This document discusses different types of white lesions of the oral cavity. It covers hereditary lesions like oral epithelial naevus, leukoedema, pachyonychia congenita, and dyskeratosis congenita. It also discusses traumatic lesions caused by mechanical, chemical, or thermal injury. Infective lesions covered include candidiasis and hairy leukoplakia. Dermatological conditions discussed are lichen planus and lupus erythematosus. Neoplastic lesions of carcinoma-in-situ and squamous cell carcinoma are also mentioned. Idiopathic leukoplakia is categorized separately. Each lesion is described clinically and histologically.

1. The University of Jordan
Faleh Sawair: BDS, FDS RCS (England),PhD
Professor of Oral Pathology
Oral Pathology

2. http://elearning.ju.edu.jo
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Aims, Objectives, Recommended readings:

3. White Lesions

5. 3

7. Material Alba:

8. Coated Tongue

9. White Lesions
 Hereditary
 Oral Epithelial Naevus
 Leukoedema
 Pachyonychia Congenita
 Dyskeratosis Congenita
 Tylosis
 Hereditary Benign Intraepithelial Dyskeratosis
 Follicular Keratosis

10.  Traumatic
 Mechanical (Frictional Keratosis)
 Chemical
 Thermal
 Infective
 Candidiasis
 Pseudomembranous
 Chronic Hyperplastic
 Chronic Mucocutaneous
 Syphilitic Leukoplakia
 Hairy Leukoplakia

11.  Dermatological
 Lichen Planus
 Lupus Erythematosus
 Neoplastic
 Carcinoma-in-situ
 Squamous cell carcinoma
 Idiopathic
 Leukoplakia

12. Hereditary Lesions

13.  Oral Epithelial Naevus (White Sponge Naevus):
AD
 Mutation in genes of keratin 4 or 13.
 Clinically:
 Asymptomatic
 Whitish, soft
 Irregularly thickened
 Usually bilateral (all OM)
The gingival margin and
dorsum of the tongue are
almost never affected

14.  Border
 Other sites

15.  Hist:
 Acanthosis
 Moderate-marked hyperparakeratosis
 Marked intracellular oedema (prickle & parakeratin)
  Dysplasia
  Inflammation in LP
cytological smears

16. Leukoedema:
 Variation of normal
 ↔ Racial pigmentation
 Site: BM bilaterally, ↓ LB of tongue
 Clin:
 Asymptomatic
 Diffuse, translucent, grayish-white, folded lesion

17.  “Stretch test."

18.  Hist:
 Mild parak & acanthosis
 Intracellular edema
 Normal LP

19. OEN vs. Leukoedema

20.  Pachyonychia Congenita:
 AD
 Extreme thickening of nails (≈ birth)
 Palmoplantar hyperkeratosis & hyperhidrosis
 White patches on D or LBT or BM
 Hist: ≈ WSN

22.  Dyskeratosis Congenita:
 ? Mode of inheritance
 Pigmentation of skin
 Dystrophic nails
 Destructive periodontitis
 Hyperkeratosis of oral & other MMS
 Premalignant

23.  Tylosis:
 AD
 Palmoplantar hyperkeratosis
 Esophageal Ca in later life
 ± Oral hyperkeratosis

24.  Hereditary Benign Intraepithelial Dyskeratosis:
 AD (North Carolina)
 Conjunctival plaques → blindness
 Oral white folds and plaques
 Hist:
Acanthosis &
premature keratinization

25. Follicular Keratosis (Darier’s disease):
 AD & sporadic
 Face, trunk, ears & scalp: ↑ k papules (coalesce & infected)
 Orally: Small whitish papules on K mucosa
 Hist:
 Hyperk
 Suprabasal clefts
 Dyskeratotic cells

26. Traumatic
Keratosis

27. A) Mechanical:
 Frictional Keratosis
 Prolonged mild abrasion
 Tooth, restoration, denture
 Biting
• Clin:
 Dense white patch
 Rough surface
 Cheek biting

28. How to differentiate cheek biting
keratosis from white sponge nevus

30. • Dx:
 Cause
 Size & shape
 Resolves when cause removed
• Hist:
 Hyperplasia & Hyperk
  Dysplasia
 Scattered CICI in LP

31. B) Chemical:
 Aspirin burn
 Cinnamon

32. Tobacco: either form
Hyperkeratosis&
hyperplasia

33. C) Thermal:
 Smoking ⇒ white (BM, Tong & palate)
 Pipe: tongue/palate

34. Cigarette: lip
Reverse smoking

35. • Nicotinic Stomatitis:
 Long-term pipe smokers
 Clin: Palate
 White w multiple, small,
round papules w red centers

36.  Hist:
Dilated ducts w squamous
metaplasia & periductal CICI
Hyperkatosis &
hyperplasia