oral white lesions

2. •DEVELOPMENTAL AND VARIANTS OF NORMAL MUCOSA
Fordyces Granules
White sponge nevus
Leukedema
•REACTIVE LESIONS
Lenia Alba
Traumatic/frictional keratosis
White hairy tongue
Tobacco pouch keratosis
Lichenoid reaction
Morsicatio buccarum
•POTENTIALLY MALIGNANT DISORDERS
Homogenous leukoplakia
Proliferative verrucous leukoplakia
Reticular/papular/plaque type lichen planus
Oral submucus fibrosis
Verrucous carcinoma
•INFECTIOUS
Hyperplastic candidiasis
Pseudomembraneous candidiasis
Papilloma
Hairy leukoplakia

3. Oral lichen planus
• Aetiology:immunological reaction-autoimmunity
• :stress
• Clinical features
• 6 clinical variants:
1. Reticular
2 Papular

4. 3. Plaque 5.Erosive
4.Atrophic
6.bullous

5. • Bilaterally present
• Common site;Posterior buccal mucosa
• Seen as WHITE STRIATIONS-known as WICKHAMS
STRIAE
• Erosive lichen planus involving attached gingiva is
termed as DESQUAMATIVE GINGIVITIS-which is
presented as intense sensitivity to hot and spicy food.
• Lichen planus associated with melanin pigmentation-
POST INFLAMMATORY MELANOSIS.
• DD: LICHENOID REACTION

6. TREATMENT
• ASYMPTOMATIC [Reticular/Plaque type]
• Advice on avoidance of risk factors
• Topical antifungal agent-1% CLOTRIMAZOLE to rule out hyperplastic
candidiasis
• Follow every 2 weeks
• ATROPHIC/ULCERATIVE ORAL LICHEN PLANUS
• 1. Stress reduction
• 2.topical anaesthetic-Benzydamine hydrochloride(.15%spray or
mouth rinse)
• 3.Topical antifungal(if lp becomes scrapable)
-CLOTRIMAZOLE 1%cream for 10 days
-ketoconazole 2%cream for 10 days

7. • Topical corticosteroid-(apply 2-3times/day
followed by tapering)
CLOBETASOL PROPIONATE(0.05%)
TRIAMCINOLONE ACETONIDE(0.1%)
FLUOCINONIDE (0.05%)
• Topical vitamin A /retinoids
ISOTRETINOIN GEL 0.1% gel BDx 2months
TACROLIMUS 0.1% oinment

8. • SEVERE,SYMPTOMATIC ATROPHIC/ULCERATIVE ORAL
LICHEN PLANUS unresponsive to topical measures
• Stress reduction-tab ALPRAZOLAM 0.25mg TID x5 days
• Intralesional steroid-10-20mg TRIAMCINOLONE
ACETONIDE diluted with 0.5 ml saline or 2%lidocaine
injected to the lesion 3-4 times/week
• Systemic steroids-PREDNISOLONE 1mg/kg/day
• Topical antifungal:CLOTRIMAZOLE 1%cream
• Other immunomodulatory drugs:Tab LEVAMISOLE
200mg/day x3 months

9. Leukoplakia
• Cause :tobacco, alcohol
• Clinical features
• Cracked mud appearance
• Clinically presented as:- thin /Preleukoplakia/
- thick/smooth/fissured
- nodular/rough/
verruciform
(high malignant potency)
- erythroleukoplakia (speckled)
Peak incidence >50 years
common site vestibule(site of keeping
tobacco)
sex -male>female
Malignant transformation rate: 1-20%

11. Treatment
• ELIMINATION OF HABIT: Ask Advice Assess Assist
Arrange
• PHARMACOTHERAPY:
1. Vitamin A –topical TRETINOIN 0.05% x month
2. Systemic TRETINOIN 0.5-1.5mg/kg/day
• Antioxidant –multivitamin,Lycopene(4-
8mg/day),green tea
• Antifungal agent –topical CLOTRIMAZOLE 1%apply 2-3
times/day
• Cytotoxic agents –topical BLEOMYCIN 1% for 15 days

12. CANDIDIASIS
• Causes :local factors like denture, topical steroids
• systemic factors like AIDS,immunosuppressive drugs
• Classification
• Primary oral candidiasis
• Acute : pseudomembraneous
atrophic
• Chronic: pseudomembraneous
atrophic
plaque like
nodular
• Candida assosiated lesions: denture stomatitis
angular stomatitis
median rhomboid glossitis

13. • Secondary oral candidiasis:
Familial chronic mucocutaneous candidiasis
diffuse chronic mucocutaneous candidiasis
candida associated with AIDS

14. • Acute pseudomembraneous
candidiasis(thrush)
Most common
c/c ill patients,debilitated patients, infants
Appear as soft white,slightly elevated papules
Site: buccal mucosa,tongue,palate, gingiva ,
floor of mouth.
Resembles milk curd:consist of tangled masses
of fungal hyphae,desqaumated epithelium
Scrapable-leaves erythematous mucosa
underneath.

15. Treatment
• Topical therapy (for superficial candidiasis)
1. NYSTATIN:4-6 lakh units 4-5 times daily(swish and
swallow) x7-21 days
2.CLOTRIMAZOLE:Oral susp 5ml 3-4 times/day x2 weeks
3.KETOCONAZOLE:2% Cream 2 times daily
• Systemic therapy
1.Tab KETOCONAZOLE 200-400 mg daily x7-14 days
2. Cap FLUCONAZOLE(drug of choice):200mg on day 1
followed by 100mg/day x 7-14 days

16. Oral submucous fibrosis
• Cause:arecanut,chilli, nutrition deficiency,
autoimmunity, genetic susceptibility
• CLINICAL FEATURES: Male> Female
• Prodromal symptoms(early OSMF)
• Burning sensation
• Ulcerations or recurrent inflammation
• Excesssive salivation
• Advanced OSMF
• Blanching of oral mucosa
• Loss of local vascularity- fibrosis
• Palate and faucial pillars are involved
• Fibrotic bands, hockey stick uvula

17. Treatment
• Preventive measures: advice the patient to quit
habit.
• Medical treatment: antioxidant
• -multivitamin twice daily
for 3months
-lycopene 4-8 mg/day
Physical therapy :physiotherapy with mouth
opening exercise
Intralesional injections:4mg dexamethasone or 1ml
10 mg TRIAMCINOLONE
ACETONIDE and 2mg of
HYALURONIDASE biweekly.

18. • Surgical treatment:surgical stripping of fibrous
bands
- partial thickness skin or
mucosal graft
- myotomy
- nasolabial flap

19. • ORAL LICHEN
PLANUS
 Whickhams striae
 Bilaterally seen
 Skin involvement
seen usually.
 Assosiated with
stress
 Non scrapable
 Middle age
 F>M
• LEUKOPLAKIA
 Cracked
mud/wrinkled
appearance
 Positive history of
habit
 Non scrapable
 M>F

20. • CANDIDIASIS
 Pseudomembraneous
type-scrapable ,shows
erythmatous base
 Hyperplastic type –non
scrapable
• OSMF
• Blanched oral mucosa
 Restricted mouth
opening
 Shrunken uvula
 Restricted tongue
mobility.
 Fibrotic bands
 Fishmouth appearance

21. Thank you