WHITE LESIONS

surface lesions of oral mucosa White Lesions

! White-appearing lesions of the oral mucosa resulting from

the scattering of light through an altered mucosal surface
ORAL PATHOLOGY II
! Mucosal alterations:
University of the East
! Hyperkeratosis
College of Dentistry ! Hyperplasia of the stratum malpighii
! Intracellular edema of epithelial cells
! Reduced vascularity of subjacent CT
! Color of exudate and other surface contaminant

White Lesions
White Lesions etiology
! Hereditary conditions

! Reactive lesions ! Physical trauma

! Other mucosal white lesions ! Tobacco use

! Other non-epithelial white lesions ! Genetic abnormalities

! Pre-neoplastic & neoplastic lesions ! Mucocutaneous diseases

! Inflammatory reactions

Leukoedema
Hereditary Conditions

! Leukoedema

! White sponge nevus

! Hereditary benign intraepithelial dyskeratosis(H.B.I.D)

! Follicular keratosis
Leukoedema Leukoedema
etiology clinical features

! Asymptomatic
! No definitive cause
! Symmetrical in distribution
! Implicated factors:
! Occurs on the buccal
! Smoking mucosa
! Alcohol ingestion
! Appears as a gray-white,
! Bacterial infection
diffuse, filmy or milky
! Salivary conditions surface
! Electrochemical interaction
! Exaggerated cases show a
! Poor oral hygiene & abnormal masticatory pattern whitish cast with surface
textural changes :
! Wrinkling or corrugation

Leukoedema Leukoedema
clinical features histopathology
! With stretching of the buccal mucosa, the opaque changes
will dissipate ! Epithelium is parakeratotic
! Gentle stroking with gauze pad or tongue depressor will not
! Epithelium is acantholytic
remove it
! Marked intracelullar edema of spinous cells

! Enlarged epithelial cells with small pyknotic nuclei in

optically clear cytoplasm

Leukoedema Leukoedema
differential dx treatment

! Leukoplakia ! No treatment

! White sponge nevus ! No premalignant tendencies(leukoplakia)

! Hereditary benign
intraepithelial dyskeratosis

➢ Stretching of the mucosa will

differentiate it with other
lesion
White Sponge Nevus White Sponge Nevus
clinical features clinical features
! An autosomal dominant condition (Genodermatosis) ! Painless

! Mistaken for leukoplakia ! Deeply folded, white or gray lesions affecting mucosa

! Bilateral & symmetric

! Appears early in life

! Keratosis (buccal mucosa)

White Sponge Nevus White Sponge Nevus

histopathology differential dx
! spongiosis, acanthosis & parakeratosis
! HBID

! Pachyonychia congenita

! Lichen planus(hypertrophy type)

! Cheek biting & traumatic or frictional keratosis

White Sponge Nevus

treatment
Hereditary benign intraepithelial dyskeratosis (HBID)

! No tx ! Aka Witkop’s dse

! Topical tetracycline ! autosomal dominant

! Non malignant ! Tri-racial isolate of white, Indian and african-american

composition of Halifax County, North Carolina
Hereditary benign intraepithelial dyskeratosis Hereditary benign intraepithelial dyskeratosis
clinical features clinical features

! Syndrome ! Buccal & labial mucosa

! Early onset ( first year of life) ! Labial commissures

! Bulbar conjunctivitis ! Floor of the mouth

! Foamy plaques - triangular in shape
! Lateral surfaces of the tongue
! Oral lesions
! Soft, asymptomatic white folds & ! Gingiva
plaques of spongy mucosa
! Palate

Hereditary benign intraepithelial dyskeratosis Hereditary benign intraepithelial dyskeratosis

clinical features clinical features

Oral lesions Ocular lesions

! Usually detected within the first yr of life
! Vary seasonally
! Gradually increase in intensity until midadolescence
! Patient complain of photophobia, esp in early life
! Variations: deeply folded, opaque, white lesions to more
delicate, opalescence areas ! Blindness secondary to corneal vascularization

! Involved areas along the occlusal line will be macerated ( ! Spontaneous shedding of the conjuctival plaques occurs
soften by soaking)- giving it a shaggy surface texture on a seasonal basis

