Oral soft tissues are affected by a multitude of pathologic conditions of variable etiology and significance; their appropriate management relies on their accurate diagnosis. Considerable overlapping of the signs and symptoms produced by these diverse conditions poses significant problems for their diagnosis, which can be resolved only through a thorough knowledge of the clinicopathologic characteristics of each condition and a systematic approach to diagnosis. An essential component of the diagnostic process is the formulation of a differential diagnosis, which encompasses the possible diseases and conditions that could account for a specific constellation of oral signs and symptoms. To facilitate the challenging task of differential diagnosis, this review provides comprehensive lists of the various pathologic conditions that pertain to specific oral soft tissue changes. The latter are classified into three major categories: 1) changes in color, 2) surface alterations, and 3) masses or swellings. The first part of this review offered some general considerations for the differential diagnosis of oral mucosal and submucosal lesions and presented the various pathologic conditions that result in color alterations of oral soft tissues. In the second part, lesions producing surface alterations will be reviewed. On the basis of their clinical presentation, the surface alterations of oral tissues are classified into 1) ulcerative, 2) vesiculobullous, and 3) papillary, papular or polypoid lesions; these lesions are further subclassified according to their etiology and/or pathogenesis. The salient features of each disease category and the most important specific diseases are reviewed and recommendations for specific diagnostic approaches and tests are provided.
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