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

Course Author(s): Michael W. Finkelstein, DDS, MS;Emily Lanzel, DDS, MS;John W. Hellstein, DDS, MS

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 planusMultiple 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) stomatitisHard palate; mainly in pipe or cigar smokers.
Hairy tongueDorsum of tongue.
Hairy leukoplakiaLateral surface of tongue; patient is immunocompromised, e.g. AIDS.
White sponge nevusMultiple lesions affecting broad areas of mucosa; familial history; present from early age; genital & rectal mucosa may be affected.
LeukoedemaBilateral 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.
HyperkeratosisMay 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
CandidosisHistory of antibiotic therapy, immunosuppression; xerostomia; nail and/or vaginal lesions may be present
Burn (thermal or chemical)History of burn.
Dried, thick salivaRemoved with wet gauze.
SUBEPITHELIAL WHITE LESIONS
Asymptomatic; smooth to palpation; surface is translucent.
CystsSmall 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 scarringHistory of injury or surgery; usually poorly defined.