CLASSIFICATION

OF ORAL LESION
A. Anggun Mauliana Putri

DEPARTEMEN ILMU PENYAKIT MULUT

FAKULTAS KEDOKTERAN GIGI
UNIVERSITAS HASANUDDIN
 White
Mucosal
Lesions
Dark
Syndrome
with Orofacial Mucosal
Features Lesions
CLASSIFICATION
OF ORAL
LESIONS

Radiographic Oral
Abnormalities Ulcers

Oral Soft Tissue

Enlargements
White Mucosal Lesions
 WHITE MUCOSAL LESIONS

Why appear white ???

EPITHELIAL SUBEPITHELIAL
SURFACE MATERIAL CHANGE
THICKENING

Symptomatik
Asymptomatic Asymptomatic
Opaque
Opaque Translucent
Rough
Rough Smooth
Soft
Doesn’t rub off Doesn’t rubs off
Rubs off → raw surface
Persists or progresses Static or progresses
Regresses (heals)
 Mucosal White Lesions of Epithelial Thickening

FOCAL LARGE OF DIFFUSE MULTIFOCAL

Homogenous Heterogenous Tobacco • Homogenous Diminished host Bilateral

• Rough, “shaggy”
appearance appearance appearance resistance to Buccal mucosa
appearance
• Sharp borders • Vogue borders • Sharp borders infection Chronic
• Vogue borders
• Located in area • Any location • Lower lip
• Midline of tongue
of friction • Maybe • Older age
• Symmetric
• Apparent cause enlarged • Loss of vermillion
• Often stained • At risk for AIDS • Lacy striae
improves with • Older age border
• Some material or HIV • May be seen
removal of the • Cofactors • Sun exposure
rubs off seropositive with erosions
cause • Progresses • Static or progresses
• Rough, • Other oral
thickened, sites may be
• Poor hygiene
Physiologic Idiopathic patcheds affected
• Some areas may
Hyperkeratosis Leukoplakia • Bilateral, lateral • May be skin
appear atrophic
(Epithelial Hairy Tongue Actinic borders of lesions
or rub off
Dysplasia or Keratosis tongue • Changes, but
• Painfull
Carcinoma) • Asymptomatic seldom
• Regresses with
• Persists or regresses
treatment
progresses
Homogenous grey Wrinckled

Red spots Velvety Hyperplastic Candidiasis Hairy Leukoplakia Lichen Planus

Palate Mucobuccal fold (Often coexist)

Pipe Smoking Smokeless tobaco Congenital,

Disappears when
stretched familial
Mildly wrinkled, milky Dramatic
Nicotinic Hyperkeratosis appearance
appearance
Stomatitis Caused by Smokeless
Tobacco Use
Leukoedema White Sponge Nevus
 WHITE MUCOSAL LESIONS

Nonpainful Painful Nonpainful

Rough Rough Smooth

Opaque Opaque Translucent

Do not rub off Rub off Do not rub off

Surface Thickening Surface Material Subepithelial Change

Mucosal White
Lesions • Curdy, white • Ragged, delicate
appearance • Delicate, grainy
• Buccal, mucosa
• Hx of surgery
• Hx of botol nut
• • Multiple, use
Characterized
Diffuse or other
• Focal pseudomembrane
• Vague borders bilateral • Asian culture
• Sharp borders • May be an trauma at
by Surface •
•
Poor oral hygiene
Diminished host • History of cause indication of cause
• Yellowish
• Asymptomatic
location • Limitation of
tissue
material or resistance • Heals • Static
• asymptomatic
• Statis
movement
• Progresses
Submucosal • Regresses with
treatment
• Adults

Change
Pesudomembranous Chemical Ulcer Fordyce Scar Submucous
Candidiasis Burn (see ulcerative Granules Fibrosis
lesions)
Dark Mucosal Lesions
 Classification of Dark Mucosal Lesions

Isolated Red Lesions

Multiple or Diffuse Red

Lesions
DARK MUCOSAL
LESIONS
Isolated Pigmented
Lesions

Multiple or Diffuse
Pigmented Areas
 ISOLATED RED ORAL LESIONS

BLANCHING NO BLANCHING

• Sharp borders • Sharp borders • Voque borders • Midline, • Large area • Borders
• Blanches, refills • Blanches only with • Balanching refills posterior tongue • Sharp borders • Often seen with
rapidly much pressure slowly • Characteristic • Maybe tender white spots
• Asymptomatic • Asymptomatic • Tender shape • Hx of trauma • No Hx of trauma
• Present for years • Small (2-4 mm) • Recent onset • Asymptomatic • Resolves • Older age, male
• May show some • Appears rounded • Apparent cause • Sharp borders • Co-factors
enlargement • Located in an area • Resolves • Atrophic (no
• Located anywhere prone to trauma papillae)
• No apparent cause • May resolve after • Persist
• Persist month

