3 Common anatomical abnormalities of the oral mucosa

3.1 Linea alba


Linea alba is an elevation of the buccal mucosa running at the level of the occlusal line from the mouth corner to third molars. Clinically, it manifests as a bilateral linear elevation of a normal mucosal or slightly whitish colour with normal consistence upon palpation. It occurs more frequently in obese individuals in whom the oral mucosa can be slightly compressed and adapted to the shape of the occlusal line of teeth.

Th.: Removal of the mechanical irritation

3.2 Fordyce spots/granules (morbus Fordyce)


Fordyce disease is a developmental abnormality characterized by the occurrence of heterotopic sebaceous glands in the mucosa of the oral cavity. Clinically, it manifests as multiple small, slightly elevated, whitish-yellow well circumscribed granules (only rarely accumulating and forming plaques). They occur most commonly on the mucosal surface of the upper lip, in commissures and on the buccal mucosa bilaterally and symmetrically attached to the molars. It is a relatively common finding and occurs in both genders. They are asymptomatic and although they can become more noticeable with increasing age, they should not cause major concern.

Th.: Without therapy.

Dif. dg.: OLP, candidiasis, leukoplakia.

3.3 Leukoedema


This abnormality is a harmless anatomical variation of the oral mucosa caused by the increased epithelial thickness arising due to an intracellular oedema in the stratum spinosum. It usually occurs bilaterally and can be most commonly found on the buccal mucosa, more rarely on the labial mucosa or tongue. Clinically, the mucosa has opalesque or whitish-grey discoloration and slightly wrinkled appearance that disappears when manually stretching the buccal mucosa. During palpation, leukoedema has a normal consistency and should not be mistaken for leukoplakia or oral lichen planus.

Th.: None.

3.4 Physiological melanin hyperpigmentations


Melanin hyperpigmentations of the oral mucosa are usually a chance finding during the dental examination. They are not usually associated with subjective problems. Melanocytes of the oral mucosa usually do not produce melanin as such, regions of a darker discoloration (melanoplakia) can be however a relatively common finding in dark-skinned persons (racial pigmentations) as in melanocytes of these individuals, bigger melanosomes with a higher activity can usually be found. The pigmentations are usually diffuse, symmetrical, localized especially on gingiva and buccal mucosa, often appearing during childhood.

Physiological pigmentations also present as freckles (ephelides) caused by an increased production of melanin after exposure to sun in fair-haired people with a low photoype. They manifest as multiple brown spots in the solar localization (face, vermilion zone), usually from the childhood.

Th.: Not necessary in physiological pigmentations

Dif. dg.: Increased deposition of dark pigments in the oral mucosa can be a symptom of many diseases. It is necessary to differentiate it from heavy metal deposits (amalgam tattoo inks, metallic pigmentations), drug-induced pigmentation, melanin pigmentations in Addisonʼs disease and Peutz–Jeghers syndrome, pigment nevi, lentigo maligna and malignant melanoma.