University Of Aden Faculty of Dentistry Department of Oral Surgery 2012-2013Oral Medicine Associate Prof. Dr. Muhgat Abdo Oral& Dentofacial Surgeonmuhgatabdo@hotmail.dewww.adendent-faculty.net
Oral Medicine IntroductionWhite Lesions ofThe Oral Mucosa
Oral Medicine IntroductionWhite lesions of the oral mucosa are amultifactorial group of disorders, the color ofwhich is produced by the scattering of the lightthrough an altered epithelial surface.The diagnosis and differential diagnosis of oralwhite lesions should be made on the basis of themedical history, clinical features, and laboratorytests.
Oral Medicine White Lesions Leukoplakia1. Hairy leukoplakia2. Lichen planus3. Lichenoid reactions4. Linea alba5. Nicotinic stomatitis6. Uremic stomatitis7. Cinnamon contact stomatitis8. Chemical burn9. Candidiasis10. Chronic biting11. Geographic tongue12. Hairy tongue13. Furred tongue
Oral Medicine White Lesions Leukoplakia14. Materia alba of the gingiva15. Fordyce’s granules16. Leukoedema17. White sponge nevus18. Dyskeratosis congenita19. Pachyonychia congenita20. Focal palmoplantar and oral21. mucosa hyperkeratosis syndrome22. Papilloma23. Verrucous carcinoma24. Squamous-cell carcinoma25. Skin and mucosal grafts26. Epithelial peeling
Leukoplakia Definition and EtiologyLeukoplakia is a clinical term, and the lesion isdefined as a white patch or plaque, firmlyattached to the oral mucosa, that cannot be classified as any other.disease entity. It is a precancerous lesionThe exact etiology remains unknown. Tobacco,alcohol, chronic local friction, and Candidaalbicans are important predisposing factors.Human papilloma virus (HPV) may also be.involved in the pathogenesis of oral leukoplakia
Leukoplakia The Clinical FeatuersThree clinical varieties are recognized:1.Homogeneous (common).1.Speckled (less common). Homogeneous2.Verrucous (rare).Speckled and verrucous leukoplakia have a greaterrisk for malignant transformation than thehomogeneous form.
Leukoplakia The Clinical FeatuersThree clinical varieties are recognized:The buccal mucosa, tongue, floor of the mouth,gingiva, and lower lip are the most commonlyaffected sites.Verrucous Speckeld
Leukoplakia Treatment1. Elimination or discontinuation of predisposing factors, systemic retinoid compounds.2. Photo Documentation.3. Surgical excision is the treatment of choice after Biopsy result.Therapy:A. Good Oral Hygiene.B. Vitamin A+E Tab. 1xBDx4 Weeks.C. Vitamin B Complex 1xBDx4 Weeks.D. Mouth Wash.
White Lesion Hairy LeukoplakiaDefinition : is an unusual form of leukoplakia that isseen only in people who are infected with HIV, haveAIDS, or AIDS-related complex. It consists of fuzzy,hence the name "hairy," white patches on the tongueand less frequently elsewhere in the mouth. It mayresemble thrush, an infection caused by the fungusCandida which, in adults, usually occurs if yourimmune system is not working properly, and may be.one of the first signs of infection with the HIV virusEtiology : Epstein–Barr virus seems to play an.important role in the pathogenesis
White Lesion Hairy Leukoplakia: Clinical featuresThe presence of white or gray coloredpatches on your tongue, gums, roof ofyour mouth, or the inside of the cheeksof your mouth may be a sign ofleukoplakia. The patch may havedeveloped slowly over weeks to monthsand be thick, slightly raised, and mayeventually take on a hardened andrough texture. It usually is painless, butmay be sensitive to touch, heat, spicy.foods, or other irritation.The lesion is not precancerous
White Lesion Hairy LeukoplakiaTreatment, if needed, involves removing the source ofirritation. For example, if leukoplakia is caused by arough tooth or an irregular surface on a denture orfilling the tooth will be smoothed and dental. appliances repairedIf leukoplakia is caused by smoking, you will be asked to minimize or stop.smoking or using other tobacco productsHairy leukoplakia requires treatment with an insome cases aciclovir or valaciclovir can be used with.success. antiviral medication products
White Lesion Hairy Leukoplakia1. Elimination or discontinuation of predisposing factors, systemic retinoid compounds.2. Photo Documentation.3. Surgical excision is the treatment of choice after Biopsy result.Therapy:A. Good Oral Hygiene.B. Vitamin A+E Tab. 1xBDx4 Weeks.C. Vitamin B Complex 1xBDx4 Weeks.D. Mouth Wash.E. Control every Weeks.
