The document discusses various oral white and red lesions. It describes lesions that appear white due to conditions like increased keratinization, edema or fungal infections. Red lesions are caused by thinning of epithelial cells and increased vascularization. Common white lesions covered include leukoplakia, lichen planus, candidiasis and hairy leukoplakia. Red lesions discussed are smoker's palate and morsicatio. Reactive, premalignant, infectious, immunopathologic and traumatic causes of white and red oral lesions are summarized.

1. ORAL WHITE & RED LESIONS

2. ORAL WHITE LESIONS
Why lesions appear white?
Increased epithelial thickness without keratin (acanthosis)
Increased surface keratin
Increased edema between epithelial cells
Necrosis of surface epithelium
Surface fungal colonies
Ectopic white structures

3. ORAL WHITE LESIONS
Why lesions appear white?
Immune mediated conditions
Overgrowth of white structure
Viral Infection
Cancer
Idiopathic

4. ORAL RED LESIONS
Why lesions appear RED?
Thinning of (atrophy) epithelial cells (Decreased No. of these cells)
Increased vascularization

5. ORAL WHITE LESIONS
Classification:
Hereditary Conditions
Leukoedema
White Sponge Nevus
Hereditary Benign Epithelial Dyskeratosis
Follicular Keratosis

6. ORAL WHITE LESIONS
Classification:
Reactive Lesions
Focal (Frictional) Hyperkeratosis
White lesions associated with smokeless tobacco
Nicotine Stomatitis
Hairy Leukoplakia
Hairy Tongue
Dentifrice-associated Slough

7. ORAL WHITE LESIONS
Classification:
Preneoplastic and Neoplastic lesions
Actinic Cheilitis
Idiopathic Leukoplakia

8. ORAL WHITE LESIONS
Classification:
Other White Lesions
Geographic Tongue
Lichen Planus
Lupus Erythromatosus

9. Classification:
Non-epithelial White- Yellow Lesions
Candidiasis
Mucosal Burns
Submucous Fibrosis
Fordyce`s Granules
Ectopic Lymphoid Tissue
Gingival Cyst of New-born
Parulis
Lipoma
ORAL WHITE LESIONS

10. Infectious diseases:
Oral Candidiasis
Hairy Leukoplakia
 Premalignant
Leukoplakia & Erythroplakia
Submucous Fibrosis
 Immunopathologic Diseases
Oral Lichen Planus
Drug-induced Lichenoid Reactions
Lichenoid Reaction of GVHD
Lupus Erythromatosis
ORAL WHITE & RED LESIONS (BURKET)

11. Allergic reactions
Lichenoid Contact Reactions
Reactions to Dentifrice & Chlorhexidine
 Toxic Reactions
Reactions to Smokeless Tobacco
Smoker`s Palate
 Reactions to Mechanical Trauma
Frictional Keratosis
Marrsicatio
ORAL WHITE & RED LESIONS (BURKET)

12.  Other Red & White Lesions
Benign Migratory Glossitis
Leukoedema
White Sponge Nevus
Hairy Tongue
ORAL WHITE & RED LESIONS (BURKET)

13. INFECTIOUS DISEASES
 Oral Candidiasis:
Definition:
•It is an opportunistic fungal infection of the oral mucosa.
•It is divided into primary and secondary infections.
•It is a disease of very young, old or sick.

14. INFECTIOUS DISEASES
 Oral Candidiasis:
Etiology & Pathogenesis:
•C. albicans, C. trapicalis, C. glabrata.
•Adherence to epithelial surface.
•Overcome constant desquamation of surface epithelial cells.
•Local & systemic predisposing factors.

15. INFECTIOUS DISEASES
 Oral Candidiasis:
Epidemiology:
•35% prevalence of Candida in normal oral flora.
•90% with improved detection techniques.
•Women, summer months, hospitalized patients, blood group O and nonsecretion of blood group antigens.
•50% prevalence of denture stomatitis.

16. INFECTIOUS DISEASES
 Oral Candidiasis:
Clinical Findings:
Pseudomembranous candidiasis (Thrush).
•The classic candida infection.
•Antibiotic medications.

17. INFECTIOUS DISEASES
 Oral Candidiasis:
Clinical Findings:
Erythematous candidiasis.
•Atrophic Candidiasis.
•Inhalation steroids.

18. INFECTIOUS DISEASES
 Oral Candidiasis:
Clinical Findings:
Chronic Plaque-type and Nodular Candidiasis.
•Candidal Leukoplakia.
•Malignant transformation.

