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  • Leukoedema is the most common benign oral condition related to individuals with skin of color.

  • No treatment is necessary for leukoedema.

  • Oral cancer incidence rate is similar among African Americans and Caucasians, but the mortality rate is higher in African Americans due to late diagnosis and lack of access to medical care.

  • Screening and early detection of oral cancer are important to decrease the high mortality and morbidity rates in African Americans.

  • Physiologic oral pigmentation is due to greater melanocytic activity rather than higher number of melanocytes.

  • Some oral conditions are seen more commonly in Native Americans.

  • In contrast to cutaneous melanoma, oral melanoma is as equally prevalent in African Americans as in Caucasians.

Evaluation of the patient with oral complaints requires an organized approach that consists of obtaining a complete medical, dental, dermatologic, family, and social and medication history. Also important are the use of medications, herbs, and vitamins, as well as a history of all possible allergic reactions, a physical examination, and evaluation of any available laboratory studies.

The physical examination includes evaluation of the musculoskeletal and soft tissues of the head and neck including lymph nodes, thyroid and salivary gland palpation, and a complete mucocutaneous examination including conjunctiva and nasal mucosa. Intraoral examination requires proper visualization with an intraoral dental mirror and a bimanual palpation of the soft and hard tissues of the head and neck including the lips, gingiva, temporomandibular joint, neck, and tongue. A complete evaluation requires the use of gauze to dry the mucosa and to facilitate visual inspection and palpation of the lips and tongue. Evaluation of the teeth and periodontal status is necessary as well.

Laboratory studies, including scrapings, cytology, serum studies, cultures, and biopsies, should be performed when indicated. This chapter will focus on the oral diseases that are commonly present in African Americans and other individuals with skin of color.


The external margin of the lips (ie, the transition zone between skin and mucous membrane) is known as the vermilion. It is pink to brown in color, hairless, and covered by a thin dry epithelium; at the junction of the vermilion and the lips, the vermilion border is slightly palpable except in advanced age or with chronic sun exposure [Figure 56-1].

FIGURE 56-1.

Lips showing the vermilion border, the junction between skin and oral mucosa, in an Asian man.

Intraorally, the oral cavity is divided into the vestibule and the oral cavity proper. The vestibule is limited by the gingiva and the teeth medially and by the labial and buccal mucosa laterally. The superior and the inferior of the vestibule are called vestibular sulci. Anterior and lateral frena traverse the vestibular sulci from the lip and buccal mucosa to the ...

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