Erythroplastic lesion on the mandibular marginal gingiva.

Carcinoma of the gingiva is a significant risk to patients because the asymptomatic characteristics of erythroplastic lesions are not always readily identified. This case report shows the similarity in clinical appearance of squamous cell carcinoma of the gingiva to the common inflammatory changes associated with periodontal disease. A similar clinical presentation might be seen in any lesion with increased vascularity, including Kaposi's sarcoma associated with human immunodeficiency virus infection. Any erythroplastic change involving the oral mucosa should be viewed with suspicion and, if not resolved after removal of local sources of irritation, must be biopsied to establish a definitive diagnosis.

Painless verrucoid plaque on the lower lip.

Verruca vulgaris is an uncommon oral lesion which is caused by an infectious agent, HPV. These growths have many clinical features in common with other oral lesions, the most serious of which are verrucous carcinoma and verrucoid squamous cell carcinoma. These various lesions can usually be separated on the basis of clinical and microscopic features. In some cases, however, immunohistochemical studies and DNA hybridization studies may be necessary before an exact diagnosis can be made.

Large nonpainful swelling of the lower lip.

The lipomas are slow-growing benign neoplasms. They are characterized by a smooth-surfaced, sessile or pedunculated, yellow-to-pink submucosal mass that is usually asymptomatic. Superficially situated lesions show a telangiectatic vascular network. Deeper lesions may only be noticed as a subtle swelling, making them difficult to detect and treat. Despite its relative infrequency in the mouth, clinicians should be aware of the possibility of lipoma when diagnosing nonulcerated, soft-tissue masses of the mouth. Proper treatment consists of surgical excision, histologic examination, and patient follow-up.

Painless swelling of the lower lip.

A characteristic example of a mucocele has been presented. Clinicians should be aware that even though these lesions have a distinctive clinical appearance and react biologically in a fairly characteristic manner, they must be differentiated from benign and malignant neoplasms that appear and react clinically similar to mucous retention phenomenons. Microscopic examination of tissue from the lesion is the only definitive method to make this differentiation.

A solitary cauliflower-like nodule on the mucosal surface of the lower lip.

The incidence of oral condylomata acuminata and simultaneous genital condylomata is not known. A review of the literature implies that the disease is rare, but it is more likely that it is only rarely reported. As the virus is autoinoculable and transmissible, the etiologic factor in this case of oral condylomata acuminatum is most likely orogenital contact. This case report serves as a reminder also that oroanogenital contact expands the anatomic range of sexually transmitted diseases.

Bilateral white corrugated lesions on the lateral tongue surface.

A patient with bilateral hairy leukoplakia and candidiasis of the tongue was diagnosed and described. Lesions of the tongue that should be considered in the differential diagnosis include: idiopathic clinical leukoplakia, tobacco-induced leukoplakia, frictional keratosis, edema, lichen planus, galvanic lesions, geographic tongue, maceration, and chronic hyperplastic candidiasis. Hairy leukoplakia occurs predominantly on the tongue as in the patient described. The typical presentation is easily diagnosed but atypical cases may be diagnosed by their lack of response to antifungal treatment and histological exclusion of other lesions. The natural history of hairy leukoplakia needs further study. Hairy leukoplakia has not been reported in patients not infected by HIV; therefore, patients with hairy leukoplakia should be considered highly suspect for subsequent development of AIDS.

Slowly enlarging pedunculated mass on the edentulous maxillary alveolar ridge.

Peripheral ossifying fibroma is a fairly common, benign, reactive lesion that should be included in the differential diagnosis of slow-growing, nonaggressive tumors arising in the tooth-bearing areas of the jaws. The variations in terms and descriptions may require that the clinician communicate with the pathologist to determine the true nature of the lesion. Although peripheral ossifying fibroma is a benign, reactive lesion, the recurrence rate is fairly high and postoperative follow-up is needed.

Multiple asymptomatic yellowish-white nodules on the free gingiva.

Gingival plane xanthomas are unusual oral presentations of hyperlipidemia and they may be of minimal clinical significance to the patient because they are asymptomatic. However, the presence of gingival xanthomas should be considered as a possible precursor of an underlying life-threatening disease process. Many of these systemic conditions may severely compromise dental therapy; they include atherosclerotic coronary disease, peripheral vascular disease, diabetes mellitus, biliary cirrhosis, multiple myelomas, leukemia, and hyperthyroidism. Clinicians should be aware of this association and its important implications.

A well-circumscribed, asymptomatic, sessile nodule on the right side of the soft palate.

