white an dredlesion(1)
TRANSCRIPT
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
ORAL WHITE & RED LESIONS (BURKET)
Other Red & White
Lesions
Benign Migratory
Glossitis
Leukoedema
White Sponge Nevus
Hairy Tongue
ORAL WHITE & RED LESIONS (BURKET)
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:
Etiology & Pathogenesis:
• 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.
PREMALIGNANT LESIONS
Oral Leukoplakia & Erythroplakia:
Etiology & pathogenesis:
• Genetic.
Activation of Oncogenes.
Deletion and Injuries to Suppressor genes.
Deletion and Injuries to DNA repair genes.
Predisposing factors.
PREMALIGNANT LESIONS
Oral Leukoplakia & Erythroplakia:
Epidemiology:
• Leukoplakia:
3%
50 years
Men
PREMALIGNANT LESIONS
Oral Leukoplakia & Erythroplakia:
Epidemiology:
• Erythroplakia:
0.02-0.1
Equal gender risk
PREMALIGNANT LESIONS
Oral Leukoplakia & Erythroplakia:
Clinical findings:
• Leukoplakia:
Homogenous.
Non-homogenous.
PREMALIGNANT LESIONS
Oral Leukoplakia & Erythroplakia:
Clinical findings:
• Erythroplakia:
PREMALIGNANT LESIONS
Oral Leukoplakia & 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.
PREMALIGNANT CONDITIONS
Oral Submucous Fibrosis:
Etiology & Pathogenesis:
• Betel quid (Areca nuts) [Arecoline]
• Genetic Predisposition:
• TNFα, TGFβ, IFУ.
• HLA-A10, B7, DR3.
PREMALIGNANT CONDITIONS
Oral Submucous Fibrosis:
Epidemiology:
• South Asia with great geographic variations.
• Women > Men in some geographic areas.
• Men in 20s years.
PREMALIGNANT CONDITIONS
Oral Submucous Fibrosis:
Clinical Findings:
• Early Lesion(s).
• Later course of the
disease.
• Defective oral
functions.
PREMALIGNANT CONDITIONS
Oral Submucous Fibrosis:
Diagnosis:
• Clinical Presentation.
• Patient history.
PREMALIGNANT CONDITIONS
Oral Submucous Fibrosis:
Diagnosis:
• International Criteria:
Palpable Fibrotic Bands.
Tough and leathery mucosal texture.
Blanching of the mucosa.
Histopathological features.
PREMALIGNANT CONDITIONS
Oral Submucous Fibrosis:
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.
IMMUNOPATHOLOGIC DISEASES
Oral Lupus Erythromatosus.
Etiology & pathogenesis:
• Innate and adaptive Immune dysregulation.
• Environmental factors.
• Genetic factors.
IMMUNOPATHOLOGIC DISEASES
Oral Lupus Erythromatosus.
Epidemiology:
• Women.
• Reproductive age
• Ethnic variations.
IMMUNOPATHOLOGIC DISEASES
Oral Lupus Erythromatosus.
Clinical findings:
• Oral Lesions Variations.
• Palatal lesions
• Malar Rush.
IMMUNOPATHOLOGIC DISEASES
Oral Lupus Erythromatosus.
Diagnosis:
• Anti-DNA, anti-smith antibodies.
• Lupus band test.
• Histopathology.
Oral Lupus Erythromatosus.
Diagnosis:
• Diagnostic criteria:
Malar rash
Discoid lesions
Photosensitivity
Oral ulcers
Arthritis of > 2 joints
Serositis
Renal disorders
Neurologic disorder
Hematologic disorder
Immunologic disorder
IMMUNOPATHOLOGIC DISEASES
IMMUNOPATHOLOGIC DISEASES
Oral Lupus Erythromatosus.
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
Reactions to Smokeless Tobacco
Clinical Manifestations:
• In its mildest form, the lesion may just be noted
as wrinkles at the site of application.
TOXIC REACTIONS
Reactions to Smokeless Tobacco
Clinical Manifestations:
• Whereas high consumers may
display a white and leathery
lesion, which sometimes contains
ulcerations
TOXIC REACTIONS
Reactions to Smokeless Tobacco
Clinical Manifestations:
• Gingival retractions.
• Oral mucosal lesions are less frequently
observed in association with chewing tobacco.
TOXIC REACTIONS
Reactions to Smokeless Tobacco
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
OTHER WHITE & RED LESIONS
Benign Migratory Glossitis (Geographic
Tongue)
OTHER WHITE & RED LESIONS
Leukoedema:
OTHER WHITE & RED LESIONS
White Sponge Nevus:
OTHER WHITE & RED LESIONS
Hairy Tongue:
THE END