Contemporary Classification and Diagnostic Pathways for Common Gingival and Alveolar Ridge Lesions

Oral lesions can be observed in different locations in the oral cavity, including periodontal supporting structures, gingiva, and alveolar ridge. Ranging from benign to potentially malignant lesions, these lesions can be described from various perspectives, including duration, size, origin, number, and clinical characteristics. Early diagnosis of these lesions can highly affect treatment procedures and outcomes, while preserving tooth-supporting tissues. This review aimed to introduce a decision tree for gingival and alveolar ridge lesions. According to the search strategy, a thorough electronic search was conducted in Web of Science, MEDLINE/PubMed, Google Scholar, EMBASE, and Scopus to identify English-language studies published from January 2000 to June 2026. All clinical studies, including case reports and series, clinical trials and cohorts, and reviews, were considered eligible for inclusion. Initial search led to 6472 findings. Following screening and full-text assessment, 129 studies were finally included. According to clinical manifestations, four main groups of gingival and alveolar ridge lesions, named ulcers and erosions, exophytic lesions, white lesions, and pigmented lesions, were introduced. Based on the clinical characteristics of lesions in each group, certain entities were identified for each category. This review presented a clinically based decision tree to enhance the diagnostic accuracy of gingival and alveolar ridge lesions. Applying this decision tree in clinical practice can help with precise diagnosis and appropriate treatment selection, thereby further improving therapeutic outcomes and preserving the integrity of periodontal structures around teeth.