White lesions of oral cavity

1. White Lesions of oral cavity
Presented by :
Sushant Pandey
653
Resource faculty :
Dr. ashish Shrestha
Dr. Shashi Keshwar
Dept. of oral pathology

2. Objectives :
• To know about common white lesions of oral cavity
• To differentiate them clinically

3. Colour of oral mucosa depends on
Amount and dilatation of blood vessels in the underlying
connective tissue
Degree of keratinisation
Amount of melanin pigment in epithelium
Thickness of epithelium

4. Presence of keratin in a normally nonkeratinized site.
Hyperparakeratosis or hyperorthokeratosis in a normally keratinized site.
Abnormal keratin formation or aggregation in epithelial cells.
Acanthosis.
Intra and extracellular accumulation of fluid in the epithelium.
Nonepithelial changes such as underlying scarring and fibrosis.
Microbes, particularly fungi, produce whitish pseudomembranes.
Why abnormally white?

6. Leukoedema
Leukoedema is a generalized mild opacification of the buccal mucosa that is
regarded as a variation of normal.
Etiology : Unknown
More common in black population.
Clinical features :
Characterized by diffuse, gray white, milky appearance of mucosa.
The surface appears folded, resulting in wrinkles or whitish streaks.
Typically occurs bilaterally on the buccal mucosa.
Asymptomatic.
Disappears when cheek is stretched.

8. White sponge nevus (Cannon disease)
Etiology = point mutations for genes coding for keratin 4 and keratin 13 which leads to
defective keratinization of the normal oral mucosa.
Clinical features :
Usually appear at birth or in early childhood.
Symmetrical, thickened, white, corrugated or velvety, diffuse plaques affect the buccal
mucosa bilaterally.
May affect ventral tongue, labial mucosa, soft palate, alveolar mucosa, and floor of
the mouth as well as extra-oral mucosa.
Does not disappear when cheek is stretched.
Asymptomatic.

10. Hereditary benign intraepithelial dyskeratosis

12. Frictional hyperkeratosis
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, and edentulous alveolar ridges
Edentulous ridges and vestibules may be affected in denture wearers.

14. Morsicatio Mucosae Oris (chronic mucosal chewing)
Morsicatio = Bite
located most frequently on the
buccal mucosa = morsicatio buccarum
labial mucosa = morsicatio labiorum
lateral border of the tongue = morsicatio linguarum
A higher prevalence of classic morsicatio mucosae oris has been found in people who are
under stress or who exhibit psychologic conditions.
Thickened, shredded, white areas may be combined with intervening zones of erythema,
erosion, or focal traumatic ulceration.

16. Smokeless tobacco keratosis (snuff pouch, tobacco pouch keratosis)
represents a characteristic white or gray plaque involving the mucosa in direct contact
chewing tobacco
The mucosa appears fissured or rippled.

18. Nicotine Stomatitis (Smoker’s Palate)
develops in response to heat rather than the chemicals.
“reverse smoking” habit produces a pronounced palatal keratosis.
With long-term exposure to heat, the palatal mucosa becomes diffusely gray or white;
numerous slightly elevated papules are noted, usually with punctate red centers. Such
papules represent inflamed minor salivary glands and their ductal orifices.

20. Leukoplakia
“a white patch or plaque that cannot be characterized clinically or pathologically as any
other disease”
Non-scrapable.
Always associated with a habit.
Premalignant lesion.
Etiology :
Tobacco
Alcohol
Sanguinaria
Candida
HPV 16 and 18

21. Forms of leukoplakia
1) Homogeneous

22. 2) Non homogenous

23. Proliferative Verrucous Leukoplakia

24. 1. Squamous papilloma
2. Verruca vulgaris
3. Verrucous carcinoma
4. SCC
Some white exophytic growths

25. Etiology – EBV
Presents as white mucosal plaque that do not rub off.
Most commonly occur on lateral border of tongue.
Sign of severe immunosuppression.
Histology : Balloon cells
Hairy leukoplakia

26. Characterized by marked accumulation of keratin on filiform, resulting in a hair
like appearance.
Commonly affects midline just anterior to circumvallate papillae.
The papillae may become brown, black due to growth of pigment producing
bacteria or staining from food.
Hairy tongue

27. Candidiasis

28. Oral Submucous Fibrosis

29. Oral Lichen Planus

30. Chemical Injuries Of The Oral Mucosa

31. Bilateral lesions Unilateral lesions
Leukoedema
White sponge nevus
HBID
Lichen Planus
Cheek chewing
Candidiasis
Frictional keratosis
Burn
Hairy leukoplakia
Leukoplakia

32. Photo Quiz !!

33. 10/M presented with bilateral folded velvety white buccal mucosal
changes.
How will you approach this case ?

34. 28/M IV drug user, presented with unscrapable white plaques on
lateral border of tongue since 6 months.
Most likely diagnosis ??

35. 55/M presented with white, lacy, plaques over the anterior
buccal mucosa bilaterally but could not recall since when. No
ulcerations were present. Earlier he was prescribed Fluconazole
by a clinician but the lesion didn’t resolve.
Most likely diagnosis ??

36. 60/F who was given Amoxycillin+Clavulanate for dental abscess
after drainage, presented with white plaques on soft palate after
2 weeks. The plaques were easily scrapable with a dry gauze.
Likely diagnosis ??

37. 70/M who had been wearing complete denture since 3 months
developed bilateral unscrapable white plaque on the mandibular
alveolar ridge.
DD ??

38. Identify the lesion

39. References :
1. Neville, Damm, Allen Oral and Maxillofacial pathology
2. Regezi, Sciubba Oral pathology clinical pathologic correlation
3. Wood, Goaz Differential diagnosis of oral and maxillofacial lesions

40. Thank you
You are awesome !!

41. Questions ??