19. INFECTIOUS DISEASES
 Oral Candidiasis:
Clinical Findings:
Denture Stomatitis:
•Denture-bearing palatal areas.
•Candida-associated infection..

20. INFECTIOUS DISEASES
 Oral Candidiasis:
Clinical Findings:
Angular Cheilitis:
•Nutritional deficiency.
•Denture stomatitis related.
•Candida-associated infection.

21. INFECTIOUS DISEASES
 Oral Candidiasis:
Clinical Findings:
Median Rhomboid Glossitis:
•Smoking, denture wearers &
inhalation steroids.
•Candida-associated infection.

22. INFECTIOUS DISEASES
 Oral Candidiasis:
Clinical Findings:
Secondary Oral Candidiasis (CMC):
•Immune deficiency and systemic MC.
•Many systemic diseases.

23. INFECTIOUS DISEASES
 Oral Candidiasis:
Diagnosis:
•Clinical presentations.
•Smear, swab, imprint culture, impression culture, salivary culture, oral rinse.
•Histopatholgy.

24. INFECTIOUS DISEASES
 Oral Candidiasis:
Treatment:
•Identify & modify/eradicate/correct the predisposing factors.
•Polyene antifungal (Amphotericin B and Nystatin).
•Azole antifungal (Clotrimazole, Miconazole, Ketoconazole, Fluconazole, Itraconazole).

25. INFECTIOUS DISEASES
Hairy Leukoplakia:
Definition:
Is a white lesion on the lateral borders of the tongue and associated with AIDS.

26. INFECTIOUS DISEASES
Hairy Leukoplakia:
Etiology & Pathogenesis:
•EBV
•Low CD4
•Low CD1a+ Langerhans` Cells

27. INFECTIOUS DISEASES
Hairy Leukoplakia:
Epidemiology:
•Prior to HAART era.
•AIDS patients.
•Gender.
•Smoking.

28. INFECTIOUS DISEASES
Hairy Leukoplakia:
Clinical Findings:
•Vertical white folds oriented as a palisade along the borders of the tongue.
•May also be displayed as white and somewhat elevated plaque, which cannot be scraped off.
•Symptomless.

29. INFECTIOUS DISEASES
Hairy Leukoplakia:
Diagnosis:
•Clinical features.
•Histopathology.
•Detection of EBV.

30. INFECTIOUS DISEASES
Hairy Leukoplakia:
Treatment:
•Antiviral.

31. PREMALIGNANT LESIONS
Oral Leukoplakia & Erythroplakia:
Definition:
•WHO definition.

32. PREMALIGNANT LESIONS
Oral Leukoplakia & Erythroplakia:
Etiology & pathogenesis:
•Genetic.
 Activation of Oncogenes.
 Deletion and Injuries to Suppressor genes.
 Deletion and Injuries to DNA repair genes.
Predisposing factors.

33. PREMALIGNANT LESIONS
Oral Leukoplakia & Erythroplakia:
Epidemiology:
•Leukoplakia:
3%
50 years
Men

34. PREMALIGNANT LESIONS
Oral Leukoplakia & Erythroplakia:
Epidemiology:
•Erythroplakia:
 0.02-0.1
 Equal gender risk

35. PREMALIGNANT LESIONS
Oral Leukoplakia & Erythroplakia:
Clinical findings:
•Leukoplakia:
 Homogenous.
Non-homogenous.

36. PREMALIGNANT LESIONS
Oral Leukoplakia & Erythroplakia:
Clinical findings:
•Erythroplakia:

37. PREMALIGNANT LESIONS
Oral Leukoplakia & Erythroplakia:
Diagnosis:
•Provisional clinical diagnosis.
•Definitive clinical diagnosis.
•Biopsy.
 Definable Vs. No definable lesion.

38. PREMALIGNANT CONDITIONS
Oral Submucous Fibrosis:
Definition:
•Is a chronic disease that affects the oral mucosa as well as the pharynx and the upper two-thirds of the esophagus.

39. PREMALIGNANT CONDITIONS
Oral Submucous Fibrosis:
Etiology & Pathogenesis:
•Betel quid (Areca nuts) [Arecoline]
•Genetic Predisposition:
•TNFα, TGFβ, IFУ.
•HLA-A10, B7, DR3.

40. PREMALIGNANT CONDITIONS
Oral Submucous Fibrosis:
Epidemiology:
•South Asia with great geographic variations.
•Women > Men in some geographic areas.
•Men in 20s years.

