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Pigmented Lesions of the Oral Mucosa and to Derive a Differential One Diagnosis for Various Pigmented Lesions

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Pigmented Lesions of the Oral Mucosa and to Derive a Differential One Diagnosis for Various Pigmented Lesions 2015 self-study course one course The Ohio State University College of Dentistry is a recognized provider for ADA CERP credit. ADA CERP is a service of the American Dental Association to assist dental professionals in identifying quality providers of continuing dental education. ADA CERP does not approve or endorse individual courses or instructors, nor does it imply acceptance of credit hours by boards of dentistry. Concerns or complaints about a CE provider may be directed to the provider or to ADA CERP at www.ada.org/goto/cerp. The Ohio State University College of Dentistry is approved by the Ohio State Dental Board as a permanent sponsor of continuing dental education ABOUT this FREQUENTLY asked COURSE… QUESTIONS… Q: Who can earn FREE CE credits? . READ the MATERIALS. Read and review the course materials. A: EVERYONE - All dental professionals in your office may earn free CE . COMPLETE the TEST. Answer the credits. Each person must read the eight question test. A total of 6/8 course materials and submit an questions must be answered correctly online answer form independently. contact for credit. SUBMIT the ANSWER FORM Q: What if I did not receive a ONLINE. You MUST submit your confirmation ID? answers ONLINE at: A: Once you have fully completed your us http://dentistry.osu.edu/sms-continuing-education answer form and click “submit” you will be directed to a page with a . RECORD or PRINT THE unique confirmation ID. phone CONFIRMATION ID This unique ID is displayed upon successful submission Q: Where can I find my SMS number? of your answer form. 614-292-6737 A: Your SMS number can be found in the upper right hand corner of your ABOUT your monthly reports, or, imprinted on the toll free back of your test envelopes. The SMS FREE CE… number is the account number for 1-888-476-7678 your office only, and is the same for everyone in the office. TWO CREDIT HOURS are issued for Q: How often are these courses fax successful completion of this self- available? study course for the OSDB 2015-2016 614-292-8752 biennium totals. A: FOUR TIMES PER YEAR (8 CE credits). CERTIFICATE of COMPLETION is used to document your CE credit and e-mail is mailed to your office. [email protected] . ALLOW 2 WEEKS for processing and mailing of your certificate. The Ohio State University College of web Dentistry is an American Dental dentistry.osu.edu/sms Association (ADA) Continuing Education Recognized Provider (CERP). Page 1 PIGMENTED LESIONS OF THE 2015 ORAL MUCOSA course This course will help dental professionals to familiarize themselves with common pigmented lesions of the oral mucosa and to derive a differential one diagnosis for various pigmented lesions. INTRODUCTION clinical appearance. No treatment is necessary, unless for aesthetic Pigmented lesions of the oral reasons. mucosa are one of the leading causes for which patients seek POST-INFLAMMATORY professional treatment. These PIGMENTATION lesions can have a wide spectrum of diagnoses and can be physiologic or Post-inflammatory pigmentation pathologic in origin. A variety of occurs on the oral mucosa which discoloration, including brown, gray, had previous injury or black, blue, purple, and yellow, can inflammation. occur on oral mucosa. Patient history, clinical presentation, and Clinical Features: location can be very helpful in narrowing down the differential Like physiologic pigmentation, diagnosis of these various post-inflammatory pigmentation pigmented lesions. is seen more often in dark-skinned individuals. The discoloration can BROWN, GRAY, AND/OR be focal or diffuse and is commonly seen in patients with BLACK LESIONS chronic mucosal conditions such as lichen planus, pemphigus, and PHYSIOLOGIC PIGMENTATION mucous membrane pemphigoid. Physiologic pigmentation usually Treatment: occurs as diffuse discoloration of oral mucosa in dark-skinned The pigmentation may resolve individuals and it is considered a gradually, once the condition is normal variation. treated. written by Clinical Features: SMOKER’S MELANOSIS neetha santosh, dds The discoloration is usually seen on Smoker’s melanosis is a diffuse the gingiva, but can also involve the pigmentation of the oral mucosa labial mucosa, buccal mucosa, and seen among heavy smokers. edited by the tip of the fungiform papillae of Chemicals in tobacco smoke, such rachel a. flad, bs the tongue. The color can range as nicotine, increases melanin karen k. daw, mba, cecm from light brown to black and is due production which causes the to an increased melanin deposition pigmentation. in the basal layer of oral epithelium. Clinical Features: Treatment: Smoker’s melanosis is frequently Diagnosis is made by a typical seen in light-skinned individuals. Page 2 Females are more likely to be affected due to the Gradual fading of the pigmentation is seen once influence of female sex hormones along with the offending drug is discontinued. smoking. The anterior facial gingiva is