This document discusses several benign disorders of the oral cavity. It begins by defining common oral lesions including ulcers, erosions, abscesses, cysts, and more. It then categorizes benign oral disorders into congenital lesions, inflammatory/traumatic conditions, autoimmune diseases, precancerous lesions, and benign tumors. Specific conditions are discussed in detail such as torus, lingual thyroid, fibroma, aphthous ulcers, lichen planus, leukoplakia, hemangioma, and ranula. Treatment options are provided for each condition. The document serves as a comprehensive overview of benign oral pathology.

1. BENIGN DISORDERS
OF ORAL CAVITY
-Dr. Harshal Atul Tayade
M.B.B.S., M.S. General Surgery

2. TERMINOLOGY
• Ulcer: A defect or break in continuity of the mucosa (epithelium)
that creates a punched-out area similar to a crater.
• Erosion: A shallow defect in the mucosa caused by mechanical
trauma.
• Abscess: A localized collection of pus in a circumscribed
area.
• Cyst: A closed sac or pouch that is lined with epithelium and
contains fluid or semisolid material

3. TERMINOLOGY
• Blisters: Also known as vesicles, lesions filled with a watery fluid
• Pustule: Similar in appearance to a blister, but contains pus.
• Hematoma: Also similar to a blister, but it contains blood.
• Plaque: Any patch or flat area that is slightly raised from the
surface.

4. BENIGN DISORDERS OF ORAL CAVITY
• Congenital Lesions
• Inflammatory lesions/Traumatic condition
• Autoimmune diseases
• Precancerous lesions(Leukoplakia & erythroplakia)
• Benign Tumors of Oral Cavity

5. CONGENITAL LESIONS

6. TORUS
• Developmental anomaly
• Mucosally covered bony outgrowths
of the palate and mandible: Torus
palatinus and torus mandibularis
• Presents in the second decade of
life and continue to grow slowly
throughout life
• Occur in 3% to 56% of adults and
are more common in women

7. TORUS
• Tori of the palate are found only in
the midline of the hard palate
• Mandibular tori are found to involve
only the lingual surface of the
anterior mandible, primarily in the
premolar region

8. TORUS
• Pedunculated or multilobulated
• Broadly based
• Smooth
• Bony; consist of dense lamellar
bone with relatively small marrow
spaces
• Usually Asymptomatic.
• If symptomatic – Excision
• Recurrence rare.

9. LINGUAL THYROID

10. LINGUAL THYROID
• Due to lack of descent of thyroid tissue during development.
• Approximately 90% of all ectopic thyroid tissue is associated with the
dorsum of the tongue.
• found in the midline in the area of foramen cecum.

11. LINGUAL THYROID
• Asymptomatic, the presence of lingual thyroid can be associated with
hypothyroidism.
• Symptoms occur at the time of metabolic demands such has growth
spurts during adolescence and during pregnancy
• Lethargy, Cold Intolerance, Dry skin, Hair Loss, Puffy Face, Hoarseness
of voice, Constipation, Weight gain despite poor appetite.
• Airway Obstruction, Dysphagia, Dyspnoea, Hematemesis
• Malignant transformation is rare.

12. LINGUAL THYROID
• Management: hypothyroid patients –thyroid hormone replacement
therapy, which may also reduce the size of the lingual thyroid
• symptomatic euthyroid patients- surgical excision
• Postoperative exogenous thyroid hormone replacement therapy
because approximately 70% of patients have lingual thyroid as the
only functioning thyroid tissue.

13. INFLAMMATORY/TRAUMATIC
LESIONS

14. FIBROMA / FIBRO-EPITHELIAL POLYP
• Found in1.2% of adults and has a
66% female predilection.
• Assymptomatic, Sessile,
pedunculatedm firm mass.
• Microscopically: dense and minimally
cellular fascicles of collagen fibers
and relatively avascular appearance.
• usually solitary and seldom are larger
than 1.5 cm
• Most common along the "bite line."

15. FIBROMA / FIBRO-EPITHELIAL POLYP
• Management :- Antibiotics and Anti-
Inflammatory
• Surgical Excision

16. Pyogenic Granuloma
• Due to acute or chronic trauma or
infection
• Highly vascular lesions similar to
granulation tissue
• raised or pedunculated lesions that
remain less than 2.5 cm in size.
• Treatment- excision

17. INFLAMMATORY LESIONS
• Inflammation of the mouth (Stomatitis)
• Inflammation of the Lips (Cheilitis)
• Inflammation of the soft tissues around teeth typically resulting from
inadequate oral hygiene (Gingivitis)
• Inflammation of the tongue (Glossitis).

