This PPT includes :- 1. Case presentation of leukoplakia 2.Brief about leukoplakia and its cause 3.Investigation of precancerous lesions 4.Treatment of leukoplakia

1. LEUKOPLAKIA
Nitish kumar
(BDS final year)
Sarjug Dental college
And Hospital,
Darbhanga

2. CASE PRESENTATION

3. Name- Safi alam
Age-30 years
Sex-Male Date-
25.11.21
Adress-kakarghati. Opd no-
10905

4. CHIEF COMPLAINT
➤ Patient complaints of white patches bilaterally in cheek
region since 6 months.

5. HISTORY OF PRESENT ILLNESS
➤ Patient was apparently asymptomatic 6 month ago untill he
noticed a white patches in buccal mucosa bilaterally.
➤ Pt. Feels burning sensation in the white patches on eating of
spicy food.
➤ No history of trauma.
➤ No history of ulcer.
➤ No history of noticing discharge from lesion
➤ No history of skin lesion.

6. ➤ :-Since 6 months
➤ Pain and sensitivity in the associated area.
➤ Burning sensation was present.

7. ➤ Past-dental history :- No relevant history
➤ Past-medical history :- No relevant history
➤ Family history :- No relevant history

8. ➤ Personal history :- Married
➤ Habits :-1.patient gives history of chewing tobaco
2 pack per day since 5 years.
2.patient cleans his teeth once a day with
toothbrush.

10. ORAL EXAMINATION
A.
Facial symmetry - No obvious asymmetry
Lips - No abnormality detected
Eyes - No abnormality detected
Ears - No abnormality detected
Nose - No abnormality detected
Tmj - No clicking sound present
Lymph Node - Non-palpable

11. B.INTRA-ORAL EXAMINATION
• Buccal mucosa - white patches are present bilaterally i.r.t
36,37,38 and 46,47,48.
• Labial Mucosa - No abnormality detected
• Gingiva - No abnormality detected
• Soft Palate - No abnormality detected
• Hard palate - No abnormality detected
• Tongue - No abnormality detected
• floor of mouth - No abnormality detected

12. • Present teeth- All teeth present
• Missing teeth - Absent
• carious teeth - proximal caries i.r.t 15,16 and 25,26
• Mobility - Absent
• Tender on percussion - 15 and 16
• Stain ++, calculus +

13. WHITE PATCHES ON RIGHT BUCCAL MUCO

14. WHITE PATCHES ON LEFT BUCCAL MUCOS

15. 1.INSPECTION
• A white patch seen on buccal mucosa bilaterally in respect to
36,37,38 and 46,47,48 measuring “
• surface is rough and crack mud appearance.
•Rough oval in shape.
•No erythematous or ulcerative lesion seen.

16. • No discharge seen.
• No pigmentation seen.
• Surrounding mucosa appears normal.

17. 2. PALPATION
• No tenderness present.
• It has leathery consistency.
• Non-scrapable in nature.
• No discharge elicited.
• All inspectory findings are confirmed on palpation.

18. ‘Homogeneous Leukoplakia’ at both left and right
buccal mucosa.

19. DIFFERENTL DIAGNOSIS
1. Lichen planus (plaque type) - distinguished by often occurrence of
multiple lesions and presence of “wickham’s striae”. Most commonly
seen on dorsum of tongue.
2. Chronic Hyperplastic candidiasis - improves with antimycotic t/t
while leukoplakia remains unchanged.
3.chemical burn - History is important.
4.white sponge nevus - occurs soon after birth or atleast by puberty.
5. Psoriasis - Auspitz’s sign is positive and skin lesion sre also
present.

20. 7. Leukoedema - Faint milky appearance with folded and
wrinkled pattern as compared definite whiteness of leukoplakia.
8.Cheek biting lesion- careful history elicts the cause and
promotes proper diagnosis.

21. INVESTIGATION
A.BLEEDING TIME - 2 MINUTE 32 SECONDS
B.CLOTTING TIME - 3 MINUTE 15 SECOND
C. HAEMOGLOBIN - 13 MG/DL
D.HIV TEST - NEGATIVE
E.BIOPSY

22. MANAGEMENT
Pt. Should be asked to cease smoking
immediately.Many cases of lekoplakia get regress after smoking is
ceased.
Dentist should remove sharp,broken
teeth.
like
syphilis,alcohol,dissimilar metal restoration,etc. should be eliminated.

23. RX.
1. VITAMIN A (1500-300 IU PER DAY 3 MONTH)
-It has a protective effect on the epithelium.
2. Lycopene-10 mg bd for 1 month.
- Lycopene’s strong antioxidant action may prevent or slow down the progression of
some types of cancer.
- One of the biggest benefits of lycopene is that it is an antioxidant and
protects the body from free radical stress, which can damage DNA and other
cell structures.

24. - is a natural compound that is found in fruits and vegetables like tomatoes,
watermelon, and grapefruit.
- Lycopene is a carotenoid, which are yellow, orange, or red pigments that give this
color to its plants.
3. Retino A - 0.025% ointment for topical use.