Hereditary benign intraepithelial dyskeratosis Hereditary benign intraepithelial dyskeratosis

histopathology histopathology
! Cell-within-a-cell
! Eosinophilic cells within the
! Similarities between oral and conjunctival lesions are
noted microscopically middle & superficial spinous
regions become surrounded
! Epithelial hyperplasia by adjacent cells
! Acanthosis
! Significant hydropic degeneration ! Non-dyskeratotic cells
! Enlarged, hyaline & so-called waxy eosinophiic cells present ! Enlarged & edematous &
in the epithelium become elongated
HBID HBID
differential dx treatment

! White sponge nevus ( oral lesions) ! No treatment is necessary

! Pachyonychia congenita (oral mucosa) ! Condition is self limiting

! Fingernail & toenail changes (extreme thickening along the
free nail edge) ! No risk of malignant transformation
! Defects of teeth, angular cheleitis, follicular keratosis &
corneal dyskeratosis (corneal opacities)

! Hypertropic lichen planus (oral mucosa)

! No evident inheritance pattern
! No eye changes
! Nail changes ( related to nail fold destruction)

Follicular Keratosis Follicular Keratosis

etiology pathogenesis

! Darier’s disease ! Less well understood

! Darier-White disease ! Four theory

! Genetically transmitted disorder with an autosomal 1. Genetic defects producing abnormalities in the
dominant mode of inheritance desmosome-tonofilament complex
! 50% chance of an affected offspring developing the
disease 2. Precocious cell development coupled with altered
epithermal cell turnover rates
! With equal gender distribution
3. Genetic defects in vitamin A utilization by epithelial cells
! 50% of cases involve the oral cavity –followed closely by
the onset of epidermal lesions 4. Possible defects in cell-mediated immunity

Follicular Keratosis Follicular Keratosis

pathogenesis clinical features

! The clinical & pathogenic end result from several test is
an acantholytic process
! Onset: childhood or adolescence
Skin manifestations:
! Small, skin-colored papular lesions symmetrically
distributed over the face, trunk & intertriginous areas
! Papules eventually coalesce & feel greasy (excessive
keratin production)
! Coalesced areas form patches of vegetating to
verrucous growths ( become infected & malodorous)
Follicular Keratosis Follicular Keratosis
clinical features clinical features

! Skin lesions may occur unilaterally or in a zosteriform ! Favored oral mucosal sites:
pattern
! Keratinized regions: attached gingiva & hard palate
! Thickening of the palms & soles (hyperkeratosis palmaris et ! All oral sites involvement have been reported
plantaris) by excessive keratotic tissue is common
! Small, whitish papules (ranges from 2-3 mm) producing an
! Flat warts on the dorsa of the hands or verruca plana or overall cobblestone appearance (coalesce)
acrokeratosis verruciformis ( Hopf’s keratosis)
! May extend into the oropharynx & pharynx
! Fingernail changes: (helpful in Dx)
! Fragility , splintering & subungual keratosis

! Localized lesions may follow sunburn

! Esp on the legs

Follicular Keratosis
Follicular Keratosis histopathology

! Oral lesions closely resemble the cutaneous lesions

! Suprabasal lacunae (clefts) formation containing

acantholytic epithelial cells

! Basal layer proliferation immediately below & adjacent to

the lacunae or clefts

! Formation of vertical clefts that show a lining of

parakeratotic & dyskeratotic cells

Follicular Keratosis Follicular Keratosis

histopathology clinical features

! Presence of specific benign dyskeratotic cells- corps

rounds & grains

! Corps rounds- large, keratinized squamous cells with round

uniformly basophilic nuclei & intensely eosionphilic
cytoplasm

! Grains are smaller parakeratotic cells with pyknotic

hyperchromatic nuclei
Follicular Keratosis Follicular Keratosis
differential dx treatment

! Dyskeratosis congenita (rare) ! Vitamin A

! Acanthosis nigricans ! Systemic toxicity were reported

! Condyloma acuminatum ! Vitamin A analogues or retinoids used

! Nicotine stomatitis ! Side effects: cheilitis, elevated of serum liver enzymes &
triglycerides & severe dryness of the skin
! Acantholytic dyskeratosis (histopath)

! Hailey-Hailey disease (histopath.)

