Lips

Actinic atrophy

Thin atrophic mucosa with erosive areas; predisposes to neoplasia

Angioedema

Acute swelling

Angular cheilitis (cheilosis)

Fissuring at corners of mouth, often with maceration

Cheilitis glandularis

Enlarged, nodular labial glands with inflamed, dilated secretory ducts; sometimes everted, hypertrophic lips

Cheilitis granulomatosa

Diffusely swollen lips, primarily the lower

Erythema multiforme

Multiple bullae that rupture quickly, leaving hemorrhagic ulcers; includes Stevens-Johnson syndrome

Exfoliative cheilitis

Chronic desquamation of superficial mucosal cells

Keratoacanthoma

A locally destructive epithelial tumor thought to be a form of squamous cell carcinoma that usually regresses spontaneously

Peutz-Jeghers syndrome

Brownish black melanin spots, with GI polyposis

Secondary herpes simplex (cold sore)

Short-lived vesicle (≤ 1 day) followed by small painful ulcer (≤ 10 days) at the vermillion border (common)

Verruca vulgaris (wart)

Pebbly surface

Buccal mucosa

Painful white area; when wiped off, exposes an inflamed area

Fordyce granules

Cream-colored macules about 1 mm in diameter; benign; aberrant sebaceous glands

Hand-foot-and-mouth disease

Small ulcerated vesicles; coxsackievirus strain infection in young children; mild

Herpangina

Vesicles in posterior of mouth

Irritation fibroma

Smooth-surfaced, dome-shaped, sessile

Koplik spots

Tiny, grayish white macules with red margins near orifice of parotid duct; measles precursor

Linea alba

Thin white line, typically bilateral, on the level of the occlusal plane; benign

Smokeless tobacco lesion

White or gray corrugated; usually behind lower lip; a risk factor for oral cancer

Verrucous carcinoma

Slow-growing, exophytic, usually well differentiated; at site of snuff application; metastasis unusual, occurs late

White sponge nevus

Thick white folds over most of buccal mucosa except gingivae; benign

Palate

Granulomatosis with polyangiitis (formerly Wegener granulomatosis)

Lethal midline granuloma, with bone destruction, sequestration, and perforation

Infectious mononucleosis

Petechiae at junction of hard and soft palate

Kaposi sarcoma

Red to purple painless macules progressing to painful papules

Necrotizing sialometaplasia

Large, rapidly developing ulcer, often painless; appears grossly malignant; heals spontaneously in 1–3 months

Papillary inflammatory hyperplasia

Red, spongy tissue, succeeded by fibrous tissue folds; velvety texture; benign; occurs under poorly fitting dentures

Red punctate areas are ducts of minor salivary glands, appearance is red spots surrounded by leukoplakia (often severe, usually benign)

Secondary herpes simplex

Small papules quickly coalescing into series of ulcers (uncommon)

Torus palatinus

Overgrowth of bone in midline; benign

Tongue and floor of mouth

Ankyloglossia

Tongue unable to protrude; speech difficulty

Pulling away of the gingiva by the lingual frenulum

Benign lymphoepithelial cyst

Yellowish nodule on ventral part of tongue or anterior floor of mouth

Benign migratory glossitis (geographic tongue, erythema migrans)

Changing patterns of hyperkeratosis and erythema on dorsum and edges; desquamated filiform papillae in irregular circinate pattern, often with an inflamed center and a white or yellow border

Dermoid cyst

Swelling in floor of mouth

Enlargement of tongue (macroglossia)

Localized or generalized depending on how many teeth are missing; adjacent teeth may indent tongue; posterior enlargement associated with obstructive sleep apnea and snoring

Fissured (scrotal) tongue

Deep furrows in lateral and dorsal areas

Glossitis

Red, painful tongue; often secondary to another condition, allergic, or idiopathic

Hairy tongue

Dark, elongated filiform papillae

Linea alba

Thin white line on edges of tongue, usually bilateral

Lingual thyroid nodule

Smooth-surfaced nodular mass of thyroid tissue follicles, on the far posterior dorsum of tongue, usually at the midline

Ludwig angina

Painful, tender swelling under the tongue resulting from odontogenic infection; can compromise the airway by forcing the tongue superiorly and posteriorly

Median rhomboid glossitis

Red (usually) patch in midline of tongue, without papillae; asymptomatic

Neurilemoma

Persistent swelling, sometimes at site of prior trauma; can be painful

Pernicious anemia

Smooth, pale tongue, often with glossodynia or glossopyrosis

Ranula

Large mucocele penetrating the mylohyoid muscle; may plunge deep into the neck; swollen floor of mouth

Thyroglossal duct cyst

Midline swelling that moves upward when tongue protrudes

Tuberculosis

Ulcers on dorsum (firm), cervical adenopathy

Salivary glands

Benign lymphoepithelial lesion (Mikulicz disease)

Unilateral or bilateral enlargement of salivary glands; often with dry mouth and eyes

Sialadenitis

Swelling, often painful; benign

Sialolithiasis

Swelling (eg, of floor of mouth) that increases at mealtime or with ingestion of sour or bitter foods

Sjögren syndrome

Systemic disease causing dry mucous membranes

Xerostomia

Dry mouth; usually secondary to drugs

Various

Acute herpetic gingivostomatitis

Widespread ulcerating vesicular lesions; always present on gingiva; other locations may be involved; usually in young children

Behçet disease

Multiple oral ulcers similar to those of aphthous stomatitis; also includes dry eyes

Canker sores, recurrent aphthous stomatitis

Small painful ulcers (canker sores) or large, painful scarring ulcers (recurrent aphthous stomatitis)

Cicatricial pemphigoid

Bullae that rupture quickly, leaving ulcers; ocular lesions develop after oral lesions; found on alveolar mucosa and vestibules

Condyloma acuminatum

Sexually transmitted warts forming cauliflower-like clumps

Dyskeratosis

Occurs with erythroplakia (red), leukoplakia (white patch on mucous membrane that does not rub off), and mixed red and white lesions; precancerous

Hemangioma

Purple to dark-red lesions, similar to port wine stain; benign

Hereditary hemorrhagic telangiectasia

Localized dilated blood vessels

Lichen planus

Lacy pattern (Wickham striae), sometimes erosive; may become malignant; most common on buccal mucosa, lateral tongue

Lymphangioma

Localized swelling or discoloration; benign; most common on tongue

Mucocele (mucous retention cyst)

Soft nodule resulting from traumatized salivary gland; if superficial, covered by thin epithelium; appears bluish; most common on lips and floor of mouth

Noma

Small vesicle or ulcer that rapidly enlarges and becomes necrotic

Pemphigoid

Small yellow or hemorrhagic tense bullae; may last several days before rupture; most common on vestibules and alveolar mucosa

Pemphigus

Bullae that rupture quickly, leaving ulcers; can be fatal without treatment

Syphilis

Chancre (red papule rapidly developing into a painless ulcer with a serosanguineous crust), mucous patch, gumma