Clinical  and Radiographic Findings

Clinical examination reveals multiple well-demarcated pinpoint-sized dark brown macules of a graded shade of brown (Fig 1). The largest is about 1 mm in diameter and is present in the area apical to teeth #s 23 and 24. There was no induration or palpation sensitivity. The patient had a full set of teeth and fair oral hygiene. Radiographically, tooth #1 was partially impacted, #2 was fully erupted with decay, and #32 was horizontally impacted. Localized periodontal disease in areas adjacent to teeth #s 2 and 31 were identified. There was no evidence of swelling or lymphadenopathy.

Figure 1. This is clinical photograph representing the first clinical presentation where multiple small and pigmented lesions are noted on the anterior mandibular gingiva. The pigmented lesions range in color from tan to very dark brown.