Follicular Keratosis
prognosis
Reactive Lesions

! Chronic ! Focal (frictional) hyperkeratosis

! Slowly progressive ! White lesions associated with smokeless tobacco

! Remissions may be noted in some patients ! Nicotine stomatitis

! Non malignant ! Hairy leukoplakia

! Hairy tongue

! Dentifrice associated slough

Focal Hyperkeratosis

! Frictional Hyperkeratosis

! Benign Hyperkeratosis

! Denture callous or Ridge Callous ( when denture related)

! Pachyderma oris

! Pachyderma orealis

! Most common white lesions in the oral cavity (71%)

Focal Hyperkeratosis Focal Hyperkeratosis
etiology clinical features

! Chronic irritation ! Hyperplasia

! broken tooth, restoration, habitual cheek- or lip-biting,
vigorous tooth brushing , hyperocclusion or an ill-fitting
! A circumscribed, adherent, white plaque at the site
denture
of chronic irritation
! Common sites: order of frequency
! Hyperkeratotic white lesion (analogous to callus on the ! Mandibular mucosa
skin) ! Cheek ( cheek-biting/pathomimia, morsicato buccarum)
! lip
! Protective action against low-grade long-term trauma ! palate
! Floor of the mouth
! Maxillary mucosa
! Tongue

Focal Hyperkeratosis Focal Hyperkeratosis

Focal Hyperkeratosis
Focal Hyperkeratosis histopathology

! Thickened layer of keratin (hyperkeratosis) or parakeratosis

(keratin layer shows remnants of epithelial nuclei)

! Infiltration by plasma cells & lymphocytes (chronic

inflammation)
Focal Hyperkeratosis Focal Hyperkeratosis
differential dx treatment

! Plaque-type lichen planus ! Elimination of the cause

! Repair broken tooth, restoration or ill-fitting denture
! Chronic hyperplastic candidiasis
! Excision if the lesion is large
! Hairy leukoplakia ( lateral tongue)
! Palliative treatment, local application of Benzocaine
! Smoking-related leukoplakia (Orabase®) or Triamcinolone (Kenolog®)
! Smokeless tobacco keratosis

Focal Hyperkeratosis
prognosis
Smokeless Tobacco Keratosis

! Good prognosis ! Painless

! Lesions disappear spontaneously 2-3 weeks after the ! Prevalent in regions of common use
removal of the cause
! Pouch (tobacco) keratosis commonly seen in the
! If excised, no recurrence mandibular vestibule

! Patient reports a history of smokeless tobacco use with

signs of adjacent teeth & periodontium damage

Smokeless tobacco
Smokeless Tobacco Keratosis- etiology lesion
! chemical carcinogens liberated from smokeless tobacco
( chewing and moist snuff)
Smokeless tobacco
lesion Smokeless Tobacco Keratosis- diff dx

! Frictional keratosis

! Hyperplastic candidiasis

! Leukoedema
Slight to moderate parakeratosis often in form of chevrons
acanthosis ! Plaque-type Lichen Planus

Smokeless Tobacco Keratosis- tx Nicotine Stomatitis

! Cessation ! Nicotinic stomatitis

! Biopsy maybe required in persistent lesion, ulcerated and ! Smoker’s palate

indurated lesions
! Long exposure increases risk for malignant transformation ! Stomatitis nicotina

! Leukokeratosis nicotini palatini

Nicotine Stomatitis Nicotine Stomatitis

etiology clinical features
! Chronic exposure to the heat from tobacco

! pipe & cigar smoking ! Diffuse , white, thickening of the Palatal mucosa with
interspersed elevated white Papules- red central
depression

! Painless

! Persistent/Prevalent in Patients with Hx of pipe &/cigar

smoking
 Nicotine Stomatitis
Nicotine Stomatitis Histologic features

! Hyperkeratosis and
acanthosis of surface
epithelium
! Dilated salivary gland duct
with squamous metaplasia
of lining
! CT Surrounding exhibits
inflammation
Inflammed openings of the minor salivary gland along the palatal mucosa

