Pigmentary Changes involving the Oral Cavity

Question 1

What is this an example of?

Answer 1

Amalgam tattoo

Question 2

Describe the shape of an oral melanoma lesion

Answer 2

Irregular, poorly defined borders & thickening in nodular phase

Question 3

What is this an example of?

Answer 3

Amalgam tattoo

Question 4

Where are amalgam tattoos commonly found?

Answer 4

Mandibular gingivae and alveloar mucousa

Question 5

What is this an example of?

Answer 5

Black hairy tongue with geographic tongue

Question 6

Besides OHI what should be implemented in a patients brushing routine with black hairy tongue?

Answer 6

Tongue brushing

(but avoid excessive brushing which may worsen prominent filiform)

Question 7

What is an oral melanoma?

Answer 7

Malignant tumour of Melanocytes

Question 8

Where are common sites for oral melanoma lesions?

Answer 8

Palate (most common)
Lips
Gingivae

Question 9

When a graphite tattoo is expected what should be done?

Answer 9

Biopsy mandatory to rule out malignancy

Question 10

What is this an example of?

Answer 10

Ethnobotanical tattooing

Done by African tribes on women for rites of passage

Question 11

Oral melanotic macules found on the lip may arise due to what?

Answer 11

Lesions on the lip may represent reaction to sun damage

Question 12

What is this an example of?

Answer 12

Varices

Question 13

At a cellular level what causes oral melanotic macules?

Answer 13

Focal increase in melanin production

Question 14

What can be prescribed to a patient to help manage black hairy tongue?

Answer 14

Oxidising mouthwash (peroxyl)

Question 15

What is this an example of?

Answer 15

Black hairy tongue

Question 16

What is this an example of?

Answer 16

Black hairy tongue

Question 17

What is this an example of?

Answer 17

Amalgam tattoo

Question 18

What is the prognosis of oral melanoma?

Answer 18

Poor prognosis of 5-20% 5 year survival

Often metastasises as it has a rich blood and lymph node supply

Question 19

Where are graphite tattoos commonly seen?

Answer 19

Often seen on anterior palate of younger children
(from chewing of graphite pencils)

Question 20

What can spontaneous ecchymosis (brusing) suggest?

Answer 20

May indicate platelet/coagulation disorder or leukaemia

Question 21

What is the clinical name of an amalgam tattoo?

Answer 21

Focal Agyrosis

Question 22

What is this an example of?

Answer 22

Oral melanotic macules

Question 23

What are some predisposing factors of black hairy tongue?

Answer 23

Antiseptic mouthwash use
Broad spectrum antibiotics
Heavy smokers
Poor OH

Question 24

What is this an example of?

Answer 24

Graphite tattoo

Question 25

What is this an example of?

Answer 25

Metal salt deposition

From bismuth, lead, mercury salts

Question 26

What groups of individuals have predisposing factors for oral melanoma?

Answer 26

Females
African & Japanese
People with increased UV radiation exposure

Question 27

What is this an example of?

Answer 27

Ecchymosis (bruising)

Question 28

When can amalgam tattoos arise?

Answer 28

Following;
XLA of an amalgam-filled tooth
Removal of amalgam restoration

Question 29

What causes oral melanotic macules?

Answer 29

Focal increase in melanin production

Question 30

What happens in the oral cavity during black hairy tongue?

Answer 30

Elongation of filliform papillae
Where pigment producing bacteria can grow
This causes extrinsic staining