White lesions of oral cavity

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

4. Why abnormally white?

5. 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.

6. 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.

7. Hereditary benign intraepithelial dyskeratosis

8. 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.

9. 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.

10. 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.

11. 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.

12. 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

13. Forms of leukoplakia 1) Homogeneous

14. 2) Non homogenous

15. Proliferative Verrucous Leukoplakia

16. Squamous papilloma Verruca vulgaris Verrucous carcinoma SCC Some white exophytic growths

17. 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

18. 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

19. Candidiasis

20. Oral Submucous Fibrosis

21. Oral Lichen Planus

22. Chemical Injuries Of The Oral Mucosa

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

24. Photo Quiz !!

25. 10/M presented with bilateral folded velvety white buccal mucosal changes. How will you approach this case ?

26. 28/M IV drug user , presented with unscrapable white plaques on lateral border of tongue since 6 months. Most likely diagnosis ??

27. 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 ??

28. 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 ??

29. 70/M who had been wearing complete denture since 3 months developed bilateral unscrapable white plaque on the mandibular alveolar ridge. DD ??

30. Identify the lesion

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

32. Thank you You are awesome !!

33. Questions ??