Intraoral colours

IN almost every case oral diseases may be classified scientifically by their colour and there are 50 diseases in which the lesion may be brownish, bluish or black. The colour generally originates from one of the two sources:

(1) the accumulation of coloured material in abnormal amount and/or locations in the superficial tissues, or (2) a pooled clear fluid just beneath the epithelium (uppermost layer of the skin).

The amassed material that affects the colour changes may be either exogenous (external) or endogenous (internal) in origin. The exogenous substances producing the brownish, bluish, black conditions usually include heavy metals not normally found in the body, commercial dyes, vegetable pigments and various other stains that have been either ingested or introduced directly into the tissues. The point of introduction may be at the site of or remote from the lesion in question.

The endogenous chromatic materials producing coloured conditions usually results from increased melanin states or are derived from blood pigments and/or abnormal aggregations of metals normally found in the body. The colour imparted by such materials is a function of not only the amount of pigment but also the depth at which the pigments have been deposited in the tissues. For example, the superficial melanin deposits appear brown whereas the deeper deposits seem more bluish.

Refraction phenomena cause abnormal colouration in superficial fluid-filled cavities such as some cysts and retention phenomena in the minor salivary glands. Although in these conditions the distinctive bluish colour might appear to be due to pigment in the area, it is actually the result of altered reflection and absorption of the light in the area.

Everyone, except some albinos (who suffer from a congenital disease), has a discernable degree of melanin pigmentation distributed throughout the epidermis of the skin.

So technically, it is impossible for a person to be white or black. In dark-skinned persons, it is common to see melanoplakia which are patches of pigmentation anywhere in the mouth.

Varicosities are painless, bluish areas located mainly under the tongue and seen especially in older persons. They are distended veins due to either a structure exerting external pressure or from partial blockage existing in the vessel preventing proper circulation of blood. Amalgam tattoo is a frequently occurring dark bluish lesion usually seen on the gum in mouths in which teeth have been filled with silver amalgam. When gingivitis is present at the time of the procedure, fragments of silver can become embedded in the tissues.

A black hairy tongue is a harmless entity which is the result of an elongation of the filiform papillae found in the upper surface, in some cases to such an extent that they resemble hair. Dark patches sometimes appear on the tongue (geographic tongue) and are also harmless.

These often disappear before the person even is aware of its presence.

Hemangioma, which is dark blue, is a benign tumour of patent blood vessels that may be congenital or traumatic in origin. Kaposi sarcoma which is similar is characteristic of HIV/AIDS.

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