Gingival plane xanthomas are unusual oral presentations of hyperlipidemia and they may be of minimal clinical significance to the patient because they are asymptomatic. However, the presence of gingival xanthomas should be considered as a possible precursor of an underlying life-threatening disease process. Many of these systemic conditions may severely compromise dental therapy; they include atherosclerotic coronary disease, peripheral vascular disease, diabetes mellitus, biliary cirrhosis, multiple myelomas, leukemia, and hyperthyroidism. Clinicians should be aware of this association and its important implications.