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.

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