White Lesion Lichen PlanusDefinition: Lichen planus is a relatively commonchronic inflammatory disease of the oral mucosa.and skinEtiology: Although the cause is not well known, Tcell-mediated autoimmune phenomena are.involved in the pathogenesis of lichen planus
White Lesion Lichen Planus (Etiology)A minority of patients may have disease that closelymimics lichen planus, both clinically andhistologically, and are described as ‘lichenoidlesions’. Examples include lichenoid drug reactions,anti-hypertensive agents including beta blockers]thiazide diuretics, angiotensin converting enzymeinhibitors5 and calcium channel blockers,sulphonylureas, anti-malarials, gold, penicillamine,allopurinol6 and nonsteroidal anti-inflammatoryagents], lichenoid reactions seen in close proximity toamalgam restorations ]and other metallic and also
White Lesion Lichen PlanusClinical features: White papules that usuallycoalesce, forming a network of lines (Wickman’sstriae), are the characteristic oral lesions of thedisease. Six forms of the disease are recognized inthe oral mucosa, classified according to: frequency1.The common (reticular, erosive).2.The less common (atrophic,hypertrophic).1.The rare (bullous, pigmented).The prognosis of lichen planus is usually good.
White Lesion Lichen Planus: Differential diagnosisDrug induced "lichenoid" reactionsDiscoid / Systemic lupus erythematosusNon specific ulcerationCandidosisLeukoplakiaHairy LeukoplakiaMucous Membrane PemphigoidPemphigusWhite sponge naevus and othergenodermatoses
White Lesion Treatment of Lichen PlanusTreatment: Not required; however, in some casesaciclovir or valaciclovir can be used with success.No treatment is needed in asymptomatic lesions.Topical steroids (ointment in Orabase, intralesionalinjection), may be helpful.Systemic steroids in low doses can be used in severeand extensive cases.The topical use of antiseptic mouthwashes should beavoided.
White Lesion Lichenoid ReactionsDefinition : Lichenoid or lichen planus reactions area heterogeneous group of lesions of the oral mucosa that show clinical and histopathological similarities.to lichen planus, but have a different courseEtiology : Hypersensitivity to dental restorativematerials, amalgam, composite resins and dentalplaque accumulation are the most common causativefactors. Rarely, a reaction to drugs may be. responsible
White Lesion Lichenoid ReactionsClinical features: Clinically, they appear as whiteand/or erythematous lesions, usually associated with . peripheral delicate white striaeErosions are also common. The lesions mimic erosive. lichen planusCharacteristically, the lesions are strictly confined tothe mucosa directly in contact with the restorative. materials, and do not migrate to other sitesThe lesions disappear after removal of the adjacent. material. The diagnosis: is usually made clinically diagnosis
White Lesion Lichenoid ReactionsLaboratory tests: A skin punch test may be helpful.in some casesDifferential diagnosis: Lichen planus, fixed drug eruption, discoid lupus erythematosus, cicatricial.pemphigoid, cinnamon contact stomatitisTreatment: Replacement of the restorative material,polishing and smoothing, and good oral hygiene arerecommended. Topical steroid treatment for a short.time is also helpful
White Lesion Lichenoid ReactionsLichenoid reaction to dentalamalgam and cold: white anderythematous lesions on the.buccal mucosa Lichenoid drug reaction to allopurinol: white hyperkeratotic lesions and superficial erosions on the .sides of the tongue
White Lesion Linea AlbaDefinition: Linea alba is a relatively common.alteration of the buccal mucosaEtiology: Pressure, sucking.from the buccal surface of the teethClinical features: It presents as anasymptomatic, bilateral, linear elevation with aslightly whitish color at the level of the occlusalline of the teeth . It has a normal consistency on palpation. The diagnosis.is based on clinical grounds alone.Treatment: No treatment is required
