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INTRODUCTION

KEY POINTS

  • Examination of the oral mucosa should be a part of the complete skin examination.

  • Familiarity with variations in normal oral anatomy is essential in distinguishing benign findings from conditions requiring treatment intervention.

  • Recognition of common oral mucosal diseases and their characteristic signs and symptoms is important in initiating prompt and effective therapy.

BENIGN ORAL FINDINGS

Geographic Tongue

Geographic tongue, also known as benign migratory glossitis, is an idiopathic inflammatory condition that is caused by a loss of filiform papillae on the dorsal tongue. It has a prevalence of 1% to 2.5% and is more common in children with diminishing frequency with age.1 In some instances it can be associated with an underlying condition such as psoriasis, hormonal disturbances, diabetes, atopy, psychological stress, Reiter syndrome, Down syndrome, nutritional deficiencies, and fissured tongue. There are also rare reports of a genetic predisposition to the disorder. It has been found to be inversely associated with tobacco smoking.2,3

Geographic tongue is characterized by asymptomatic erythematous patches with a slightly raised border and a centrally denuded area. It typically involves the anterior two-thirds of the dorsal tongue. Patches have well-demarcated and irregular, serpiginous, raised, yellow to white borders [Figures 57-1 and 57-2]. They are migratory, meaning that they change in shape and location over time, and may change within minutes or hours. The migratory pattern and irregular appearance of the lesions can be distressing to the patient. Although most often asymptomatic, some patients may complain of tongue sensitivity, burning, a foreign body sensation, or pain.1,2 Most often, simply reassuring the patient is all that is necessary. However, in symptomatic patients, topical steroids, topical antifungals, topical antihistamines, topical anesthetics, and topical tacrolimus can be used.2,4

FIGURE 57-1.

Geographic tongue: pink patches with white borders on the dorsal tongue.

FIGURE 57-2.

Geographic tongue. Note prominence of white borders. (Used with permission from Henry W. Lim, MD, Henry Ford Hospital, Detroit, MI.)

Palatal and Lingual Tori

The prevalence of oral tori is 12% to 15%.5,6 Some studies have shown an association between oral tori and bruxism (grinding).7 Genetic and environmental factors likely play a role in the development of tori. However, the etiology of tori is unknown.8,9

Tori present as asymptomatic bony sessile protuberances that develop during puberty. Torus palatinus occurs at the midline on the hard palate [Figure 57-3]. Torus mandibularis occurs on the lingual aspect of the mandible [Figure 57-4]. Oral tori are generally benign exostoses that do not require treatment. Tori may be surgically ...

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