Nicotine Stomatitis Nicotine Stomatitis

treatment prognosis

! Elimination of smoking ! Rarely evolves into malignancy

! Condition may regress ! Except in reverse smoking ( lit end positioned inside the
mouth)
! re-evaluation ! This habit intensifies the carcinogenic effect of heat, smoke &
tobacco constituents on the palate

! respiratory tract may be affected

! Significantly increases the overall risk the development of
malignancies

Dentrifice associated slough

Dentrifice associated slough Etiology

! Common phenomena associated with use of different ! Believed to be a form of chemical burn or a reaction to
toothpaste brand an ingredient of a dentrifrice

! A painless white lesion that is not known to progress or ! Possible causative component
transform to any significant condition ! Detergent
! Flavorings

! Can also be caused by mouthwash with similar causative

ingredient
Dentrifice associated slough Dentrifice associated slough
Clinical feature Prognosis

! Superficial whitish slough seen on the buccal mucosa ! Benign white lesion

! Commonly described by the patient as ‘peeling’, ‘oral ! Lesion will resolve once the dentrifice/mouthwash is
peeling’ discontinued

! Shifting to a more blander toothpaste is often necessary

Case 1

! 68 yo white man came dental school routine dental care

! PMH – pulmo emphysema & HTN tx Aldumet

! Oral exam – extensive filmy, translucent, white lesion affecting

most labial, buccal and lateral lingual mucosa with floor of the
mouth involvement and edentulous ridge

! When strecthed, a fissured pattern apparent, non-ulcerated,

linear, pink, parallel fissure interrupting the confluent white
patches

Case 1
! Other condition DD of extensive and bilateral white lesions Listerine was D/C and the lesion has resolved in 2 weeks
were R/O by Hx and clinical appearance

! Habits – occasional use cough drops and excessive use of

Listerine, denies tobacco and alcohol use
 Hairy Tongue
! White hairy tongue

! A condition occurring on the dorsal surface of the tongue

Hairy Tongue Hairy Tongue

etiology clinical features

! Generally idiopathic ! Hypertrophy of the filiform papillae

Initiating factors ! With concomitant retardation of the normal rate of
! Broad-spectrum antibiotics: penicillin desquamation
! Systemic corticosteroids ! Resulting to a thick matted surface, with entrapped
! Oxgenating mouth rinses containing hydrogen peroxide & carbamide bacteria, fungi, cellular debris & foreign material
peroxide
! Filiform papillae may be as long as several millimeters in
! Seen in intense smokers close examination
! Seen in individuals who have undergone radiotherapy to the head &
neck region
! Alteration in the microbial flora, with overgrowth of fungi & chromogenic bacteria

Hairy Tongue
clinical features Hairy Tongue

! Symptoms are generally minimal

! Gagging or ticking sensation may be felt when the

elongation of the filiform papillae become exaggerated

! Color ranges from white to tan to deep brown or black

! Depending on the diet, oral hygiene, & the composition of
the bacteria
Hairy Tongue Hairy Tongue
histopathology diagnosis
! Presence of elongated filiform
papillae ! Clinical features are quite characteristic

! Surface contamination by clusters of ! Biopsy is not necessary to confirm the diagnosis

microorganisms & fungi

! Keratinization may extend into the

mid-portions of the stratum spinosum

! Mild inflammation occurring in the

lamina propria

Hairy Tongue Hairy Tongue

treatment treatment

! Discontinuation of the use of etiologic agents In cases which individuals have undergone radiotherapy

! Disappearance of the elongated papillae within a few ! With resultant xerostomia & altered bacterial flora
weeks
! Management is more difficult

! Brushing of the tongue

! Fastidious oral hygiene

Hairy Tongue
prognosis Hairy Leukoplakia

! Benign lesions ! Unusual white lesions

! Self-limiting ! lateral margins of the tongue

! Tongue will return to normal subsequent to institution of ! Predominantly in male homosexuals

treatment
! Represents an opportunistic infection related to the
presence of the Epstein-Barr virus ( herpes virus)

! clinical & laboratory features of AIDS (80%)