18. HERPETIC GINGIVOSTOMATITIS
• Multiple small vesicles involving many oral cavity sites
• Vesicles rupture in 24 hours leaving ulcerations
• Ulcerations typically heal over a 7-14 day course
• Fever, arthralgia, malaise, headache, cervical lymphadenopathy
• Greatest infectivity rate when vesicles rupture

19. HERPETIC GINGIVOSTOMATITIS
Vesicles and
Ulcerations
Gingivostomatitis Gingivostomatitis

20. HERPETIC GINGIVOSTOMATITIS
• Re-activation – 15-45% patients
• Triggers – UV light, stress, immune suppression
• Diagnosis – Serology :- ELISA, Western Blot, PCR
• Treatment: Valacyclovir, Famcyclovir – inhibit DNA polymerase –
controls symptoms
• Antipyretics, analgesics, hydration

21. VARICELLA ZOSTER
• Primary infection is chicken pox; secondary infection is shingles
• Spread by respiratory droplets and less commonly by direct
contact
• Incubation time is 2 weeks
• Fever, headaches, malaise, and a rash
• Rash
- Vesicles -> Pustules -> Rupture (ulcers) -> Crust
- Oral cavity involvement typically involves buccal mucosa and
hard palate – resembles aphthous ulcers in oral cavity
- Lasts 7-10 days

22. VARICELLA ZOSTER

23. VARICELLA ZOSTER
• Diagnosis : clinical picture, Fluorescent Anti body test, ELISA, PCR
• Treatment: - Valacyclovir, Famcyclovir – inhibit DNA polymerase –
controls symptoms
• Antipyretics, analgesics, hydration
• Prevention - Vaccination

24. CANDIDIASIS
• Candida species part of normal oral flora – 40-65% of patients
• Infections typically the result of immunocomprimised state, oral
trauma, or recent antibiotic use; rare in healthy individuals
• 90% of HIV patients typical affected

25. CANDIDIASIS
• Pseudomembranous candidiasis
(Thrush)
- Most common form
- Whitish plaque that can be
scrapped off to reveal a
“beefy” red base or ulceration
that is tender to palpation

26. CANDIDIASIS
• Atrophic Candidiasis
• Erythmatous patch lateral
aspect of tongue
• Poor Fitting dentures
• Subtypes:-
• Chronic Atrophic Candidiasis
• Angular chelitis

27. CANDIDIASIS
• Mucocutaneous Candidiasis
• Most severe form
• Diffuse involvement of oral cavity, lips, skin, other mucosal
surfaces
• Lesions similar to pseudomembranous candidiasis but more
diffuse and numerous
• Immunocompromised

28. CANDIDIASIS
• Diagnosis: Clinical Picture, KOH mount, Culture, Serum (1,3)
Beta-D-Glucan detection assay
• Treatment : Topical Nystatin, Nystatin + Clotrimazole
• Fluconaole in immunocompromised
• IV Amphotericin B in severe cases

29. VINCENT’s ANGINA
• Borellia vincenti
• Immunocompromised
• Punched out erosions→
ulceration→involves all gingival
margin, which become covered
by a necrotic pseudomembrane
• Treatment: Antibiotics

30. AUTOIMMUNE DISEASES

31. Lupus Erythematosus
• 40-50 cases per 100,000 people
• Two main types
• Discoid –skin + oral cavity
WITHOUT visceral
involvement
• Systemic – skin, oral, and
visceral involvement
• Both can present with oral
lesions
• DLE – 25% of cases
• SLE – 40% of cases

32. Lupus Erythematosus
• Oral Manifestations:-
• Erythematous plaques or erosions that can evolve into ulcerations
• White keratotic striae radiating from lesion margins
• Areas of involvement: buccal mucosa, gingiva, labial mucosa, and
vermillion border
• Diagnosis: clinic appearance, immunofluorescence test of antibody-
antigen complex, ANA, SS-A/SS-B antibodies, anti-dsDNA antibody
• Treatment: Oral lesions typically do not need to be treated.
• However, topical corticosteroids can improve lesions
• corticosteroids with or without cytotoxic agents (cyclophosphamide
and azathioprine)
• Methotrexate

33. BULLOUS PEMPHIGOID
• Antibodies directed at the epithelial
basement membrane illicit an inflammatory
response
• Lesions appear as vesicles that can then
rupture to form open ulcerations
• Oral involvement- 40%, self limiting
• Skin involvement first and then oral
involvement

34. PEMPHIGUS VULGARIS
• Antibodies directed at intercellular bridges –
leads to separation of cells in the epithelial layer
with formation of very thin walled bullae
• Lesions occur in oral cavity first and then
skin becomes involved
• Lesions appear as ulcerations with a
grey membranous covering
• Nikolsky sign – scrapping the mucosa around
the lesion results in slothing of the mucosa

35. PEMPHIGUS VULGARIS
• DIAGNOSIS: Biopsy shows “tombstone”
appearance with Tzanck cells (free squamous
cells forming a spherical shape)
• Direct immunofluorescence shows IgG against
cell-cell adhesion junctions
• Treatment
• Typically requires high doses of systemic
steroids + cytotoxic agents
• Plasmapheresis has been utilized with good
results

