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Oropharynx (Teeth (Congenital syphilis (Hutchinson teeth), Bulimia…

- - - - 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
    - - Riboflavin deficiency
      - most common cause is Monilia (Candida)
    - - upper and lower lips are extremely swollen
      - onset is sudden, and the lesions are nontender
      - most common etiology is drug reaction, especially to sulfonamides
    - - Diffuse swelling of the upper and lower lips with mild discomfort
    - - Fever blisters (“cold sores”)
    - - precancerous lesion on the lips
    - - Syphlitic chancre
      - mucous patches of secondary syphilis
- - - - 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 warty or corrugated projections, particularly on the lateral aspects of the tongue and cheeks that cannot be scraped off with a tongue blade
      - occurs in persons seropositive for the acquired immunodeficiency syndrome (AIDS),
      - other immunosuppressed conditions
    - - White reticulated lesions and erosions clinically identical to lichen planus
      - Onset of chronic GVH disease is between 100 and 400 days after transplantation
    - - White Patches like flecks of cottage cheese, can be scraped off, although that often leaves a denuded bleeding undersurface
      - frequent presenting sign of human immunodeficiency virus (HIV) infection
- - - - linear pigmentation of the gums
    - - Bleeding gums
      - Hypertrophy of the gums
- - - - 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
    - - Absence of saliva in the gingival-labial fold is positive evidence of dehydration, even in the patient who is mouth breathing
    - - 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
    - - mucosa can develop spots of melanin, as if someone had sprinkled black fountain pen ink on the buccal mucosa
- - - - 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
    - - ammoniacal breath odor
      - Fetor hepaticus, on the other hand, has a musty component because of mercaptans, dimethyl sulfide, and dimethyldisulfide
    - - musty, like a mouse
    - - ammoniacal breath odor
      - there is a second, fishy component of dimethylamine and trimethylamine. Additionally, the breath of chronic renal failure often smells uriniferous.
    - - Freshly baked brown bread
    - - breath odor of acetone
      - like the breath after chewing fruit-flavored chewing gum.