nodule or have a bossellated, multinodular, or papillary appearance and is discussed in Chapter 5 . Inflammatory papillary hyperplasia of the palatal mucosa Clinical findings This occurs in adults wearing maxillary dentures (usually in the sixth decade upwards) and is occasionally seen in patients with high-arched palates and mouth-breathing habit. Patients may report sensitivity, especially if…

Definitions Choristoma : An overgrowth of tissues that is mature and found in an area where such tissue is not usually present, such as an osseous or cartilaginous choristoma of the tongue. Hamartoma : An overgrowth of tissue that is mature and normally found in that area, such as a leiomyomatous hamartoma. Nevus : An overgrowth of tissue that is normally found in the skin or…