Table 1. White Surface Lesions of Oral Mucosa

EPITHELIAL THICKENING WHITE LESIONS
Asymptomatic; rough to palpation; fixed to the surface (won’t rub off)

Lichen planus

Multiple areas of mucosa involved; bilateral distribution; white plaques arranged in striated pattern associated with erythema; ulcers may be present; skin lesions may be present.

Nicotine (nicotinic) stomatitis

Hard palate; mainly in pipe or cigar smokers.

Hairy tongue

Dorsum of tongue.

Hairy leukoplakia

Lateral surface of tongue; patient is immunocompromised, e.g. AIDS.

White sponge nevus

Multiple lesions affecting broad areas of mucosa; familial history; present from early age; genital & rectal mucosa may be affected.

Leukoedema

Bilateral on buccal mucosa. Disappears when tissue is stretched.

Erythema migrans (geographic tongue, benign migratory glossitis)

Multiple red patches with irregular yellow-white border; dorsal lateral tongue; lesions migrate; usually asymptomatic.

Hyperkeratosis

May resolve spontaneously.

Epithelial dysplasia
Carcinoma-in-situ
Superficially invasive squamous cell carcinoma

Persistent; usually asymptomatic; more common as red lesion or mixed red and white lesion.

SURFACE DEBRIS WHITE LESIONS
Pain or burning; rubs off; submucosal erythema

Candidosis

History of antibiotic therapy, immunosuppression; xerostomia; nail and/or vaginal lesions may be present

Burn (thermal or chemical)

History of burn.

Dried, thick saliva

Removed with wet gauze.

SUBEPITHELIAL WHITE LESIONS
Asymptomatic; smooth to palpation; surface is translucent.

Cysts

Small cysts of oral mucosa can appear white. Examples are congenital keratotic cyst and lymphoepithelial cyst.

Fordyce granules (ectopic sebaceous glands)

Yellow, circumscribed, in clusters; most commonly located on buccal mucosa and upper lip.

Mucosal scarring

History of injury or surgery; usually poorly defined.

A Guide to Clinical Differential Diagnosis of Oral Mucosal Lesions
Table 1. White Surface Lesions of Oral Mucosa