Viral infection in HL Hairy Leukoplakia

immunosuppressed
! Immunocyto
chemical

patient like those

staining for
EBV (+) in the
prickle cell
layer associated with organ
transplantation may
become affected

Hairy Leukoplakia
clinical features
Hairy Leukoplakia

! Unilateral or bilateral

! Irregular surface contour that is often folded, corrugated

or papillary (hairy)

! Smooth & macular

! lateral margins of the tongue

Hairy Leukoplakia
clinical features Hairy Leukoplakia

! No associated symptoms

! Suprainfection with Candida albicans

! In more sever condition, the entire dorsum of the tongue

may become involved
Hairy Leukoplakia Hairy Leukoplakia
histopathology histopathology

! hyperparakeratotic

! Candida albicans hyphae are often seen extending into

the superficial epithelial cell layers

! Alterations of nuclear chromatin

! Presence of inflammatory cells

! Presence of EBV within the cells

Hairy Leukoplakia Hairy Leukoplakia

differential dx treatment

! Idiopathic leukoplakia
! Diagnosis to
! Leukoplakia associated with tobacco use ! May be a pre-AIDS sign

! Lichen planus ! Responses to acyclovir treatment

! With a return of lesions upon discontinuation
! Chronic hyperplastic candidiasis
! Topical corticosteroid therapy
! Frictional hyperkeratosis ! May amplify the lesion ( reversibly)

Hairy Leukoplakia
prognosis

! 10% of individuals with diagnosed hairy leukoplakia have chronic low tissue reaction: white lesion on
AIDS at the time of diagnosis grade irritation -hyperkeratosis buccal mucosa
! 18% develop AIDS within 8 months -acanthosis

! 50% develop AIDS at 16 months

! 80% develop AIDS by 30 months

!96
Other White Lesions Geographic Tongue
! Erythema migrans
! Geographic tongue
! Benign migratory glossitis
! Lichen planus

! Lupus erythematosus

Geographic Tongue white lesions

Geographic Tongue white lesions

etiology etiology
! Associated with several different conditions:
! Unknown cause ! Psoriasis
! Seborrheic dermatitis
Numerous theories
! Reiter’s syndrome
! Emotional stress ! Atopy

! Fungal infections

! Bacterial infections

Geographic Tongue white lesions

Geographic Tongue white lesions

clinical features clinical features

! Affecting women slightly more often than men

! Children may occasionally affected

! Presence of small, round to irregular

areas of dekeratinization &
desquamation of filiform papillae

! Desquamated areas appear:

! Red & are slightly tender
! Elevated margins around the red zones
are white to slightly yellowish-white
exhibiting a circinate pattern
Geographic Tongue
clinical features
white lesions

Geographic Tongue white lesions

! Asymptomatic

! Occasional complain of irritation or

tenderness esp. in consumption of spicy
foods & alcoholic beverages

! Severity of symptoms varies with time & is

often indicator of the intensity of lesional
activity

! Lesions may periodically disappear &

recur wit no apparent reason

Geographic Tongue white lesions

Geographic Tongue white lesions

histopathology histopathology

! Filiform papillae are reduced in number & prominence

! Margins of the lesions demonstrate hyperkeratosis &

acanthosis

! Presence of neutrophils & lymphocytes

! Histologic picture: psoriasiform type of intraoral eruption

Geographic Tongue white lesions

Geographic Tongue white lesions

differential dx treatment

! Usually diagnostic based on clinical appearance ! Not required

! Candidiasis ! Self-limiting & asymptomatic

! Leukoplakia ! When symptoms occur, palliative treatment:

! Lichen planus ! Topical steroids, esp. containing antifungal agent

! Lupus erythematosus
Geographic Tongue
prognosis
white lesions

Lichen Planus white lesions

! Lesion is totally benign

! Reassure the patient that this does not represent any !The importance of this disease relates
serious illness will relieve anxiety to the degree of frequency of
occurrence, its occasional similarity to
other mucosal diseases, its occasional
painful nature & its possible
connection to malignancy

