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Physiologic Pigmentation, Amalgam Tattoo, Titanium Implants, Intentional…
Physiologic Pigmentation
Etiology
Melanocytes and increased melanin in area; usually found on the gingiva but can occur throughout the mouth
Category of Lesion
Variation of normal
Differential Diagnosis
Peutz-Jeghers syndorme
Addisons disease
Melanoma
Oral Characteristic
Brown-black to dark blue in color that does not blanch
Treatment
No treatment is needed once definitive diagnosis is confirmed
Epidemiology
Usually found in darker skinned individuals
Increased pigmentation during pregnancy due to hormones
No sex or age predilections
Amalgam Tattoo
Differential disgnosis
Nevus
Melanoma
Cultural tattoo
Etiology
Amalgam particles becoming embedded within tissue
Also called "focal argyrosis"
Category of Lesion
Traumatic of inflammatory lesion
Oral Characteristics
IO: Localized, gray to blue/black in color involving the gingiva and rarely the floor of the mouth; adjacent to amalgam restoration
Treatment
No treatment is needed
Epidemiology
Occurs in all ages, groups and no sex predilection
Titanium Implants
Eitology
Accumulation of titanium ions in tissue
Differential Diagnosis
None
Category of Lesion
Metal pigmentation
Treatment
None
Epidemiology
None
Oral Characteristics
Oral tissue has blue cast with some darker pigmentation at papillae;
Intentional Tattooing
Etiology
Oral tattoo
Differential Diagnosis
None
Category of Lesion
Metal pigmentation
Treatment
None
Epidemiology
None
Oral Characteristics
Darkening of area where ink is applied
Heavy Metal Pigmentation
Etiology
Exposure to various types of metals such as arsenic,bismuth, platinum, lead, sliver, copper, and mercury
Differential Diagnosis
Any pigmented lesion
Category of Lesion
Metal pigmentation
Treatment
Blood tests are needed to determine the extent of heavy metal accumulation
Epidemiology
None
Oral Characteristics
Argyria: slate gray or bluish discoloration, discontinuing exposure
Lead: darkened blue, gray, or black line around gingival margins
Bismuth: thin blue-black line
Minocycline Tissue Staining
Etiology
Also called "Black Bone staining"
Caused by ingestions of minocycline from ance medications
Differential Diagnosis
Physiological pigmentation
Addisons disease
Melanoma
Peutz-Jeghers syndrome
Category of Lesion
Pigmentation due to Drugs
Treatment
No treatment is needed
Epidemiology
All age groups are affeceted, however, more often found in adults
No sex predilection
Oral Charcateristics
generalized darker pigmented areas in the alveolar, palatal, and vestibular areas
Lips may appear slightly darker depending on severity
AZT
Oral Characteristics
Buccal mucosa, tongue, palate and nail beds are common affected areas
Heavy pigmentation
Etiology
Azidothymidine (AZT) used for treatment of AIDS
Category of Lesion
Pigmentation due to Drugs
Differential Diagnosis
Physiological Pigmentation
Treatment
No treatment needed
Epidemiology
Found in patients with AIDS
Smoking Associated Melanosis
Etiology
Tobacco products stimulate production of melanocytes
Differential Diagnosis
Addison Disease
Peutz-Jeghers syndorme
Physiological Pigmentation
Category of lesion
Pigmentation due to Drugs
Treatment
Smoking cessation
Epidemiology
Higher percentage is women, especially those using contraceptives
Any age group can be affected
Oral Characteristics
Light pigmentation occurs with the labial gingiva with the degree of association depending upon the amount of tobacco used
Soft palate experiences light brown pigmentation that diffuses through the area
Tongue pigmentation experiences soft brown with elongation of filiform papillae
Betel Quid Use
Etiology
Arecoline is a substance found in areca nuts. Released when chewed or ground
Considered premalignant
Mixture of tobacco, areca nut, flavoring, slaked lime
Epidemiology
Betel chewing and areca nut use are common in India, Southeast Asia, East Asia, Pakistan, Bangladesh, Nepal, Sri Lanka, China, Taiwan, Melanesia, and the Pacific Islands
Cultural norms are in play, and children may use some of the products at an early age.
The sale and distribution are concentrated, and sales are open to all ages.
Differential Diagnosis
None
Category of Lesion
Drug
Oral Charcateristics
Areca nut has a fibrous core that is chewed and produces a red color that stains the teeth/tissues
Treatment
Cessation of product
Toombak Use
Epidemiology
Oral cancer is 6th leading cancer
Used in Sudan
It is highly addictive and very destructive on the oral tissues
Etiology
Toombak
Category of Lesion
Drug
Differential Diagnosis
None
Treatment
Cessation of product
Oral Characteristics
Oral cancer
Nevus
Differential Diagnosis
Amalgam tattoo
Melanoma
Kaposi sarcoma
Hemangioma
Epidemiology
All age groups are affected
No sex predilection
Whites are affected most often
Oral Characteristics
Intradermal nevus: found in the connective tissue. But termed, the intramucosal nevus when found orally
The junctional nevus is found between the epithelium and the connective tissue
The compound nevus is found in both the basement membrane and the underlying dermis
Etiology
Also called mole
Exposure to sun light
Category of Lesion
Congenital
Treatment
Biopsy is performed to determine malignancy
Oral Melanotic Macule
Differential Diagnosis
Addison disease
Peutz-Jeghers syndrome
Lauger-Hunziker syndrome
Melanoma
Epidemiology
Childhood or 20 to 30 years old
Intraoral lesions usually occur in those older than 40.
3% of population
Lip is most common (AKA: ephelides pl.).
Oral characteristic
Pigmented, flat and well defined
Called a Ephelis when occurs on lip: usually .5 cm and occurred by sun exposure
Etiology
focal pigmented lesion occurs on lip or intraoral tissue
Category of Lesion
Congenital or genetic
Treatment
All pigmented lesion should be biopsied
Laugier-Hunziker Pigmentation
Etiology
Category of Lesion
Disease associated
Epidemiology
Functional alteration of the melanocytes that induce increased synthesis of melanosomes and transport to the basal cell layer
Treatment
Syndrome is benign but laser surgery, cryotherapy can remove of cosmetic purposed
Oral Charcateristics
This disease state may appear as sun damage or as a mere freckle
EO: nail beds are mildly discolored , macules ranging from 1 to 5 mm on toes, fingers, lips and other cutatous areas
IO: Dark brown pigmentation most often seen on buccal mucosa and lips, however, hard/ soft palate, gingiva, floor of mouth and tongue can be involved
Differential Diagnosis
Addisons Disease
Heavy metal pigmentation
Physiological pigmentation
Oral Melanoma
Epidemiology
.02 to 8% of all melanoma
Occurs more in males in the 50-year-old age group
Spreading laterally through tissue
Differential Diagnosis
Intramucosal nevus or blue nevus
Amalgam tattoo
Physiologic pigmentation
Oral Characteristics
Hard palate and MX gingiva are most commonly affected
Brown, red, black or black-bluish color and may be slightly raised with irregular borders
Etiology
Etiology is unknown, but suspected contributors are sunlight, tobacco/alcohol use, genetics, formaldehyde, and more emphasis is being placed on lifestyle factors such as nutrition as well
Category of Lesion
Neoplasm
Treatment
Early detection is important due to growth rate and tendency to metastasize is high; Chemotherapy and radiation for head and neck