36. Aphthous Ulcers (Canker Sores)
• Most common cause of non-traumatic ulcerations of the oral cavity
• Etiology unknown
• 10-20% of general population
• Classifications
• Minor aphthous ulcer
• < 1cm in diameter, Located on freely mobile oral mucosa
• Appears as a well-delineated white lesion with an
erythematous halo
• burning or tingling in area prior to ulcer’s appearance
• Resolves in 1 week, no scar

37. Aphthous Ulcers (Canker Sores)
• Major aphthous ulcer
• 1cm in diameter
• Involves freely mobile mucosa, tongue, and palate
• Last much longer – 6 weeks or more
• Typically scar upon healing

38. • Treatment:
• Topical application of steroids
• Cauterization with 10% silver nitrate
• Severe cases: 250 mg of tetracycline dissolved in 50 ml of water is
given as mouth rinse and then to be swallowed, four times a day.
Aphthous Ulcers (Canker Sores)

39. BEHCET’s SYNDROME
• Vasculitis secondary to a
hypersensitivity reaction to HSV
and/or streptococcal antigen
• M: F 20:1
• Presents as Aphtous Ulcers
• Treatment: Tetracycline solution,
Topical Steroids

40. LICHEN PLANUS
• T cells destroy basal cell layer of
epidermis
• Hepatitis C Virus
• 5 P’s of cutaneous lesions
• Purple, Pruritic, Planer, Polygonal,
Papules
• Oral involvement in 70% of cases

41. LICHEN PLANUS
• Reticular – white striae on buccal mucosa that does not scrape
off
• Plaque – resemble leukoplakia, and typically located on dorsum of
tongue or buccal mucosa
• Bullous – rare form, appear as bullae that rupture leaving areas
of ulceration
• Erosive – very painful, erythematous erosions with fibrous
covering

42. LICHEN PLANUS
• Malignancy arising from lesions in 1-5% of cases
• Cutaneous lesions typically resolve in 6 months, but oral lesions tend
to last longer, up to 5 years
• Diagnosis: Clinical, biopsy of lesions with HPE and DIF examination
• Treatment
• Topical steroids
• Cyclosporine mouth wash for 4-8 weeks improves oral disease
• Severe disease – systemic steroids

43. Premalignant Lesions

44. LEUKOPLAKIA

45. LEUKOPLAKIA
• Whitish plaque that cannot be scrapped off
• 5-20% malignant potential
• Microscopic examination reveals hyperkeratosis and atypia
• Aetiologic factors include smoking, tobacco chewing,
• chronic trauma: due to ill-fitting dentures or cheek bites
• Sites : Buccal mucosa and oral commissures are the most common
sites, also involves floor of mouth, tongue, gingivobuccal sulcus
and the mucosal surface of lip.
• Lesions on lateral tongue, lower lip, and floor of mouth more likely
to progress to malignancy

46. • MANAGEMENT
• Many of the lesions will disappear spontaneously if causative agent is
removed.
• In lesions with higher potential for malignant change, a biopsy is
taken to rule out malignancy
• In suspicious small lesions,
• surgical excision
• ablation with laser
• cryotherapy can be done
LEUKOPLAKIA

47. • Red patch or macule with
soft, velvety texture
• Much higher chance of
malignancy = 60- 90%
• Biopsy is mandatory
• Treatment is surgical excision
or laser ablation
ERYTHROPLAKIA

48. BENIGN TUMORS

49. SQUAMOUS CELL PAPILLOMA
• Associated with HPV-6 and HPV-
11 virus subtypes.
• Single, asymptomatic, soft,
pedunculated mass with numerous
finger-like projections at the surface.
• Histologically, the projections have
fibrovascular cores and demonstrate a
relatively narrow base.
• Treatment -surgical excision or ablation
with use of a CO2 laser.

50. HEMANGIOMA
• Hemangioma of the oral cavity
represents 14% of all
hemangiomas. Present at birth with
a rapid proliferative phase.
• Lip is the most frequent site of
hemangioma involving the oral cavity.
• Present as a soft, painless mass that
is red or blue , typically less than 2
cm in greatest dimension
• Excision if interferes with function of
oral cavity/oropharynx

51. GRANULAR CELL TUMORS

52. GRANULAR CELL TUMORS
• Usually diagnosed in third decade of life.
• Found throughout the body, more than half of all cases occur in the oral
cavity.
• Site - dorsum of the tongue , soft palate, uvula, and labial mucosa
• Typically present as firm, painless, relatively immobile, sessile, nodular-
appearing lesions less than 1.5 cm in greatest dimension.
• Treatment -Surgical excision. Recurrence is less than 10%, even with
a microscopically positive margin

53. MUCOCELE
• Most common site-lower lip.
• retention cyst of minor salivary glands
of the lip.
• The lesion appears as a soft and cystic
mass of bluish colour.
• Treatment is surgical excision.

54. RANULA
• Blockage of duct of Sublingual
Gland  Retention cyst 
ruptures  Extravasation cyst
• Contains saliva
• Clinically bluish, smooth, soft,
fluctuant, transiluminant
• Treatment: Small – Excision
• Large – Marsupilization

55. THANK YOU