This document summarizes several normal anatomical variations that can occur in the oral cavity. It describes variations that can be seen on the buccal mucosa such as leukedema and Fordyce's granules. Variations of the gingiva, tongue, and lips are also discussed including physiologic pigmentation, fissured tongue, median rhomboid glossitis, and commissural lip pits. Finally, some common radiographic variations like idiopathic osteosclerosis and Stafne bone defects are mentioned. For each variation, the document discusses epidemiology, clinical features, diagnosis, and differentiation from pathologic conditions.

1. Dr Megha B
Senior lecturer
Department of Oral Medicine and Radiology
MINDS, MAHE

2. Normal anatomical variations of oral cavity

3. • Introduction
• Fundamental to diagnosing oral pathologic conditions is the
ability to recognize the spectrum of clinical findings that
represents variation of normal within the population.
• Some are purely developmental, while others have a clear
inflammatory or traumatic etiology.

4. • 1.Variation On Buccal Mucosa
• Leukedema
• Fordyces Granule
• Linea Alba
• 2.Variations On Gingiva
• Physiologic Pigmentation
• 3.Variations On Tongue
• Fissured Tongue
• Geographic Tongue
• Oral Varicosity
• Median Rhomboid Glossitis
• Bifid Tongue
• Folliate Papilla
•

5. • 4.Variations On Lips
• Commissural Lip Pit
• Paramedian Lip Pit
• 5.Radiological Variations
• Idiopathic Osteosclerosis
• Focal Osteoporotic Bone Defect
• Stafne Bone Defect

7. • Leukedema
• Common developmental alteration of the oral mucosa which
present most typically as an asymptomatic, bilateral, whitish, grey
semitransparent macule of the buccal mucosa
• Epidemology
• Distribution between genders has
been found to be equal
• The incidence and intensity
increases with age

8. • Clinical features
• White and wheel like alteration of oral mucosa
• bilaterally on buccal mucosa
• Less clinically evident after stretching of the mucosa but
reappear after this manipulation is discontinued

9. • Asymptomatic
• No malignant transformation
• Differential diagnosis
• Clinical examination readily differentiate leukedema from
leukoplakia since there is no loss of pliability or flexibilty of
involved tissue
• In addition tissue affected by leukedema manifest an
edematous state

10. • lichen planus
• White spongy nevus
• cheek biting

12. • Linea alba
• Normal variations which appear as a white line extending from the
corner of the mouth to posterior region at the level of occlusal
plane bilaterally
• Frictional keratosis
• Trauma from facial surface of teeth.

13. • Usually present bilateraly
• It is believed that parakeratosis occur along the line of occlusal
plane as the cheeks sucks in due to negative pressure

15. • Fordyces granule
• Ectopic sebaceous gland located on oral mucosa and vermillion
border of lips
• 80% of the adult population
• More pronounced in males
• Male to female ratio 11:5

16. • Clinical features
• The buccal mucosa and vermillion border are the most common
locations
• Alveolar ridge, gingiva, palate and tongue
• Maculopappular lesions typically smaller than 2mm
• White or cream colour spots
• May occasionally coalesce and form plaque

17. • Treatment
• Not required
• Chemical peel
• Laser
• Surgical diathermy or cryotherapy

19. • Physiological pigmentation
• increased melanotic activity rather than an increase in number of
melanocytes
•
• Africans, Asians and Mediterranean
• both gender
• 1st two decades
Epidemiology
Epidemiology

20. • Clinical features
• Attached gingiva
• light to dark brown
• It appears as bilateral, well demarcated, ribbon like dark brown
band
• The buccal mucosa, hard palate, lips and tongue may also be
affected
• symmetrically distributed

22. • Disease that may be confused with melanin pigmentation are
• Addisons disease ,
• Oral melanotic macule.
• Oral mucosal melanoma,
• Drug induced pigmentation

24. • Geographic tongue
• Is an annular lesion affecting the dorsum of tongue and margins
• Also known as erythema migrans
• Epidemiology
• 1-2.5% prevalence
• Gender distribution is equal

25. • Clinical features
• comprise a white yellow or grey slightly
elevated peripheral zone
• Erythmatous patch =atropy of filiform papilla .
• white border regenerating= filiform papilae and a mixture of
keratin and neutrophil

26. – Tip
– lateral border
– dorsum of the tongue
• Geographic tongue is circumferentially migrating and leaves an
erythmatous area behind
• The peripheral zone disappear after sometime and healing of
depapilated and erythmatous area starts
• The lesion may commence at various starting points, the
peripheral zones fuse and typical clinical features of geographic
tongue appears