INFLAMMATION MEDIAN
HEMANGIOMA VARIX ECCHYMOSIS
(CONSIDER DIFFUSE RHOMBOID ERYTHROPLAKIA
(HEMATOMA)
LESIONS AND GLOSSITIS (EPITELIAL
POSSIBLE CAUSES) DYSPLASIA OR
EARLY
SQUAMOUS CELL
CARCINOMA)
Isolated Red Lesions of the Oral Cavity
 Dark Mucosal Lesions

Dark appearance of red and reddish-blue lesions result

from :
1. An abnormally dense focal concentration of blood
vessels.
2. Abnormal enlargement or distention of blood vessels.
3. Abnormal thinning of the surface epithelium.
4. Bleeding into the loose connective tissue.
Multiple and Diffuse Red
Lesions of the Oral
Cavity
Pigmented Lesions
Oral Ulcers
 Lesion
Onset

Presence of Ulcer
Systemic
Manifestation Duration

Presence
of
Vesicles

Critical Factor in Classifying Oral Vesiculoulcerative

With Acute Onset
• Bacterial infections or injury
and Short • Generalized viral infections
Duration

• Genetic disease
• Recurrent viral and idiopathic
With Chronic or disease
Recurrent Course • Autoimmune disease
• Granulomatous disease and
malignancy

Combination to Form the Classification of Oral Ulcers

(Onset and Duration)
 Initial
Classification
of Oral Ulcers
Classification
of Acute Oral
Ulsers
Classification
of Oral
Ulceration
with Chronic
or Reccurent
Course
 Oral Ulsers
caused By
Autoimmune
Disease
Oral Ulsers
Associated
with Tissue
Destruction
Oral Soft Tissue
Enlargement
 Papillary
enlargement
of the surface
epithelium

Acute
Malignant
inflammatory
neoplasms
enlargement

Classification of Oral Soft Tissue

Enlargement

Benign
Reactive
submucosal
hyperplasias
neoplasms
Classification of Soft Tissue Enlargement
 Papillary
Enlargements
of Surface
Epithelium
 Acute
Inflammatory
Soft Tissue
Enlargement
Soft Tissue Reactive Hyperplasias
Benign Submucosal Cysts and Neoplasms
 Soft Tissue
Malignancies
Radiographic
Abnormalities
 CLASSIFICATION OF
RADIOGRAPHIC ABNORMALITIES
Focal Lesions
(Bone, generalized bone condition, maxillary sinus,
soft tissue calcifications, and TMJ)

• Radiolucencies (Unilocular, multilocular, irregular shaped

radiolucensies)
• Mixed radiolucent radiopaque lesions
• Radiopacities
 Initial
Classification
of
Radiographic
Abnormalities
Classification of Jaw Radiolucencies
 Mixed
Radiolucent-
Radiopaque
Lesion
Radiopaque Lesions of The Jaws
Syndromes with
Orofacial
Features
 DEFINITION
Syndromes : signs and symptoms associated with morbid process
that together constitute the picture of the disease.

Acquired Congenital
Syndromes Syndromes
Syndrome with Orofacial Features by Primary
Clinical Manifestations
 Epidermolisis
Pierre Robin Crouzon
Bullosa
Syndrome Syndrome

Peutz-Jegher Syndrome
 Nevoid Basal Cell Hereditary Hemorrhagic
Carcinoma Syndrome Telangiectasia
Gardner Syndrome

Papillon-Lavefre Plummer-Vinson
Melkersson- Syndrome Syndrome
Rosenthal Syndrome
 CONCLUSION

The classification of lesions is the way for clinicians to

classify and categorize the lesion by primary
manifestation.

The classification of the lesion will be easier to identify,

compare, and learn about lesions thus supporting
obtaining a definitive diagnosis.
 REFERENCE

Coleman GC, Nelson JF. Principles of oral diagnosis.

St. Louis : Mosby. 1993.