| 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. |
