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Pigmented Lesions, Chris Martin DEN 222 6/14/2020 All information…
Pigmented Lesions
Pigmentation Associated w/ Drugs
Minocycline Tissue Staining (Black Bone Staining)
etiology:
ingestion of minocycline
method of transmission:
n/a
characteristics:
generalized darker pigmented areas in alveolar, palatal, vestibule areas; lips may appear slightly darker; teeth are blue/gray; black to brown focal/generalized staining throughout and toward roots of teeth
dental implications:
pts may request bleaching and other cosmetics
tx & prognosis:
discontinue medication, good prognosis
AZT (Asidothymidine or Retrovir)
Smoking-Associated Melanosis
etiology:
tobacco products that stimulate the production of melanocytes
method of transmission:
n/a
characteristics:
pigmentation of lips and labial gingiva; degree of pigmentation associated w/ amount of tobacco used; pigmented tongue and elongation of filiform papillae; diffuse, light brown color
dental implications:
tobacco cessation
tx & prognosis:
tobacco cessation; discontinued use results in less pigmentation and maybe complete resolution
Betel Quid Use
seen in Asia, Taiwan, Papua New Guinea, India, and neighboring countries; quid placed in mouth and held for extended periods; high risk of oral cancer
Toomback Use
seen in Sudan; high risk of oral cancer; leaves of Nicotiana rusticata plant
Other Metal Pigmentations
Titanium Implants
titanium ions can cause rxns leading to gray-blue tissue around gingiva and in papillae associated with a titanium implant
Intentional Tattooing
usually seen in oral vestibular tissue
Heavy Metal Pigmentation
excessive ingestion, inhalation, or prolonged cutaneous exposure to arsenic, bismuth, platinum, lead, silver, copper, mercury; rarely seen because of new safety practices
Congenital or Genetic Disorders
Nevus (Blue Nevus)
etiology:
mole seen orally; benign; genetic predisposition involved
method of transmission:
n/a
characteristics:
intramucosal nevus is rare; usually found in palate and buccal regions; gray/brown/blue; well-circumscribed and slightly raised
dental implications:
closely monitor; biopsy
tx & prognosis:
surgical removal; biopsy
Oral Melanotic Macule (Focal Melanosis)
etiology:
increase in melanin deposits; not associated with sun exposure
method of transmission:
n/a
characteristics:
flat, well-delineated; uniform color; occur in multiples on buccal mucosa; seen on lip, palate, and gingiva; brown/blue/black
dental implications:
monitor closely for changes that may be suspicious
tx & prognosis:
malignant transformation possible; biopsy suggested
Variations of Normal
Physiologic Pigmentation
etiology:
may occur during pregnancy or post-menopause bc of increased hormones
method of transmission:
n/a
characteristics:
typically associated with skin color; oral pigmentation ranges from brown/black/dark blue; does NOT blanch; not caused by excess blood in the area
dental implications:
some pts concerned about cosmetic factors
tx & prognosis:
no tx, excellent prognosis
Traumatic or Inflammatory Lesions
Amalgam Tattoo (Focal Argyrosis)
etiology:
amalgam particles embedded within tissue
method of transmission:
n/a
characteristics:
typically adjacent to amalgam restoration; localized; gray/blue/black; on gingiva; opaque metal fragments seen radiographically
dental implications:
rule out pathology
tx & prognosis:
no tx, excellent prognosis
Disease-Associated Melanosis
Laugier-Hunziker Pigmentation or Syndrome (LHS, Idiopathic Lenticular Mucocutaneous Pigmentation)
etiology:
unknown
method of transmission:
n/a
characteristics:
nail involvement; develop in midlife; dark brown pigmentation seen in buccal mucosa and lips; may involve palate, gingiva, floor of mouth, and tongue
dental implications:
may occur suddenly
tx & prognosis:
benign, but proper diagnosis is crucial; wear sunscreen daily
Neoplasms
Oral Melanoma
etiology:
unknown; tobacco, chronic irritation, formaldehyde exposure, family hx, and cryogenic defects may play a role
method of transmission:
n/a
characteristics:
commonly seen in hard palate and MX gingiva; brown/red/black/blue; raised, irregular borders; rapid growth, deep invasive nature; exophytic or ulcerative; asymmetry
dental implications:
deadly lesion that should be recognized and removed promptly; pain is not a feature; easily misdiagnosed
tx & prognosis:
poor prognosis compared to other melanomas; excision with wide margins; chemo and radiation may be necessary
Chris Martin
DEN 222
6/14/2020
All information gathered from pages 353-371 of Delong & Burkart's
General and Oral Pathology for the Dental Hygienist