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White Oral Lesions: Introduction & Classification

White lesions in the oral mucosa can indicate various conditions, from normal variations to precancerous potential. This guide explores the causes, classification, and distinguishing features of white oral lesions.

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White Oral Lesions: Introduction & Classification

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  1. WHITE LESIONS PART - I INTRODUCTION & CLASSIFICATION

  2. WHITE LESION is a non-specific term used to describe any abnormal area of oral mucosa that on clinical Examination appears whiter than surrounding tissue & is usually slightly raised, roughened or of different texture From adjacentnormal tissue

  3. WHY LESION APPEARS WHITE Normal  Coral pink due to reflection of light by underlying capillary bed • Increased production of keratin • Foreign body • Decreased blood supply • Imbibition of fluid by upper layer of mucosa

  4. ALTERED MUCOSA • DUE TO • EPITHELIAL THICKENING • SURFACE DEBRIS • SUBEPITHELIAL • Fibrosis • Fordyces granule

  5. Hyperkeratosis Epithelial dysplasia Carcinoma - in – situ Squamous cell carcinoma Lichen planus Nicotina stomatitis Hairy tongue Hairy leukoplakia Geographic tongue Candidiasis Burn Fibrin clot SURFACE DEBRIS EPITHELIAL THICKENING

  6. CAUSES FOR WHITISH DISCOLORATION: • TRAUMA • CHEMICAL INJURY • IMMUNOLOGICAL PROCESS • RACIAL/GENETICALLY DETERMINED • TOBACCO USE • MUCOCUTANEOUS DISEASE

  7. CLASSIFICATION - 1 • Normal Variations: Leukoedema / Linea Alba / Fordyce Granules • Nonkeratotic Lesions: Cheek bite / Burns / Candidiasis • Keratotic Lesions: Nicotina Stomatis / White spongy Nevus / Geographic tongue / Hairy Tongue • Lesions with precancerous potential: OSMF / Leukoplakia

  8. CLASSIFICATION - 2 • Scrapable Lesions • Candidiasis • Mucosal Burns • Radiation mucositis • Non Scrapable • Leukoplakia • OSMF • Leukoedema • White Spongy Nevus

  9. LEUHOEDEMA • Use of tobacco • Male predliction 2 : 1 • Bilaterally on buccal mucosa, lip • Normal softness & flexibility with greyish white slightly folded opalescent appearance

  10. LEUKOEDEMA

  11. Epithelium covered with diffuse edematous film • Disappears by stretching of mucosa • D/D: • LEUKOPLAKIA • CHEEK BITE • WHITE SPONGE NEVUS • NO TREATMENT

  12. LENIA ALBA • Line of keratinization parallel to line of occlusion • Frequent frictional contact with food & teeth • Effect of smoking • Buccal mucosa

  13. LINIA ALBA

  14. FORDYCES GRANULE • Heterotropic collection of sebacious glands covered with intact mucosa • Any age • Bilateral • Small yellow spots • Smooth surface with cheesy consistancy

  15. FORDYCES GRANULE

  16. MORSICATO BUCCARUM HABITUAL CHEEK / LIP BITE • Frequent & repeated rubbing , sucking or chewing movement • Neurological unconscious nervous habit • Occclusal discrepancies, rough tooth surface • Any age , buccal mucosa • Homogenous opaque white appearance

  17. CHEEK BITE

  18. D/D: • White sponge nevus • Chemical burn • Candidiasis • Rx: • Diazepam 5 to 10 mg at bed time • Occlusal night guard

  19. BURNS • THERMAL BURNS: • Hot food • Pain last for short duration • Ant 1/3rd of tongue & palate • Produce coagulation necrosis of tissue • Rarely ulceration & stripping of mucosa • Surface layer of epi is disquamated

  20. MUCOSAL BURNS

  21. CO2 BURNS • Age  children's • Tongue & lip • Prolonged contact of ice cream, ice, very cold glass & metal with lip • Epithelium becomes dry & rougher than surrounding tissues

  22. CHEMICAL BURNS Caustic chemical agents • Aspirin, clove oil, ethyl alcohol, Vit C tabs • Irregular white pseudomembrane covered lesion • painful Coagulation necrosis of epi Inflammation

  23. RADIATION MUCOSITIS • Basal layer Radiosensitive vegetative & differentiating inter mitotic cells • Area of redness & inflammation with pseudo membrane , grayish white slough • Difficulty in food intake • Rx  Topical anesthetics & good oral hygiene • Healing within 2 months

  24. RADIATION MUCOSITIS

  25. STOMATITIS NICOTINA PALATI/ SMOKERS PALATE STOMATITIS NICOTINA • Pipe ,cigarette, cigar & reverse smoking • Middle & elderly adults • Palatal mucosa • Stage I, II, III

  26. NICOTINA STOMATITIS

  27. Mucosa is reddened Grayish white thickened & fissured • D/D: • Papillary hyperplasia • Rx: • Reversible Wrinkeled irregular Multinodular appearance

  28. CANNANS DISEASE  Described by cannon in 1935 WHITE SPONGE NEVUS • Commonly in childrens • Cheek, palate, gingiva, floor of the mouth, tongue • Mucosa appears thickened & folded WHITE FOLDED GINGIVOSTOMATITIS CONGENITAL LEUKOKERATOSIS

  29. WHITE SPONGE NEVUS D/D: LEUKOEDEMA LEUKOPLAKIA LICHEN PLANUS

  30. HAIRY TONGUE • Generally caused by broad spectrum antibiotic and steroids. • Intense smoking and H&N radiotherapy. • Contaminated filliform papillae. • Basal cell hyperplasia .

  31. GEOGRAPHIC TONGUE • Unknown cause • Associated with Psoriasis. • Mostly affects Females and rarely in children

  32. TRAUMATIC KERATOSIS • Local irritants • Ill fitting denture • Sharp cusp • Site : Lip & Buccal mucosa • Thickened whitish area • Rx: remove the cause / biopsy iii

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