• Anatomy
• White lesions of the mouth
• Ulcerating lesions of the mouth
• Hyperpigmentation of the Oral Mucosa

• Lips: vividly pinkish-red (vermilion), surround entrance to oral cavity
• Vermilion Border: between oral mucosa and skin. No evidence of keratinization.
• Labial Mucosa: mucous saliva can be detected as secretions
  from numerous orifices of the minor salivary glands. Maxillary and mandibular labial mucosa are attached to gingiva and alveolar bone by a midline frenulum.
• Buccal Mucosa: minor salivary glands. Linea alba: white ridge where the teeth rest. Fordyce granules in 75% of individuals. They are ectopic sebaceous glands and present as < 2mm yellow papules.
• Tongue: muscle covered by keratinized mucosa containing taste buds. Accessory lymphoid tissue or lingulal tonsil is normally found in healthy individuals. Sublingual veins are present on the undersurface of the tongue. The lingual frenulum originates in the midline of the ventral tongue and inserts into the floor of the mouth.
• Hard Palate: covered by parakeratinized epithelium. Appears as
  a lighter pink due to keratin and a less vascular lamina propria.
• Soft Palate: lacks osseous support, is highly mobile and extends posteriorly closing the nasopharynx. Uvula is a midline extension of the soft palate.
  
  

Candida

Discoid lupus erythematosus (DLE)

Syphilis

White lesions of the mouth:

1. Lichen planus
2. Candida
3. Verrucae
4. Squamous cell carcinoma
5. Lupus erythematosus
6. Syphilis
7. Oral hairy leukoplakia
   
   

   Leukoplakia

   Oral hairy leukoplakia

Herpes simplex

Lichen planus

Lichen planus

Lichen planus

1. Herpes simplex
2. Aphthous stomatitis
3. Behcet’s syndrome
4. Lichen planus
5. Pemphigus/pemphigoid
6. Stevens Johnson syndrome/erythema multiforme major
   
   

   Pemphigus

   Erythema multiforme

   Erythema multiforme

Exogenous:

• Foreign materials: amalgam tattoos, carbon, seeds, leaves of various plants, tobacco
• Pharmacologic agents: minocycline, AZT, antimalarials, amiodarone, OCP, doxorubicin
• Heavy metal exposure: bismuth, mercury, silver, lead, tin, copper

Endogenous:

• Systemic disease: Addison’s disease, Peutz-Jeghers syndrome, hemochromatosis
• Neoplasms: nevi, oral and labial melanotic macules, melanoma
• Reactive process: postinflammatory hyperpigmentation