the most common location and presents as diffuse, light HAIRY TONGUE brown pigmentation. Hairy tongue is described as a hair-like Treatment: appearance due to the elongation and keratin accumulation on the filiform papillae of the dorsal History of smoking, along with clinical tongue. It can be due to an increase in keratin presentation, is usually sufficient to make a production or a decrease in keratin removal from diagnosis. Smoker’s melanosis will resolve the dorsal surface of the tongue. gradually once the person quits smoking. A biopsy of the area may be required if Clinical Features: pigmentation is in an unusual area, such as the hard palate, or if there are any sudden changes in Hairy tongue is mostly seen in heavy smokers or clinical presentation. people with poor oral hygiene. The midline of the tongue, anterior to the circumvallate papillae, is DRUG-INDUCED PIGMENTATION the most frequent location. Brown, yellow, or black discoloration of elongated filiform papillae A variety of medications such as antimalarial is due to stains from tobacco and food or agents (chloroquine, hydroxychloroquine, and pigment-producing bacteria. quinidine), tranquilizers (chlorpromazine), chemotherapeutic agents, minocycline, estrogen, Treatment: or medications to treat AIDS can cause drug- induced pigmentation of the oral mucosa. The Hairy tongue is diagnosed by its characteristic pigmentation can be due to drug-induced clinical appearance. Scraping the tongue and melanin production or by the deposition of drug improving oral hygiene are the recommended metabolites. treatments. Clinical Features: AMALGAM TATTOO Drug-induced pigmentation can cause the skin An amalgam tattoo is the pigmentation of the and mucosal surfaces to have a diffuse or specific oral mucosa due to the implantation of amalgam. pattern of pigmentation depending on the Amalgam particles can be embedded into the oral medication. Females are more prone to be mucosa during restoration or removal of an affected due to the interaction with sex hormones. amalgam filling, or during the extraction of an Minocycline can cause blue-gray discoloration of amalgam-filled tooth. the bone and developing teeth. It usually affects the hard palate and the facial surface of the Clinical Features: alveolar bone and can also cause rare pigmentation of soft tissues such as the lips, An amalgam tattoo usually appears as a black, tongue, eyes, and skin. Antimalarial drugs and blue, or gray macule and commonly occurs on the tranquilizers can cause blue-black discoloration of gingiva, alveolar mucosa, and buccal mucosa. the hard palate. Estrogen, chemotherapeutic Usually an amalgam-filled tooth can be seen in agents, and medications to treat AIDS can cause the vicinity of the lesion, unless the tooth has diffuse brown pigmentation of the skin and oral been extracted. Amalgam material, which has mucosa. been embedded in the alveolar ridge, can be seen as radiopaque fragments in radiographs of the Treatment: area. Diagnosis can be made by the history of onset of the pigmentation shortly after drug usage. Page 3 Treatment: Treatment: Diagnosis is usually made by the clinical Diagnosis is typically made by the characteristic appearance of the lesion and can be confirmed by clinical presentation of a flat, well-demarcated the presence of radiopaque amalgam fragments brown macule. No treatment is necessary unless in radiographs. If a clinical correlation cannot be for aesthetic reasons. If there is any change in size made or metallic fragments are not detected in a or appearance of the lesion, surgical excision is radiograph, a biopsy of the lesion is the treatment of choice. Excised tissue must be recommended to rule out melanocytic lesions. No submitted for histopathological examination treatment is necessary unless there are aesthetic since the differential diagnosis of an oral reasons. melanotic macule includes the oral melanocytic nevus, amalgam tattoo, and melanoma. NON-AMALGAM TATTOO ORAL MELANOCYTIC NEVUS Graphite tattoos and intentional tattoos are some types of intraoral exogenous pigmentations. The melanocytic nevus, also known as the common mole, is a benign proliferation of nevus Clinical Features: cells. They can be congenital or acquired, depending on the time of occurrence. An Graphite tattoos are commonly seen on the palate intraoral melanocytic nevus is much less common and occur from the accidental embedding of compared to its cutaneous counterparts. graphite particles from a pencil. The hard palate is the most common site of graphite tattoos and an Clinical Features: isolated grayish macule of mucosa (similar to an amalgam tattoo) is seen. Intentional tattoos can The oral melanocytic nevus is more commonly be cultural tattoos seen on the maxillary facial seen in females and is a well-demarcated macule. gingiva or amateur tattoos on the lower labial The color can range from brown to black, mucosa. although it can sometimes present as a non- pigmented macule. Most of them are seen on the Treatment: palate, mucobuccal fold, and the gingiva. A congenital melanocytic nevus is larger in size No treatment is usually necessary. Corticosteroids compared to an acquired nevus.
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