This document discusses several conditions that cause white lesions in the oral mucosa. It describes hereditary conditions like oral epithelial naevus which is due to mutations in keratin genes. It also discusses lukoedema which causes mild opacification and dissipates with stretching. Reactive conditions discussed include frictional hyperkeratosis from chronic rubbing, nicotine stomatitis from smoking, and hairy leukoplakia associated with immunosuppression. Other conditions mentioned are hairy tongue believed to be related to oral flora alterations, and lichen planus which is a chronic mucocutaneous disease that affects women more commonly.

1. Keratosis and related
disorder of the oral mucosa

2. Hereditary conditions:
 Oral epithelial naevus (white
spnge naevus):
- autosomal-dominant condition
that is due to point mutations
for genes coding for keratin 4
and/or 13.
- Asymptomatic
- Bilateral shaggy white buccal
mucosal change
- appears early in life
- Does not disappear when
cheek is stretched
- No treatment, no malignant
potential
- histologically; marked
spongiosis, acanthosis, and
parakeratosis .

3. Lukoedema :
- a generalized mild
opacification of the buccal
mucosa that is regarded as
a variation of normal .
- the cause has not been established.
Factors such as smoking, chewing tobacco, alcohol ingestion,
bacterial infection, salivary conditions, electrochemical
interactions play a significant rule.
- asymptomatic and symmetrically distributed in the buccal
mucosa, and to a lesser extent over the labial mucosa.
- It appears as a gray-white, diffuse, filmy, or milky surface
alteration .
- With stretching of the buccal mucosa, the opaque changes
dissipate .
- Histologically; the epithelium is parakeratotic and acanthotic,
- no treatment required.

4. Reactive conditions:
 Frictional (focal)
hyperkeratosis:
-white lesion that is related
to chronic rubbing or friction
against an oral mucosal
surface.
- occur in areas that are
commonly traumatized, such
as the lips, lateral margins of
the tongue, buccal mucosa
along the occlusal line.
- hyperkeratosis is noted
without dysplastic change.
- If cause is removed, lesion
should subside. When in
doubt, perform a biopsy.
chronic rubbing of the lip against
teeth
cheek chewing

5.  Nicotine Stomatitis:
- Caused by pipe,
cigar, and cigarette
smoking “reverse
smoke”.
- Opacification of the
palate caused by
heat.
- Generalized
hyperkeratosis seen
in hard palate with
Red dots in the
palate represent
inflamed minor
salivary duct
orifices.
Reverse smoker’s palate

6.  Hairy Leukoplakia:
- unusual asymptomatic
white lesion along the
lateral margins of the
tongue .
- Associated with
immunosuppression
(esp. AIDS and organ
transplantation).
- Most commonly seen
on lateral tongue, often
bilateral.
- Papillary, filiform, or
plaquelike architecture.
- May occur before or
after the diagnosis of
AIDS.

7.  HAIRY TONGUE:
- condition of filiform
papillary overgrowth on the
dorsal surface of the tongue
of variable color.
- believed to be related to
alterations in oral flora (by
Use of broad-spectrum
antibiotics, systemic
corticosteroids, hydrogen
peroxide).
- usually asymptomatic.
- treatment; identify and
eliminate the initiating factor,
brush the tongue with baking
soda.

8. Other white lesions
 Lichen planus:
- chronic mucocutaneous disease
of unknown cause, with oral
lesions occurring most commonly
in women between 30 and 60
years of age.
- affects women more frequently.
- types of lichen planus;
1) reticular form : most common
type
characterized by numerous
interlacing white keratotic striae
(Wickham’s striae) that produce
lacy pattern, The buccal mucosa
bilaterally is the site most
commonly involved.

9. 2) plaque form:
resemble leukoplakia clinically but has
a multifocal distribution.
range from slightly elevated to smooth
and flat,The primary sites are the
dorsum of the tongue and the buccal
mucosa.
3) erythematous (atrophic) form:
red patches with very fine white striae.
may be seen in conjunction with
reticular or erosive form.
The attached gingiva commonly
involved.
Patients may complain of burning,
sensitivity, and generalized discomfort.
4) erosive form:
central area of the lesion is ulcerated,
pseudomembrane covers the ulcer.
- corticosteroid successfully controlled
but not cure lichen planus.
erosive form
reticular form