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Pigmentation, Burkhart, N.W., & Delong, L. (2019). General and Oral…
Pigmentation
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Variations of Normal
Physiologic Pigmentation
- Etiology: Usually found in the gingiva but can occur throughout the mouth. May occur through pregnancy from increased hormone levels.
- Method of Transmission: Not applicable
- Characteristics:
1) Extraoral: Pigmentation can occur extraorally and may be associated with disease states and with a genetic predisposition.
2) Perioral and intraoral: Oral melanin pigmentation may range from brown or blak to dark blue. The deeper pigmentation is usually black.
3) Distinguishing: Physiologic-pigmented lesions do not blanch because they are due to melanin production and not to blood pooling within the tissues as a vascular pigmentation produces.
- Dental Implications: Some patients complain about the cosmetic factors related to physiologic pigmentation when pigmentation is noticeable such as on the gingiva or perioral tissues. The tongue and gingiva may be visible when speaking, and the appearance may be troublesome to the patient. Some patients may want to have the pigmented area removed for esthetic reasons.
- Treatment and Prognosis: Prognosis is excellent, and no treatment is required once a definitive diagnosis is condirmed.
Pgs. 354-355
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Neoplasms
Oral Melanoma
- Etiology: Malignant of the head and neck region are rare and account for 0.2 to 0.5% of all melanomas in the United States. More common in areas of the world where the sun is more intense. Tobacco use, family history, and cytogenetic defects may play some role in its development.
- Method of Transmission: Not applicable
- Characteristics:
1) Extraoral: The cutaneous lesions related to melanoma.
2) Perioral and Inraoral: The most commonly affected sites are the hard palate and maxillary gingiva. Usually brown, red, black, and even black-bluish color and may be slightly raised, with irregular borders. Lesions grow rapidly with a deep invasive nature. Asymmetry and irregular borders are key signs related to melanomas.
3) Distinguishing: The intraoral melanoma may appear as a dark blue or black pigmented area with irregular borders increasing as the lesion continues to expand.
- Dental implications: The intraoral melanoma is a deadly lesion that should be recognized and removed in its earliest stage.
- Treatment and Prognosis: Poorer prognosis related to the rich vascular network. Early detection and treatment are of extreme importance. Chemotherapy and radiation for head and neck cancers may be used as well, depending upon the size, location, and progressive nature of the lesion.
Pgs. 370-372
Burkhart, N.W., & Delong, L. (2019). General and Oral Pathology for the Dental Hygienist (3rd). Philadelphia: Wolters Kluver. pp. 352-372