Oropharynx

Lips

Different diagnostic clues

Peutz-Jeghers syndrome

Rendu-Osler-Weber syndrome

Angular stomatitis

Stevens-Johnson syndrome

Crohn disease

HSV- Type 1

Leukoplakia

Syphilis

Syphlitic chancre

mucous patches of secondary syphilis

precancerous lesion on the lips

Fever blisters (“cold sores”)

Diffuse swelling of the upper and lower lips with mild discomfort

Riboflavin deficiency

most common cause is Monilia (Candida)

10 to 20 pigmented maculae around the mouth and lips, 1 mm in size and like apple jelly in color

small, round, circumscribed lesions around mouth and lips. red,
like senile hemangiomas or cherry-red spots

upper and lower lips are extremely swollen

onset is sudden, and the lesions are nontender

most common etiology is drug reaction, especially to sulfonamides

Tongue

Different diagnostic clues

Kawasaki disease in children

MEN type 2B and MEN 3

Syphilis

Leukoplakia

chronic graft versus host (GVH) disease

Candidiasis

White Patches like flecks of cottage cheese, can be scraped off, although that often leaves a denuded bleeding undersurface

white warty or corrugated projections, particularly on the lateral aspects of the tongue and cheeks that cannot be scraped off with a tongue blade

frequent presenting sign of human immunodeficiency virus (HIV) infection

occurs in persons seropositive for the acquired immunodeficiency syndrome (AIDS),

other immunosuppressed conditions

tongue can become so red and inflamed that it resembles a strawberry, due to the desquamation of the filiform papillae

similar finding seen in scarlet fever and toxic shock

Mucosal neuromas

most of the tongue fissures are longitudinal

White reticulated lesions and erosions clinically identical to lichen planus

Onset of chronic GVH disease is between 100 and 400 days after transplantation

Teeth

Congenital syphilis

Bulimia

Sjögren syndrome

Fluorosis

Tetracycline administration

brown teeth

brown-and-black pits

Lipstick adhering to the teeth suggests dry mucous membranes

Erosion of the enamel on the lingual, palatal, and posterior surfaces of the teeth because of frequent contact with gastric acid

Hutchinson teeth

Gums

Diagnostic clues

Lead poisoning

Scurvy

Bleeding gums

Hypertrophy of the gums

linear pigmentation of the gums

Buccal Mucosa

Diagnostic clues

Measles

Dehydration

Xerostomia

Primary chronic adrenocortical insufficiency

mucosa can develop spots of melanin, as if someone had sprinkled black fountain pen ink on the buccal mucosa

buccal mucosa will appear pale and dry because of epithelial atrophy and the loss of the mucous coating. The tongue blade sticking to the oral mucosa is a crude but probably valid indicator of oral dryness

Absence of saliva in the gingival-labial fold is positive evidence of dehydration, even in the patient who is mouth breathing

Koplik spots are white, the size and color of grains of salt, each on an erythematous background, and are seen on the buccal mucosa, especially around the orifice of the Stensen duct and the lower labia

ECHO virus 9 and coxsackie A16 infections may have oral mucosal spots just like Koplik spots

Odor

Diagnostic clues

Cyanide poisoning

Pseudomonas

hepatic failure

Phenylketonuria (PKU)

chronic renal failure

Typhoid

Diabetic ketoacidosis

breath odor of acetone

like the breath after chewing fruit-flavored chewing gum.

ammoniacal breath odor

there is a second, fishy component of dimethylamine and trimethylamine. Additionally, the breath of chronic renal failure often smells uriniferous.

Fetor hepaticus, on the other hand, has a musty component because of mercaptans, dimethyl sulfide, and dimethyldisulfide

smell of bitter almonds from breath

This is due to hydrogen cyanide gas, which is intensely toxic. (Vomitus from such patients must be handled with care, lest medical personnel also be affected by the cyanide.)

sweet smell

musty, like a mouse

Freshly baked brown bread