Leukoplakia and erythroplakia are two clinical lesions widely considered to be premalignant. The term leucoplakia describes a white plaque that does not rub off and cannot be clinically identified as another entity. Most cases of leukoplakia are a hyperkeratotic response to an irritant and are asymptomatic, but about 20% of leukoplakic lesions show evidence of dysplasia or carcinoma at first clinical recognition. An erythroplakia is a red lesion that cannot be classified as another entity. Far less common than leukoplakia, erythroplakia has a much greater probability (91%) of showing signs of dysplasia or malignancy at the time of diagnosis. Dr Sachdeva’s Dental, Aesthetic And Implant Institute is one of the leading clinics in Delhi. So hurry up and book an appointment with us Ashok Vihar, Delhi which has state of the art clinic and all the latest and advanced equipments. To book an appointment contact: Dr. Rajat Sachdeva Director & Mentor Dr Sachdeva’s Dental Aesthetic And Implant Institute I 101, Ashok Vihar Phase 1, Delhi- 110052 Contact us at Phone : +919818894041,01142464041 Our Websites: www.sachdevadentalcare.com www.dentalimplantindia.co.in www.dentalclinicindelhi.com www.dentalcoursesdelhi.com Facebook- dentalcoursesdelhi Youtube- drrajatsachdeva Linkedin- drrajatsachdeva Slideshare- Dr Rajat Sachdeva Twitter Page- drrajatsachdeva Instagram page- surgicalmasterrajat

2. It has been known for over a century that oral
cancer may develop in areas of pre-existing mucosal
pathology in the oral cavity.
Some oral mucosal lesions and conditions are
specifically associated with quid-chewing habits.
Two categories of quid-related lesions are
recognized:

3. A precancerous lesion is a
morphologically altered
tissue in which oral cancer is
more likely to occur than in
its apparently normal
counterpart.
A precancerous condition
is a generalized state
associated with a
significantly increased risk of
cancer.

4. Of the 400 million individuals aged 15 years and
above in India, 47% use tobacco in smoke form, while
16% use it in a smokeless form.
About 250 million kilograms of tobacco is consumed
each year, of which 86% is used for smoking, 13% in
smokeless forms, and 1% as snuff.

5. Smokeless tobacco is used in diverse forms in
different regions of India - for chewing, holding in the
mouth, or applying over teeth and gums.
Smokeless tobacco is chewed, more often as betel
quid (paan), consisting of betel leaves (Piper betle),
areca nut (Areca catechu), slaked lime and catechu
(e.g., Manipuri tobacco, mawa, paan masala).
A mixture of tobacco and slaked lime (khaini) is kept
in the mouth and sucked.

6. Some of the common
pre-malignant lesion/condition
Leukoplakia and erythroplakia or
erythroleukoplakia, when both coexist are two very comm
clinical lesions
Oral submucous fibrosis (OSMF)
Lichen planus (very low risk of turning malignant)
Other lesions (smokeless tobacco keratosis, leukoedem
and leukoderma)

8. Leukoplakia is a white patch or plaque occurring on the
surface of mucous membrane of oral cavity.
The beginning of lesions may be non-palpable , faintly
transluscent, white discoloration may be seen.
Later from opaque white and fine granular texture the
lesion may progress to thickened white lesion and ulcer
formation.
Generally, most leukoplakias are asymptomatic and are
found during a routine visual examination by a practitioner.

10. An erythroplakia is a red lesion far less common
than leukoplakia, erythroplakia has a much greater
probability of showing signs of dysplasia or malignancy
at the time of diagnosis.
Such lesions have a flat, macular, velvety
appearance and may be speckled with white spots.
The most frequent sites where floor of mouth, retro-
molar area, tongue, palate and then mandibular
mucosa and sulcus.

12. Very early cases : Here the common initial symptom is
burning sensation of the mouth.
 There might be acute ulcerations and recurrent
stomatitis. Mouth opening is normal.
Early cases : There is limited mouth opening. The
buccal mucosa appeared mottled and marble like. Red
erythroplakia patches may be seen.
 There is widespread fibrosis and inter incisal opening is
of 26 to 35 mm.

13. Moderately advanced cases
 Here trismus is evident, with
an inter incisal mouth opening of
15 to 25 mm.
 The buccal mucosa is pale and
firmly attached to the underlying
tissues.
 Vertical fibrous bands could be
palpated in the premolar area.
 Patients cannot blow or
whistle with their cheeks.