White Lesion Nicotinic StomatitisDefinition : Nicotinic stomatitis, or smoker’s palate,is a common tobacco- related type of keratosis thatoccurs exclusively on the hard palate, and isclassically associated with heavy pipe and cigar. smokingEtiology : The elevated temperature, rather than the.tobacco chemicals, is responsible for this lesion
White Lesion Nicotinic StomatitisClinical features: Clinically, the palatal mucosainitially responds to the high temperature withredness. Later, it becomes wrinkled and takes on adiffusely grayish-white color, with numerousmicronodules with characteristic punctate redcenters, which represent the inflamed and dilated . orifices of the minor salivary gland ductsThe lesions are not premalignant, in contrast to the “reverse smoker’s palate” lesion, which is associated.with reverse smoking. The diagnosis: is usually made clinically diagnosis
White Lesion Nicotinic StomatitisLaboratory tests: Usually not required. However, a.histopathological examination is useful.Differential diagnosis: Reverse smoker’s palate.Leukoplakia. Discoid lupus erythematosus.Candidiasis. Lichen planus.Treatment: Cessation of smoking
White Lesion CandidiasisDefinition : Candidiasis is the most common oralfungal infection. Over the last two decades, the.disease has taken on major importanceEtiology : It is usually caused by Candida albicans,and less frequently by other fungal species (C.(.glabrata, C. krusei, C. tropicalis, C. parapsilosisPredisposing factors are local (poor oral hygiene,xerostomia, mucosal damage, dentures, antibioticmouthwashes( and systemic (broad-spectrumantibiotics, steroids, immunosuppressive drugs,radiation, HIV infection, hematologicalmalignancies, neutropenia, iron-deficiency anemia,(.cellular immunodeficiency, endocrine disorders
White Lesion Candidiasis: Clinical features: Oral Candidiasis is classified asPrimary: consisting of lesions exclusively on the •.oral and perioral areaSecondary: consisting of oral lesions of.mucocutaneous disease:Primary Candidiasis: includes five clinical varieties•Pseudomembranous.•Erythematous.•Nodular.•Papillary hyperplasia of the palate.•Candida-associated lesions. (angular cheilitis,
White Lesion CandidiasisThe main forms of candidiasis that produce white: lesions are the following:Pseudomembranous CandidiasisIs the most common form of thedisease, and is clinically characterizedby creamy-white, slightly elevated,removable spots or plaques . Thelesions may be localized or generalized,and appear more frequently on thebuccal mucosa, soft palate, tongue, andlips. Xerostomia, a burning sensation,and an unpleasant taste are the most.common symptoms
White Lesion Candidiasis: Nodular CandidiasisIs a chronic form of the disease; it, appears clinically as a white, firm and raised plaque that usually.does not detach: Mucocutaneous CandidiasisIs a heterogeneous and rare group ofclinical syndromes, characterized bychronic lesions of the skin, nails, andmucosa, and usually associated withimmunological defects. Clinically, theoral lesions appear as white andusually multiple plaques, which cannot .be removed
Oral Medicine White Lesions1. Leukoplakia2. Hairy leukoplakia3. Lichen planus4. Lichenoid reactions5. Linea alba6. Nicotinic stomatitis7. Candidiasis8. Uremic stomatitis9. Cinnamon contact stomatitis10. Chemical burn11. Chronic biting12. Geographic tongue13. Hairy tongue14. Furred tongueMateria alba of the gingiva
Oral Medicine White Lesions15 White sponge nevus16 Dyskeratosis congenita17 Pachyonychia congenita18 Focal palmoplantar and oral mucosa hyperkeratosis syndrome19 Papilloma20 Verrucous carcinoma21 Squamous-cell carcinoma22 Skin and mucosal grafts23 Epithelial peeling