25. 4.FOLLOW-UP AFTER 1 MONTH.

26. The term leukoplakia originates from two greek words-
Leuko- white , Plakia -patch
:- It is defined as a any white patch on mucosa,which cannot be
rubbed or scraped off and which can not be attributed to any other
diagnosable disease.
#The white color of mucosa is results from thickened surface of
keratin layer.

27. IN 2005 WHO DEFINED LEUKOPLAKIA AS “ A
WHITE PLAQUE OF QUESTIONABLE RISK
HAVING EXCLUDED (OTHER) KNOWN DISEASES
OR DISORDERS THAT CARRY NO INCREASED
RISK OF CANCER.

29. DIAGNOSTIC PROCEDURES
Rule out other definable white lesion before giving clinical diagnosis of oral
leukoplakia.
#Toluidine blue staining
It is effective in demonstrating dysplasia nd early malignant lesion which
Is not clinically recognizable.

30. AVAILABLE IN FORM OF KIT -3 COMPONENT
• 1% TOLUIDINE BLUE 10ML SLOLUTION.
•PRERINSE 1% ACEATIC ACID
• POSTRINSE 1% ACEATIC ACID
TECHNIQUES:-
1.ASK PT. TO RINSE MOUTH TWICE WITH WATER (20 SE EACH) .AFTER RINSING
WITH WATER ASK PT. TO RINSE WITH PRERINSE 1% ACEATIC ACID FOR 20
SECONDS.
2.DRYING OF AREA
3.APPLICATION OF TOLUIDINE BLUE SOLUTION FOR 5 MINUTE.
4.RINSE WITH POST-RINSE 1% ACEATIC ACID FOR 1 MINUTE.
5.RINSE WITH WTER

31. INTERPRETATION
•LUGOLS IODINE TEST
-IT IS RETAINED IN NORMAL SQUAMOUS EPITHELIAL CELLS BUT NOT IN
DYSPLASTIC OR MALIGNANT CELLS OF THE SQUAMOUS EPITHELIUM.
-THE USE OF TOLUIDINE BLUE IN COMBINATION WITH LUGOLS IODINE HAVE
POTENTIAL ADVANTAGE.
THE TOLUIDINE BLUE WILL STAIN THE ABNORMAL EPITHELIUM WHEREAS
LUGOLS IODINE SOLUTION WILL BIND TO GLYCOGEN PRESENT IN NORMAL
EPITHELIUM .

32. B. ORAL CDX TEST
- it is highly specialized computer-assisted analysis of an oral brush biopsy performed on
oral tissue.
- This technique is ideal for determining the need for scalpel biopsy in benign appearing
oral mucosal leukoplakia.
1.collection or sample- use disposable brush to collect transepithelial celss.
2.computer screening - the sample is screened by computer which is programmed to
detect cytologic changes associated with premalignancy and scc.
3. Image processor- this is especially designed to detect as few as two abnormal epithelial
cells scattered among more than cell on each biopsy specimen.

33. INDICATES NO EPITHELIAL ABNORMALITY
INDICATES DEFINITIVE CELLULAR EVIDENCE
OF EPITHELIAL DYSPLASIA.PT. SHOULD BE REFERRED TO
SCALPEL BIOPSY.

34. C. VIZILITE
-vizilte is nontoxic chemiluminescent light that is shined in the mouth .
-tissue which is not normal will glow differently as compared to normal
tissue.
Content:- vizilite rinse 1% aceatic acid sloution, vizilite capsule-
chemiluminescent light stick , vizilite retractor-sheath and handle.
Mechanism- Normal tissue absorb vizilite and as a reason they appear
dark.This is not the case with dysplastic cells.

35. 1.APPLICATION OF VIZILITE RINSE- ACEATIC ACID
SOLUTION SHOULD BE APPLIED FIRST.
2.VISUALIZING THE MUCOSA WITH VIZILITE- THE
CHEMILUMINESCENT CAPSULE IS PROJECTED ON THE
MUCOSA.THE ABNORMAL MUCOSA LIKE DYSPLASTIC
MUCOSA WILL SHOW MORE REFLECTION OF LIGHT AND WILL
APPEAR WHITER AS COMPARED TO NORMAL MUCOSA.

36. D.EXFOLIATIVE CYTOLOGY
IN THIS, THE SURFACE OF THE LESION IS EITHER WIPED
WITH SOME SPONGE MATERIAL OR SCRAPED TO MAKE A
SMEAR.
1.WITH GAUZE , GENTLY REMOVE EXCESS SALIVA AND DEBRIS
2.VIGOROUSLY SCRAP AND ROTATE CYTOBRUSH OVER ENTIRE
LESION.
3.TAKE CYTOBRUSH AND SPREAD CYTOBRUSH ON GLASS SLIDE
STARTING AT FORSTED SIDE.
4.SPRAY SURFACE OF GLASS SLIDE WITH SPRAYCYTE OR 95%

37. LABORATORY INVESTIGATION
•BIOPSY