BackgroundOral pigmentation can be either normal or abnormal discolouration of the oral mucosa. Objective: To help clinicians establish a better approach towards the care of patients with pigmented oral lesions and to establish early diagnosis and treatment of such conditions. Data source: Works of literature concerning oral pigmentations, clinical features and treatment were reviewed thoroughly from renowned electronic databases such as PubMed, Medline, Google Scholar, and Cochrane Library and personal clinical experience in managing such conditions. The following words were used for the search: oral pigmentation, aetiology, and clinical presentations. Findings: Oral pigmentation presents in various clinical patterns that can range from just physiologic changes to oral manifestations of systemic diseases and malignancies. Oral pigmentation may be physiological or pathological. Knowledge of the different presentations of oral pigmented lesions is quite crucial to improve and mastering the skill of differential diagnosis, definitive diagnosis and prompt treatment. The deposition of pigments in oral tissues may be due to various etiological factors. It can arise from intrinsic and extrinsic factors and can be physiological or pathological. Conclusion: A good understanding of the various presentations of oral pigmented lesions would aid in the proper diagnosis and treatment of the condition.