Brown to Black

Question 1

DIFFUSE

Answer 1

◦ Physiological Pigmentation
◦ Smoker’s Melanosis
◦ Drug-related Discoloration
◦ Brown Hairy Tongue

Question 2

ISOLATED

Answer 2

◦ Melanotic Macule
◦ Non-amalgam tattoo (Graphite)
◦ Melanocytic Nevus
◦ Oral Melanoma

Question 3

Physiologic/Racial Pigmentation

Answer 3

Darken of the gingiva tissue, most commonly on attached gingival area
Typically found in African American and Asian patients
Anterior gingival area and palate are most common sites
Tx: None

Question 4

Drug-Related Discoloration

Answer 4

Antimalarial drugs (chloroquine)
Antibiotics (minocycline)
◦ Typically seen in adolescent patients being treated for acne
Hormones (Estrogen)
◦ Birth control pills
Result from long term use, NOT single or new onset use
Hard palate and gingiva typically show most discoloration

Question 5

Brown Hairy Tongue

Answer 5

Exogenous staining of the filiform papillae
Bismuth found in Pepto-Bismol can cause staining
Bacterial and fungal overgrowth can lead to discoloration
◦ Certain foods, antibiotics, medicines, tea/coffee, dehydration, xerostomia,
poorer oral hygiene and mouthwashes with peroxide/witch hazel or menthol
can all contribute
TX: Increase oral hygiene, stop causative agent or increase salivary flow

Question 6

Melanotic Macule

Answer 6

Common lesion that results from focal increase in melanin
Solitary, round to oval shaped macule
◦ Brown-grey-black in color
Commonly occurs on lip, buccal mucosa, gingiva and palate
TX: Not required, no malignant potential. Make note of color, border
configuration and diameter.
◦ Can be excised if sudden onset occurs or rapid growth
◦ Only way to DX is with excisional biopsy
Diff Dx: Melanocytic nevus, Amalgam or graphite tattoo, late stage
ecchymosis

Question 7

Amalgam or Graphite Tattoo

Answer 7

Grey or blue colored macule found on gingiva, palate or alveolar ridge
area
Due to entrapment of foreign body or debris
◦ Clinical restorative history will help with diagnosis
◦ Review previous radiographs or restorative work completed
◦ Radiopaque area or foreign body may appear on radiograph
Tx: None, continue to monitor size and shape or macule

Question 8

Melanocytic Nevus

Answer 8

Benign proliferation of nevus cell
Common on skin, Uncommon in mouth, but will likely occur on
palate
◦ Palate, buccal mucosa, gingiva, lip
Blue nevus and intramucosal nevus are most common type
85% are pigmented AND 70% are elevated
◦ No elevation in macule
Tx: Excisional biopsy to R/O malignancy, Malignancy is rare
Diff Dx: Melanotic macule, amalgam or graphite tattoo

Question 9

Oral Melanoma
Oral Melanoacanthoma

Answer 9

Melanoma
◦ Most common site is palate or gingiva
Oral melanoacanthoma
◦ Rapidly enlarging lesion found in African American populations