27. • single to multiple lesions
• Usually non symptomatic

29. • Fissured tongue
• shallow to deep grooves or furrows
• dorsal surface of the tongue
Epidemiology
• Higher frequency among males
• Hereditary

30. clinical features
• Aging and local environmental factors
• Fissured tongue is diagnosed on the basis of fissures clinically
• Based on the position of the fissures it can be classified as
median and lateral type

31. • Diagnosis
• Clinical features are diagnostic , biopsy is rarely done
• Histology
• Shows increase thickness of lamina propria
• Hyperplasia of rete ridges
• Neutrophillic microabcess in the upper epithelial layer
• Mixed inflammatory infiltrate in lamina propria

33. • Bifid tongue
• A completely cleft or bifid tongue is a rare condition
• A partially cleft tongue is considerably more common and is
manifested simply as a deep groove in the midline of dorsal
surface

34. • The lateral lingual structures rapidly grow and cover the
tuberculum impar to form the anterior two-thirds of the tongue.
When this process is disturbed, tip of the tongue is divided
longitudinally for a certain distance giving rise to cleft
tongue/bifid tongue.
• Mostly associated with orofacial digital syndrome

36. • Median rhomboid glossitis
• Median rhomboid glossitis is clinically characterized by
erythmatous lesion in the center of posterior part of dorsum of
tongue
• Developmental defect resulting from an incomplete desent of
tuberculum impar and entrapment of a portion between
fusing lateral halves of the tongue
• 3:1 male predilection

37. • rhomboid shaped, smooth erythmatous mucosa lacking in
papilla or taste buds
• atropic candidiasis

38. • Clinical features
• Present in the posterior midline of the dorsum of the tongue
• Less than 2cm
• Surface is smooth
• lobulated

39. • kissing lesion
• Occasionally lesions are located somewhat anterior to usual
location. None have been located posterior to circumvallate
papilla

41. • Oral varicosities
• Varicosities are aquired benign lesion of a vein, artery or lymphatic
vessel abnormally dilated and tortuous but in within oral cavity is
only used in reference to venous lesions
• sublingual varix
• Males
• over 50years

42. • Clinical features
• Irregular, blue purple lesion
• Multiple with a bilateral linear distribution
• Thrombosed varix
• Diascopy

44. • Commisural lip pit
• congenital or developmental defects
• Their location suggest that they may represent a failure of normal
fusion of embryonal maxillary and mandibular process

45. • Unilateral or bilateral
• Clinical features
• Invagination is usually 1-2mm in diameter, may be as deep as
4mm and is lined by stratified squamous epithelium

47. • Periapical idiopathic osteosclerosis
• Enostosis
• Dense bone island
• Localized growth of compact bone
• Asymptomatic
• vary in size from 2 mm to 1-2 cm.

48. • Mandible
• Premolar molar area
• Radiographic image- radiopaque
• Asymptomatic
• Etiology – no

49. • margins or capsule
• D/D

51. • Folliate papilla
• Occurs as an area of vertical fold and grooves located on the
extreme posterior lateral surface of tongue
• Occasionaly mistaken for tumours or inflammatory disease
• Bilaterally symmetrical

52. • In some people the papilla are small and inconspicious whereas
in others they are prominent

54. • Stafne bone defect
• First described by Stafne in 1942
• The exact pathogenesis is still obscure.
• Epidemiology
• Men in their
• fifth or seventh decade of life

55. • Stafne suggested that the cavity could result from a failure of
normal bone deposition in the region formerly occupied by
cartilage .
• localized pressure atrophy of the lingual surface of the
mandible from the adjacent salivary gland

56. • Clinical features
• Present as asymptomatic radiolucency below the mandibular canal in
the posterior mandible between the molar and angle of mandible
• well circumscribed
• sclerotic border

57. • Superimposed over the apices of anterior teeth
• Stable in size
• 1 to 3cm in diameter
• below the inferior dental canal
• Incidental
• d/d

64. REFERENCES
1. Burket Oral Medicine: diagnosis and treatment 12th edition
2. Oral Radiology :Principle and nterpretation White and
Pharoah
3. Shafers Textbook of Oral Pathology
4. Oral diseases – Roderich A Cawson, William H Binniew, John
H Wright
5. Oral Radiology :Principle and Interpretation White and
Pharoah

65. Thank you