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Mouth and Mucous Membranes

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beefy tongue, black hairy tongue, glossitis, leukoplakia, parotid swelling

anodontia Christ-Siemens-Touraine s., IP

beefy tongue

glossitis due to vitamin B deficiency; alcoholism, pernicious anemia

Biederman’s sign

dark red color of anterior pillars of throat; syphilitics (some)

black hairy tongue

hyperplasia of filiform papillae with bacterial overgrowth; alcoholism, systemic illnesses

burning tongue

iron deficiency, pernicious anemia

carp’s mouth

narrowed mouth width; Plummer-Vinson s.

cerebriform tongue

deep rugate fissures of tongue; pemphigus vegetans (Hallopeau)

Chadwick’s sign

dark blue or purple color of vaginal mucosa; pregnancy


actinic prurigo, artichokes, beta blockers, dentrifices, glucagonoma s., idiopathic calcinosis cutis, oranges, Kawasaki’s d., lipstick, mangos

chelitis, angular

acrodermatitis enteropathica, atopic dermatitis, Candida, Down s., hypersalivation, mechanical, Plummer-Vinson s., protein deficiency, riboflavin deficiency, S. aureus infection, Streptococcal infection

cobblestone, lips

idiopathic calcinosis cutis

cobblestone oral mucosa

Cowden d., Crohn d., Darier d.

Corrigan’s sign

purple line at junction of teeth & gum; chronic copper poisoning

Cupid's bowMenkes
enamel pitsJEB, tuberous sclerosis


erythema multiforme, lichen planus, pemphigoid, pemphigus

fissured tongue

geographic tongue (20%), Melkersson-Rosenthal triad

floating teethLoss of mandibular & maxillary bone leading to loose teeth; eosinophilic granuloma 

Forscheimer spots

pinpoint rose colored macules & petechiae on soft palate; rubella

gingival bleedingacute leukemia

gingival hyperplasia

epilepsy, HSM, acute leukemia, medications, mental retardation, nail hypoplasia, sensorineural hearing loss, Zimmerman-Laband s.

gingival pigmentation

amalgam tattoo, azidothymidine, betel nut chewing, bismuth, heavy metals, minocycline, phenolphthalein, quinacrine, silver nitrate, tattooing, tobacco chewing,


Chediak-Higashi s., diabetes mellitus, Herpes simplex, Letterer-Siwe d., leukocyte adhesion s., lichen planus, lupus erythematosus, neutropenia, rosacea, scurvy

gingivitis, desquamative

cicatricial pemphigoid, lichen planus, pemphigus vulgaris

gingivitis, marginal

cyclic neutropenia


alcoholism, biotin deficiency, Candida, carcinoid s., secondary lues, folic acid deficiency, geographic tongue, giant cell arteritis, griseofulvin ingestion, hypertrichosis lanuginosa, median rhomboid glossitis, necrolytic migratory erythema, Plummer-Vinson s., primary amyloidosis, tricyclic administration, penicillamine, vitamin B1 deficiency, vitamin B2 deficiency, vitamin B12 deficiency, zinc deficiency


painful tongue; folate deficiency, geographic tongue, vitamin B12 deficiency


burning tongue;

gum hypertrophy

Cross-McKusick-Breen s., Darier’s d., dilantin administration, juvenile hyaline fibromatosis, mercury administration

hairy leukoplakia

HIV, immunosuppression

Hutchinson teethSmall, widely spaced teeth with central notching; congenital syphilis

Koplik spots

white spots on buccal mucosa; measles, coxsackievirus A16, echovirus 9

Krisovski’s sign

cicatricial lines radiating from the mouth; congenital syphilis

lead lines

blue-black macule on gingiva margin from insoluble sulfide salts; bismuth therapy, lead intoxication

lentigo; lips

Albright’s s., Laugier-Hunziger s., neurofibromatosis, Peutz-Jeghers s., labial melanotic macule


gray-white thickening of oral mucous membrane; pachyonychia congenita (60%)


alcoholism, dyskeratosis congenita

lingua plicata 

Cowden’s d., Down s., idiopathic (autosomal dominant), Melkersson-Rosenthal s.


acromegaly, amyloid (systemic), Beckwith-Wiedeman s., Down s., gangliosidosis, Hurlers, hypothyroidism, Morateux-Lamy s., mucopolysaccharidoses, Robinow s., sarcoidosis, Sturge-Weber s.

macrostomiaenlarged mouth width: Barber-Say s.
mulberry molarssixth year molars with multiple poorly developed cusps; congenital syphilis
natal teethpoorly formed (usually lower) incisors present at birth; Ellis van Creveld s., Hallerman-Streiff s., isolated, Pierre Robin s., Soto s.

oral melanosis

Addison’s d., Albright’s s., amalgam tattoo, bismuth, lead, Peutz-Jeghers s., Riehl’s melanosis

oral pain

pemphigus vulgaris

papillae of tongueabsent in familial dysautonomia
peg teethhypohidrotic ectodermal dysplasia, IP

pigment, intraoral

amalgam tattoos, oral melanoacanthoma, Peutz-Jeghers s., Addison’s d., hemochromatosis, neurofibromatosis

raspberry tongue

strawberry tongue

scrotal tongue (lingua plicata)

Cowden’s d., Down s., idiopathic (autosomal dominant), Melkersson-Rosenthal s.

smooth tongue

vitamin B deficiency

sore tongue

pernicious anemia


acute atrophic oral candidiasis, cancrum oris, glucagonoma, griseofulvin, Kawasaki’s s., lazy leukocyte s., 6-mercaptopurine, methotrexate, penicillamine administration, Reiter’s s., Stevens-Johnson s., tricyclic administration


painful mouth


burning mouth

strawberry gingivitis

Wegener’s granulomatosis (pathognomonic)

strawberry tongue

hyperplastic lingual papillae; Kawasaki’s s., scarlet fever, TSS

teeth, conicalIP 


oral candidiasis; antibiotic use, diabetes mellitus, HIV, infants, steroid use,

tongue, atrophic

achlorhydria, ariboflavinosis, cardiac disease, iron deficiency anemia, malabsorption, megaloblastic anemia, pellagra, Plummer-Vinson s., pernicious anemia

tongue, beefy red

cobalamin deficiency, glucagonoma s.

tooth pit

punctate tooth enamel defect; tuberous sclerosis (>4 teeth)

white strawberry tongue

white coating with reddened hypertrophied papillae protruding through; scarlet fever

Wickham’s striae

reticulate white lines on papules & buccal mucosa; lichen planus

wooden tonguelipoid proteinosis


aging, medications, RA, Sjögren’s s.

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