41. PREMALIGNANT CONDITIONS
Oral Submucous Fibrosis:
Clinical Findings:
•Early Lesion(s).
•Later course of the
disease.
•Defective oral
functions.

42. PREMALIGNANT CONDITIONS
Oral Submucous Fibrosis:
Diagnosis:
•Clinical Presentation.
•Patient history.

43. PREMALIGNANT CONDITIONS
Oral Submucous Fibrosis:
Diagnosis:
•International Criteria:
 Palpable Fibrotic Bands.
 Tough and leathery mucosal texture.
 Blanching of the mucosa.
 Histopathological features.

44. PREMALIGNANT CONDITIONS
Oral Submucous Fibrosis:
Treatment:
•Habit cessation.
•Different unproved treatment strategies.

45. IMMUNOPATHOLOGIC DISEASES
Oral Lupus Erythromatosus.
Definition:
•An inflammatory connective tissue disease with variable features, frequently including fever, weakness and fatigability, joint pains or arthritis resembling rheumatoid arthritis, diffuse erythematous skin lesions on the face, neck, or upper extremities.

46. IMMUNOPATHOLOGIC DISEASES
Oral Lupus Erythromatosus.
Etiology & pathogenesis:
•Innate and adaptive Immune dysregulation.
•Environmental factors.
•Genetic factors.

47. IMMUNOPATHOLOGIC DISEASES
Oral Lupus Erythromatosus.
Epidemiology:
•Women.
•Reproductive age
•Ethnic variations.

48. IMMUNOPATHOLOGIC DISEASES
Oral Lupus Erythromatosus.
Clinical findings:
•Oral Lesions Variations.
•Palatal lesions
•Malar Rush.

49. IMMUNOPATHOLOGIC DISEASES
Oral Lupus Erythromatosus.
Diagnosis:
•Anti-DNA, anti-smith antibodies.
•Lupus band test.
•Histopathology.

50. Oral Lupus Erythromatosus.
Diagnosis:
•Diagnostic criteria:
 Malar rash
 Discoid lesions
 Photosensitivity
 Oral ulcers
Arthritis of > 2 joints
 Serositis
 Renal disorders
 Neurologic disorder
 Hematologic disorder
 Immunologic disorder
IMMUNOPATHOLOGIC DISEASES

51. IMMUNOPATHOLOGIC DISEASES
Oral Lupus Erythromatosus.
Treatment:
•The disease treatment strategies.
•Oral Lesions:
 High potent local steroids.
 Intralesional steroids.
 Antifungal/chlorhexidine.

52. TOXIC REACTIONS
Reactions to Smokeless Tobacco
Types & epidemiology of Smokeless Tobacco:
South Asia
US
Scandinavia

53. TOXIC REACTIONS
Reactions to Smokeless Tobacco
Clinical Manifestations:
•In its mildest form, the lesion may just be noted as wrinkles at the site of application.

54. TOXIC REACTIONS
Reactions to Smokeless Tobacco
Clinical Manifestations:
•Whereas high consumers may display a white and leathery lesion, which sometimes contains ulcerations

55. TOXIC REACTIONS
Reactions to Smokeless Tobacco
Clinical Manifestations:
•Gingival retractions.
• Oral mucosal lesions are less frequently observed in association with chewing tobacco.

56. TOXIC REACTIONS
Reactions to Smokeless Tobacco
Cancerogenicity Risk:
•Chewing and moist impose minimal risk.
•Dry has the highest risk.

57. TOXIC REACTIONS
Smoker`s Palate:
•White leathered lesions of the palate.

58. REACTIONS TO MECHANICAL TRAUMA
Morsicatio:
•Is instigated by habitual chewing.

59. REACTIONS TO MECHANICAL TRAUMA
Frectional Keratosis:
•White lesion observed in areas of the oral mucosa subjected to increased friction caused by, for example, food intake.

60. OTHER WHITE & RED LESIONS
Benign Migratory Glossitis (Geographic Tongue)
•Is an annular lesion affecting the dorsum and margin of the tongue.
•The lesion is also known as erythema migrans.
•The typical clinical presentation comprises a white, yellow, or gray slightly elevated peripheral zone

61. OTHER WHITE & RED LESIONS
Benign Migratory Glossitis (Geographic Tongue)

62. OTHER WHITE & RED LESIONS
Leukoedema:

63. OTHER WHITE & RED LESIONS
White Sponge Nevus:

64. OTHER WHITE & RED LESIONS
Hairy Tongue:

65. THE END