An atypical presentation of a verruciform xanthoma is discussed. Usually the surface of the lesion is rougher and more warty, and the lesions generally are larger. The foregoing case, however, serves to illustrate that all lesions, regardless of how small or innocuous, should be examined microscopically to determine a diagnosis and to develop a proper treatment plan. Rarely can a definitive diagnosis be made entirely on the basis of the clinical characteristics of the lesion.

Multiple, painful oral ulcerations in a patient with Hodgkin's disease.

The frequent occurrence of the oral lesions of histoplasmosis in combination with disseminated infection necessitates prompt recognition and diagnosis. The possibility of such an infection occurring in an immunocompromised patient should be considered high on the list of differential diagnoses, and treatment should be planned accordingly. The varied clinical presentations of histoplasmosis, ranging from shallow ulcers to nodular or vegetative masses, can be confusing and may lead to inaccurate diagnosis with resultant delay in treatment or inappropriate treatment. Submission of adequate tissue sections for microbiological and histopathological assessments is crucial.

Slowly enlarging, nontender mass in the right submandibular region.

Slow-growing, soft tissue masses in the submandibular region of the neck frequently are caused by tumors of the submandibular salivary gland. These neoplasms are most commonly benign and characteristically develop during a prolonged period--often, during 15 or more years. The recommended treatment is excision of the gland, and, if adequately performed, the probability of the tumor's recurring is insignificant.

Symmetrical widening of the periodontal ligament space in a patient with multiple systemic problems.

Progressive systemic sclerosis is an uncommon disease that affects the collagen in multiple organ systems. Characteristic oral manifestations that may complicate dental treatment include limited opening, TMJ dysfunction, mucogingival problems, xerostomia, and pathological resorption of the mandible.

Rapidly developing, edematous swelling of the upper lip.

Clinicians should distinguish between hereditary and non-hereditary angioedema, as management of patients varies significantly with each. As many patients with hereditary angioedema have had serious episodes of edema associated with dental procedures, it is important that dentists understand the nature of this disease and its treatment. The potential for airway obstruction by laryngeal edema requires a knowledge and preparedness for initiation of life-support measures.

Persistent, painful ulcerations of the hard palate and buccal mucosa.

C albicans is an opportunistic fungus that produces infection almost exclusively in debilitated or immunocompromised people. The importance of the recognition of candidiasis is not only in the prompt institution of appropriate therapy but also in the identification and treatment of underlying systemic disease. The high rate of occurrence of candidiasis in patients with AIDS or ARC, often as the first symptom, is of significance to the dental practitioner, who may be the first health professional to see such patients.

Multiple nodules on the tongue of a patient with seizures.

Systemic cysticercosis with cerebral involvement is a serious disease that may be encountered with greater frequency in the southwestern United States because of the proximity to areas of endemic disease. Because oral lesions can occur, the dentist and dental specialists, by recognizing and performing biopsies of lesions in patients suspected of having the disease, can provide a valuable service.

Multiple, shallow, circinate mucosal erosions on the soft palate and base of uvula.

Stomatitis areata migrans is an uncommon oral disease that may affect mucous membranes other than the tongue or be concomitant with geographic tongue. The clinical appearance emulates geographic tongue at an ectopic site, and the lesions rarely are symptomatic.

Multiple, painless, verruciform nodules on the mucosa of the lower lip.

Oral condyloma acuminatum is an uncommon infectious disease of viral origin. Clinicians should be aware that the lesions of this disease are autoinoculable and also may be transmitted as a venereal disease. In patients with oral lesions, a history of sexual contact as a source of transmission usually can be obtained.

Flattened papillary mass on the posterior hard palate.

An unusually large, asymptomatic, exophytic mass of the palate with a papillary surface architecture--characteristic of an oral squamous papilloma--has been presented. The cause of the squamous papilloma is unknown. Surgical excision, with microscopic examination of removed tissue, is the preferred treatment. Recurrence or malignant change, or both, are unusual.

Painless, irregularly shaped erythematous area on the middorsum of the tongue.

Regardless of what name is used to identify the lesion and its nature of origin, clinicians should be aware of the clinical features and biologic activity of this relatively common oral abnormality and be prepared to reassure patients of the innocuous nature of the lesion.

Expansile radiolucent mass in the maxilla.

The adenomatoid odontogenic tumor is an uncommon, extremely benign odontogenic lesion that should be differentiated from the other osseous lesions. The surgical management should be conservative without expectation of recurrence.