123/11/2015Prof.hamam. . Principles of Oral Diagnosis: Gary C. Coleman John F. Nelson 1st Ed (1993),page 295- 299 I-White lesions of superficial materials.

**Prof.hamam

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. Principles of Oral Diagnosis: Gary C. Coleman John F. Nelson 1st Ed (1993),page 295- 299

I-White lesions of superficial materialsPseudomembranous candidiasis Hyperplastic candidiasis (white lesion of epithelial thickning )Angular chelitis Chemical mucosal burns Oral ulcersII- White lesions of submucosal change Fordyces granules ScarSubmucous fibrosis **Prof.hamam

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I-WHITE LESIONS OF SUPERFICIAL MATERIAL**Prof.hamam

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Opaque and rough or grainy.White material, soft or friable and rubbing an ulcer or erythematous Frequent burning & discomfort sensation.(food remnants, a dense accumulation of materia alba, or plaque painless, mucosa appears normal.

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The differential diagnosis is simple after removal of the white material( white surface coagulum ).therefore the differential diagnosis shifts to the ulcerative lesions category .*Prof.hamam*

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1-Pseudomembranous CandidiasisAcute superficial mucosal infection. Infants & immune compromised.systemic corticosteroid therapy, chemotherapy, AIDS, or acute debilitating illness. **Prof.hamam

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Clinical featuresDiffuse, patchy, or globular white thickened plaques.Tongue, soft palate & buccal mucosa.Can be wiped off erythematous, atrophic, or, ulcerated mucosa. Mild burning pain severe when coagulum scraped. **Prof.hamam

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Pseudomembranous candidiasis on the palate**Prof.hamam

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Thrush White patch and flecks that rubbed off(patient complained of a burning mouth )

More extensive pseudomembranous lesions associated with erythematous base

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Differential diagnosisC.F + resistance diagnosis. Chemical burns (white fibrinoid surface thinner and delicate , more focal + pt. HX. )**Prof.hamam

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Management Culture or exfoliative cytology.Spread to orophayngeal and esophageal surfaces. Medical referral. **Prof.hamam

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2-Hyperplastic Candidiasis.(White lesions of epithelial thickening )Superficial infection of the oral mucosa by the fungus Candida albicans and less common species of the same genus.* Predisposing factors,( poor oral hygiene,xerostomia,recent antibiotic treatment,dental appliance,)* Compromised Immune system. ( early infancy,AIDS,corticosteroid,anemia,diabetes mellitus,)

**Prof.hamam

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Hyperplastic candidiasisEpithelial thickening that do not rub off. Pseudomembranous candidiasis. Atrophic candidiasis.Chronic infection,red patch thinedred lesionAngular chilitis: labial commissures (non healing fissures).

**Prof.hamam

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Chronic Hyperplastic Candidosis ( candidal leukoplakia ) It appears as a thick,white leathery plaque of irregular thickness with rough surface (identical leukoplakia clinically ) The white patch is seen as triangular patch on buccal mucosa , lip commissure Bilateral distribution In some cases erythematous areas are located within the white patch ( producing feature of speckled leukoplakia )Candidal leukoplakia is often associated with angular cheilitis

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Candidal leukoplakia a chronic form of candidiasis in which firm red white plaques form In the cheek

In the palate opposite a tongue lesions ( kissing lesions **Prof.hamam

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Chronic hyperplastic candidasis. Chronic hyperplastic candidasis presenting as multiple wartilke growths on the patients lower lip **Prof.hamam

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3-angular cheilitislabial commissures characterized by nonhealing fissures two, three, or even all four forms. **Prof.hamam

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Clinical featuresHyperplastic candidiasis multiple or diffuse variably thick, patchy, do not rub off vague borders tongue. Other formsHyperplastic most resistance. vaginal itching and discharge indicative of vaginal candidiasis. **Prof.hamam

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Differential diagnosis The combination and underlying condition (resistance).Lichen planus-striae & skin lesions. Hairy leukoplakia treatment no response ?? other lesion. **Prof.hamam

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Management decisionsA working diagnosis exolifative cytology culture. Topical antifungal -1 week. Resistant systemic antimycotic. Clean mucosa brush or scrapDentures 1/2 teaspoon of bleach in 1 cup or in topical antimycotic Medical referral.**Prof.hamam

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4-chemical Mucosal Burns corrosive chemicals( aspirin tablet. Iatrogenic chemical injury )Wiped away painful central ulceration.Thin, membranous appearance Adherent patches on periphery. The lesions may be categorized as ulcerative rather than white if the superficial white material has been abraded away before examination Pt. HX.

Differential diagnosisDiffuse & multifocal candidiasis. Treatment :- remove the cause **Prof.hamam

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5-Oral Ulcerswhite superficial fibrinoid coagulum. Bulla( separation of the epithelium from the connective tissue )Wiped away **Prof.hamam

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Differential diagnosisEpithelial thickening.Candidiasis. Chemical burn.Clinically :- --------**Prof.hamam

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II-WHITE LESIONS OF SUBMUCOSAL CHANGEIt appear pale because the normally vascular mucosal connective tissue has been replaced by less vascular tissue .Smooth, translucent, don't rub off Non painfulFordyce granules, scarring,submucousfibrosis

**Prof.hamam

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1-Fordyce GranulesEctopic Sebaceous glands located within the oral mucosa ( variation of normal ). Increase in prominence with age.Buccal, labial mucosa Treatment , no treatment or follow up.Clinically ,,,,,,,,,,,,**Prof.hamam

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Fordyces granules on the buccal mucosa**Prof.hamam

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Clinical features. Small (1 to 2 mm)ovoid yellowish-white Bilaterally symmetric distribution .Differential diagnosisCharacteristic appearance Management:No treatment or observation.**Prof.hamam

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2-ScarHealing and repair of soft tissue injuries with dense collagenous connective tissue or scar often produces a pale appearance as compared with adjacent, normal tissues.( ?The hard palate and gingiva).**Prof.hamam

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Clinical features. Focal, homogeneous, pale, smooth and sharply delineated borders. No pain, or other symptoms.Pit or fissure depressions ( if the injury or surgical procedure resulted in poor tissue apposition )Stellate pattern of pale lines radiating from the depression between the tonsillar pillars that represent healing follwing a tonsillectomy .**Prof.hamam

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Differential diagnosis. Submucous fibrosis ManagementNone or observation.**Prof.hamam

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3-Submucous FibrosisGeneralized fibrosis of the connective tissue of the oral mucosa in response to habitual chewing of betal nut & spices India & southeast Asia .

**Prof.hamam

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Clinical features. Generalized yellow- to white discoloration.Smooth surfaceIntensity of the color vary.Loss of elasticity & firmness. Soft palate and buccal mucosa. Severe trismus HX. oral habits. **Prof.hamam

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Generalized oral mucosal fibrosis and history of the oral habit confirm the diagnosis **Prof.hamam

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Differential diagnosis. systemic sclerosis, Radiotherapy.Management Discontinue habit,Fibrosis is irreversible. Stretching exercises +corticosteroid clinical reexamination.( is mandatory because approximately one third eventually develop squamous cell carcinoma )**Prof.hamam

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