White an dredlesion(1)

ORAL WHITE & RED LESIONS

ORAL WHITE LESIONS

Why lesions appear white?

Increased epithelial thickness without keratin

(acanthosis)

Increased surface keratin

Increased edema between epithelial cells

Necrosis of surface epithelium

Surface fungal colonies

Ectopic white structures

ORAL WHITE LESIONS

Why lesions appear white?

Immune mediated conditions

Overgrowth of white structure

Viral Infection

Cancer

Idiopathic

ORAL RED LESIONS

Why lesions appear RED?

Thinning of (atrophy) epithelial cells (Decreased

No. of these cells)

Increased vascularization

ORAL WHITE LESIONS

Classification:

Hereditary Conditions

Leukoedema

White Sponge Nevus

Hereditary Benign Epithelial Dyskeratosis

Follicular Keratosis

ORAL WHITE LESIONS

Classification:

Reactive Lesions

Focal (Frictional) Hyperkeratosis

White lesions associated with smokeless tobacco

Nicotine Stomatitis

Hairy Leukoplakia

Hairy Tongue

Dentifrice-associated Slough

ORAL WHITE LESIONS

Classification:

Preneoplastic and Neoplastic lesions

Actinic Cheilitis

Idiopathic Leukoplakia

ORAL WHITE LESIONS

Classification:

Other White Lesions

Geographic Tongue

Lichen Planus

Lupus Erythromatosus

Classification:

Non-epithelial White-

Yellow Lesions

Candidiasis

Mucosal Burns

Submucous

Fibrosis

Fordyce`s

Granules

Ectopic Lymphoid

Tissue

Gingival Cyst of

New-born

Parulis

Lipoma

ORAL WHITE LESIONS

Infectious diseases:

Oral Candidiasis

Hairy Leukoplakia

Premalignant

Leukoplakia &

Erythroplakia

Submucous

Fibrosis

Immunopathologic

Diseases

Oral Lichen Planus

Drug-induced

Lichenoid Reactions

Lichenoid Reaction

of GVHD

Lupus

Erythromatosis

ORAL WHITE & RED LESIONS (BURKET)

Allergic reactions

Lichenoid Contact

Reactions

Reactions to

Dentifrice &

Chlorhexidine

Toxic Reactions

Reactions to

Smokeless Tobacco

Smoker`s Palate

Reactions to

Mechanical Trauma

Frictional Keratosis

Marrsicatio


Other Red & White

Lesions

Benign Migratory

Glossitis

Leukoedema

White Sponge Nevus

Hairy Tongue


INFECTIOUS DISEASES

Oral Candidiasis:

Definition:

• It is an opportunistic fungal infection of the oral

mucosa.

• It is divided into primary and secondary infections.

• It is a disease of very young, old or sick.

INFECTIOUS DISEASES

Oral Candidiasis:

Etiology & Pathogenesis:

• C. albicans, C. trapicalis, C. glabrata.

• Adherence to epithelial surface.

• Overcome constant desquamation of surface epithelial cells.

• Local & systemic predisposing factors.

INFECTIOUS DISEASES

Oral Candidiasis:

Epidemiology:

• 35% prevalence of Candida in normal oral flora.

• 90% with improved detection techniques.

• Women, summer months, hospitalized patients, blood

group O and nonsecretion of blood group antigens.

• 50% prevalence of denture stomatitis.

INFECTIOUS DISEASES

Oral Candidiasis:

Clinical Findings:

Pseudomembranous candidiasis (Thrush).

• The classic candida infection.

• Antibiotic medications.

INFECTIOUS DISEASES

Oral Candidiasis:

Clinical Findings:

Erythematous candidiasis.

• Atrophic Candidiasis.

• Inhalation steroids.

INFECTIOUS DISEASES

Oral Candidiasis:

Clinical Findings:

Chronic Plaque-type and Nodular Candidiasis.

• Candidal Leukoplakia.

• Malignant transformation.

INFECTIOUS DISEASES

Oral Candidiasis:

Clinical Findings:

Denture Stomatitis:

• Denture-bearing palatal areas.

• Candida-associated infection..

INFECTIOUS DISEASES

Oral Candidiasis:

Clinical Findings:

Angular Cheilitis:

• Nutritional deficiency.

• Denture stomatitis related.

• Candida-associated infection.

INFECTIOUS DISEASES

Oral Candidiasis:

Clinical Findings:

Median Rhomboid Glossitis:

• Smoking, denture wearers &

inhalation steroids.

• Candida-associated infection.

INFECTIOUS DISEASES

Oral Candidiasis:

Clinical Findings:

Secondary Oral Candidiasis (CMC):

• Immune deficiency and systemic MC.

• Many systemic diseases.

INFECTIOUS DISEASES

Oral Candidiasis:

Diagnosis:

• Clinical presentations.

• Smear, swab, imprint culture, impression culture,

salivary culture, oral rinse.

• Histopatholgy.

INFECTIOUS DISEASES

Oral Candidiasis:

Treatment:

• Identify & modify/eradicate/correct the predisposing

factors.

• Polyene antifungal (Amphotericin B and Nystatin).

• Azole antifungal (Clotrimazole, Miconazole,

Ketoconazole, Fluconazole, Itraconazole).

INFECTIOUS DISEASES

Hairy Leukoplakia:

Definition:

Is a white lesion on the lateral borders of the tongue

and associated with AIDS.

