Oral pigmentations:

• Exogenous
• Endogenous
• Other

White lesions:

• 1. Hereditary:
  • Leukoedema
  • White sponge naevus
• 2. Reactive:
  • Frictional keratosis*
  • Nicotine stomatitis*
  • Hairy leukoplakia
  • Burns
• 3. Preneoplastic & neoplastic:
  • Actinic chelitis
  • Leukoplakia
  • Lichen planus
  • Oral submucosus fibrosis
  • Lupus erythematous
• 4. Infective:
  • Candidiasis
  • Hairy leukoplakia
  • Koplik’s spots
  • Syphilis
• 5. Other:
  • Ectopic lymphoid tissue/ fordyce granules
  • Geographic tongue
  • Hairy tongue

* Observe for neoplastic changes

Red-blue lesions:

1. Extravascular:

• Petechia (1-2mm) – reduced platelet/clotting factors
• Ecchymoses (1-2cm) – reduced platelet/clotting factors
• Gingival enlargement – leukemic infiltrates
• Gingival inflammation/hyperplasia – poor oral hygiene
• Excessive gingival bleeding – reduced platelet/clotting factors
• Refractory gingivitis – leukemic infiltrate + reduced platelet/clotting factors

2. Intravascular:

• 1. Congenital vascular anomalies:
  • Hemangioma
  • Vascular malformation
  • Sturge-Weber syndrome
  • Rendu-Osler-Weber syndrome
• 2. Reactive lesions:
  • Acquired vascular malformations e. varices – focal dilation of single vein
  • Pyogenic granuloma
  • Peripheral giant cell granuloma
• 3. Neoplasms:
  • Erythroplakia
  • Kaposi’s Sarcoma
• 4. Metabolic endocrine conditions:
  • Vitamin B deficiency
  • Iron deficiency anemia
  • Pernicious anemia
  • Burning mouth syndrome
• 5. Immunological abnormalities:
  • Plasma cell gingivitis
  • Drug reaction and contact allergies
• 6. Infectious conditions:
  • Scarlet fever

Brown melanotic lesions:

1. HIV oral melanosis
2. Drug induced melanosis
3. Physiological pigmentation
4. Oral melanotic macule
5. Melanoma
6. Pituitary hyperfunction
7. Other hormonal imbalance
8. Naevus
9. Smokers melanosis

Syndromes with orofacial pigmentations

1. Addison’s disease
   • Chronic adrenal insufficiency
   • Clinical:
     • Bronzing of skin
     • Pigmentation of mucosa
     • Decreased cardiac activity
     • Malaise
     • Sever anemia
2. Peutz-Jegher syndrome
3. Neurofibromatosis
4. Albright syndrome