14. Advanced cases
 Here trismus is severe with an inter incisal mouth
opening of 2 to 15 mm.
 movements are limited.
 There might be diffuse papillary atrophy.
 Lips on palpation showed the presence of circular bands
around the mouth.
 Intra oral examination is difficult due to stiffness, in-
elasticity of the oral mucosa and trismus.
 These cases might show leukoplakic changes.

15. Risk factors
•TOBACCO - The
risk of developing
oral cancer is 5-9
times greater for
smokers than for
nonsmokers, and
this risk may
increase to as much
as 17 times greater
for extremely heavy
smokers who smoke
80 or more
cigarettes per day.

16. There is a common belief that waterpipe is less harmful
than cigarette due to the water filter, which supposedly
traps most of the smoke gases and nicotine.
Subsequently, waterpipe smoking may affect different
systems either directly by contact or the smoke itself (as in
the respiratory system, lips, oral cavity, and hand skin) or
indirectly by the metabolites of tobacco products.
There is strong evidence that exposure to waterpipe
smoking is as harmful as the exposure to cigarette smoking,
if not more harmful.

17. Snuff and chewing
tobacco have also
been associated with
an increased risk for
oral cancer.
Alcohol use has
been identified as a
major risk factor for
cancers of the upper
digestive tract.

18. The chronic use of betel
quid (paan) in the mouth
often results in a
progressive, scarring
precancerous condition of
the mouth known as oral
submucous fibrosis.
Chronic Irritation –
Chronic irritation from
sharp tooth, dentures,
brushing, cheek biting may
produce white lesions.

19. Techniques for investigation of
pre-malignant lesion

20. The “gold standard” for identifying and diagnosing
oral malignancies is the proper clinical examination
and histopathology examination of potentially
malignant lesions and conditions
-BIOPSY AND CYTOLOGY
-ORAL EXFOLIATIVE CYTOLOGY
-BRUSH BIOPSY
-CLINICAL TISSUE STAINING TECHNIQUES
-CHEMILUMINESCENCE TECHNIQUE
-LIGHT EMISSION TECHNIQUE

21. Treatment of PMD can be in three categories namely close
observation, surgical excision/ablation, and medical
treatment.
•Observation: patients with early small lesions that are
clinically benign looking and appear at favorable sites can be
observed. However, the need for frequent follow-ups and
possibility of malignant transformation has to be explained
to the patient.

22. Conservative surgical
excision with negative
margins remains the
treatment of choice for
leukoplakia.
• Surgical resection is
performed to remove
areas at high risk to
progress to early
carcinoma or to undergo
early malignant
transformation.

23. eradication. This approach offers the potential
advantage of reduced scarring, but a major
disadvantage is the lack of a resected specimen for
histopathologic and genetic studies. CO2 laser, Nd :
YAG laser, and KTP are used.
Cryosurgery does not seem to be of particular
benefit.
Photodynamic therapy - The tissue to be targeted is
exposed to a specific wavelength of light, which
activates the photosensitizer, causing it to transfer
energy to molecular oxygen, generating reactive
oxygen species locally, and subsequent tissue
damage.

24. Faq
Q: My dentist said I have a pre-malignant lesion, what does
it mean?
A: It means that there are slight changes that may progress
to malignancy but there is no cancer. Not all such lesions
undergo malignant transformation (i.e. turn into a cancer)
but since we cannot predict which lesions will, they should
all be treated and/or observed closely.

25. Q: I have a premalignant lesion on the cheek will this
spread to other parts of my mouth or body?
A: Oral premalignant lesions do not typically spread as would a
cancer or an infection. However, there are chances that these
lesions can transform into a cancer over time.
Q: If I quit my smoking habit , will the lesions disappear?
A: Many lesions do improve and in some cases may even
disappear. It is certainly desirable to stop smoking for many
health reasons. Even after you stop smoking, you are still at risk
for oral premalignant lesions, although your risk will decrease
over time.

26. Q: If the lesion was removed, do I still need to see my
dentist?
A: Yes. Sometimes lesions may recur. Sometimes new
lesions develop at other sites in the oral cavity. Repeated
check up are essential.
Q: Are biopsies complicated or painful?
A: No. Biopsies are usually minor procedures taking only a
few minutes. Local anesthesia is administered first, a small
piece of tissue is taken, some pressure is applied to stop
any minor bleeding, and the area may feel a little sore and
usually heals without complications.

27. @surgicalmasterrajat
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28. To book an appmt.
contact :
Dr.Rajat Sachdeva
Dr Sachdeva’s Dental
Aesthetic & Implant Institute
I 101, Ashok Vihar Phase 1,
Delhi- 110052