INFECTIOUS DISEASES

Hairy Leukoplakia:


• EBV

• Low CD4

• Low CD1a+ Langerhans` Cells

INFECTIOUS DISEASES

Hairy Leukoplakia:

Epidemiology:

• Prior to HAART era.

• AIDS patients.

• Gender.

• Smoking.

INFECTIOUS DISEASES

Hairy Leukoplakia:

Clinical Findings:

• Vertical white folds oriented as a palisade along the borders of the tongue.

• May also be displayed as white and somewhat elevated plaque, which cannot be scraped off.

• Symptomless.

INFECTIOUS DISEASES

Hairy Leukoplakia:

Diagnosis:

• Clinical features.

• Histopathology.

• Detection of EBV.

INFECTIOUS DISEASES

Hairy Leukoplakia:

Treatment:

• Antiviral.

PREMALIGNANT LESIONS

Oral Leukoplakia & Erythroplakia:

Definition:

• WHO definition.



Etiology & pathogenesis:

• Genetic.

Activation of Oncogenes.

Deletion and Injuries to Suppressor genes.

Deletion and Injuries to DNA repair genes.

Predisposing factors.



Epidemiology:

• Leukoplakia:

3%

50 years

Men



Epidemiology:

• Erythroplakia:

0.02-0.1

Equal gender risk



Clinical findings:

• Leukoplakia:

Homogenous.

Non-homogenous.



Clinical findings:

• Erythroplakia:



Diagnosis:

• Provisional clinical diagnosis.

• Definitive clinical diagnosis.

• Biopsy.

Definable Vs. No definable lesion.

PREMALIGNANT CONDITIONS

Oral Submucous Fibrosis:

Definition:

• Is a chronic disease that affects the oral mucosa

as well as the pharynx and the upper two-thirds

of the esophagus.




• Betel quid (Areca nuts) [Arecoline]

• Genetic Predisposition:

• TNFα, TGFβ, IFУ.

• HLA-A10, B7, DR3.



Epidemiology:

• South Asia with great geographic variations.

• Women > Men in some geographic areas.

• Men in 20s years.



Clinical Findings:

• Early Lesion(s).

• Later course of the

disease.

• Defective oral

functions.



Diagnosis:

• Clinical Presentation.

• Patient history.



Diagnosis:

• International Criteria:

Palpable Fibrotic Bands.

Tough and leathery mucosal texture.

Blanching of the mucosa.

Histopathological features.



Treatment:

• Habit cessation.

• Different unproved treatment strategies.

IMMUNOPATHOLOGIC DISEASES

Oral Lupus Erythromatosus.

Definition:

• An inflammatory connective tissue disease with variable features, frequently including fever, weakness and fatigability, joint pains or arthritis resembling rheumatoid arthritis, diffuse erythematous skin lesions on the face, neck, or upper extremities.



Etiology & pathogenesis:

• Innate and adaptive Immune dysregulation.

• Environmental factors.

• Genetic factors.



Epidemiology:

• Women.

• Reproductive age

• Ethnic variations.



Clinical findings:

• Oral Lesions Variations.

• Palatal lesions

• Malar Rush.



Diagnosis:

• Anti-DNA, anti-smith antibodies.

• Lupus band test.

• Histopathology.


Diagnosis:

• Diagnostic criteria:

Malar rash

Discoid lesions

Photosensitivity

Oral ulcers

Arthritis of > 2 joints

Serositis

Renal disorders

Neurologic disorder

Hematologic disorder

Immunologic disorder




Treatment:

• The disease treatment strategies.

• Oral Lesions:

High potent local steroids.

Intralesional steroids.

Antifungal/chlorhexidine.

TOXIC REACTIONS

Reactions to Smokeless Tobacco

Types & epidemiology of Smokeless Tobacco:

South Asia

US

Scandinavia

TOXIC REACTIONS


Clinical Manifestations:

• In its mildest form, the lesion may just be noted

as wrinkles at the site of application.

TOXIC REACTIONS



• Whereas high consumers may

display a white and leathery

lesion, which sometimes contains

ulcerations

TOXIC REACTIONS



• Gingival retractions.

• Oral mucosal lesions are less frequently

observed in association with chewing tobacco.

TOXIC REACTIONS


Cancerogenicity Risk:

• Chewing and moist impose minimal risk.

• Dry has the highest risk.

TOXIC REACTIONS

Smoker`s Palate:

• White leathered lesions of the

palate.

REACTIONS TO MECHANICAL TRAUMA

Morsicatio:

• Is instigated by habitual

chewing.

REACTIONS TO MECHANICAL TRAUMA

Frectional Keratosis:

• White lesion observed in

areas of the oral mucosa

subjected to increased

friction caused by, for

example, food intake.

OTHER WHITE & RED LESIONS

Benign Migratory Glossitis (Geographic

Tongue)

• Is an annular lesion affecting the dorsum and

margin of the tongue.

• The lesion is also known as erythema migrans.

• The typical clinical presentation comprises a

white, yellow, or gray slightly elevated peripheral

zone


Benign Migratory Glossitis (Geographic

Tongue)


Leukoedema:


White Sponge Nevus:


Hairy Tongue:

THE END

White an dredlesion(1)

Documents

oral mucosa

normal oral flora

erythematous candidiasis

nodular candidiasis

atrophic candidiasis

epithelial surface

clinical findings

epithelial thickness