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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\u2010supporting 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\u2010language 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\u2010text 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.<\/jats:p>","DOI":"10.1155\/ijod\/7197720","type":"journal-article","created":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T06:30:41Z","timestamp":1791873041000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Contemporary Classification and Diagnostic Pathways for Common Gingival and Alveolar Ridge Lesions"],"prefix":"10.1155","volume":"2026","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0778-5299","authenticated-orcid":false,"given":"Hamed","family":"Mortazavi","sequence":"first","affiliation":[{"name":"Department of Oral Medicine School of Dentistry Shahid Beheshti University of Medical Sciences  Tehran Iran  sbmu.ac.ir"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5311-1260","authenticated-orcid":false,"given":"Aida","family":"Kheiri","sequence":"additional","affiliation":[{"name":"Department of Periodontics School of Dentistry Shahid Beheshti University of Medical Sciences  Tehran Iran  sbmu.ac.ir"},{"name":"Dental Research Center Research Institute of Dental Sciences Shahid Beheshti University of Medical Sciences  Tehran Iran  sbmu.ac.ir"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0718-751X","authenticated-orcid":false,"given":"Shaghayegh","family":"Khoshgou","sequence":"additional","affiliation":[{"name":"Department of Periodontics School of Dentistry Shahid Beheshti University of Medical Sciences  Tehran Iran  sbmu.ac.ir"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7776-5421","authenticated-orcid":false,"given":"Ehsan","family":"Chegeni","sequence":"additional","affiliation":[{"name":"Department of Periodontics School of Dentistry Shahid Beheshti University of Medical Sciences  Tehran Iran  sbmu.ac.ir"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4227-933X","authenticated-orcid":false,"given":"Hamidreza","family":"Eghbalikhosro","sequence":"additional","affiliation":[{"name":"Department of Periodontics School of Dentistry Shahid Beheshti University of Medical Sciences  Tehran Iran  sbmu.ac.ir"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-6284-4263","authenticated-orcid":false,"given":"Amirsalar","family":"Mofid","sequence":"additional","affiliation":[{"name":"Department of Oral Medicine School of Dentistry Shahid Beheshti University of Medical Sciences  Tehran Iran  sbmu.ac.ir"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-4418-1911","authenticated-orcid":false,"given":"Zahra","family":"Karami","sequence":"additional","affiliation":[{"name":"Department of Periodontics School of Dentistry Shahid Beheshti University of Medical Sciences  Tehran Iran  sbmu.ac.ir"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,10,12]]},"reference":[{"key":"e_1_2_12_1_2","doi-asserted-by":"publisher","DOI":"10.3390\/dj7010015"},{"key":"e_1_2_12_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaad.2018.09.061"},{"key":"e_1_2_12_3_2","doi-asserted-by":"publisher","DOI":"10.18231\/j.ijpo.2023.052"},{"key":"e_1_2_12_4_2","article-title":"Impact of Oral Mucosa Lesions on the Quality of Life Related to Oral Health. 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