Lichen Planus white lesions

Lichen Planus white lesions

clinical features clinical features

! Disease of middle age Types

! Affects men & women in equal numbers ! Reticular form

! The severity of the disease parallels the patient’s level of ! Plaque form
stress
! Atrophic form
! Prevalence of secondary oral candidiasis in patients with
oral lichen planus (50%) ! Erosive form
! Altered status of cellular immunity may be responsible
! Bullous form

Lichen Planus
clinical features
white lesions

Lichen Planus white lesions

Reticular form Reticular form

! most common

! Presence of numerous interlacing keratotic lines or striae

(Wickham’s striae) that produce an annular or lacy
pattern

! buccal mucosa
 Lichen Planus
Lichen Planus white lesions

clinical features
white lesions

plaque form

! Resembles leukoplakia clinically

! Primary sites: dorsum of the tongue & buccal mucosa

Lichen Planus white lesions

Lichen Planus white lesions

clinical features clinical features

atrophic form erosive form

! attached gingiva ! Central lesion of the lesion is ulcerated

! Symptomatic: burning or pain in the area of involvement ! Fibrinous plaque or pseudomembrane covers the ulcer &
is surrounded by erythematous mucosa

! Patterns change from week to week

! Clinically, often adjacent to amalgam restoration or with

heavy accumulations of plaque

Lichen Planus white lesions

erosive form

Lichen Planus of the Gingiva

Lichen Planus
clinical features
white lesions

Lichen Planus white lesions

bullous form
bullous form

! unusual form
! Bullae or vesicles range from a few mm to several cm in
diameter
! Short-lived & upon rupturing , leave an ulcerated,
extremely uncomfortable surface
! seen on the buccal mucosa, posterior & inferior regions
adjacent to the 2nd & 3rd molars

Lichen Planus white lesions

clinical features

On the skin

! Characterized by the presence if small, violaceous,

polygonal, flat-topped papules on the flexor surfaces

! Can be hypertrophic, atrophic, bullous, follicular and

linear form

! Cutaneous lesions are noted 20-60% of patients with oral

lichen planus lesion

! Skin lesions wil wax and wane periodically

Lichen Planus
histopathology
Lichen Planus white lesions

histopathology

! hyperorthokeratosis or hyperparakeratosis

! Variable degrees of acanthosis

! Within the epithelium, increase in numbers of langerhans

cells

! lymphocytes, immunoglobulin and fibrinogen

 Lichen Planus
differential dx
white lesions
Lichen Planus white lesions

treatment

! Candidiasis ! No specific tx

! Leukoplakia ! Corticosteroids- the single most useful group of drugs

! Ability to modulate inflammation & immune response
! Squamous cell carcinoma
! Topical application / local injection of steroids
! Drug eruption ! Vitamin A ( retinoids)- systemic or topical
! DLE ! Cyclosporine –topical –
! Dapsone(diaminoiphenylsulfone)- release inflammatory or
chemotactic factors from mast cells or neutrophils

Lichen Planus
prognosis
white lesions

Non-epithelial white-yellow Lesions

! Slightly higher rate of oral squamous cell ca ! Candidiasis

! Mucosal burns
! Erosive / atrophic form are more ! Submucous fibrosis
common to develop into ! Fordyce’s Granules

malignancy 0.4-2.5 % ! Ectopic lymphoid tissue

! Gingival cysts

! Parulis

! Lipoma

Mucosal Burns white lesions

Mucosal Burns white lesions

etiology clinical features

! Topical applications of chemicals: ! Localized erythema, in cases of short-term exposure

! Aspirin or caustic agents (most common)
! Topical abuse of drugs
! Accidental placement of phosphoric acid-etching
solutions or gel by dentists
! Overly fastidious use of alcohol-containing mouthwashes
! As concentration of the offending agent increases-
resulting in a white slough or membrane( friable & painful
& bleed upon manipulation)
! With gentle traction, the surface slough will peel from the
denuded connective tissue, producing tenderness & pain
Mucosal Burns white lesions
Mucosal Burns white lesions

clinical features clinical features

! Thermal burns are common: hard palatal mucosa ! Electrical burn

! Associated with hot sticky foods ! Children who chew through electrical cords receive
rather characteristic initial burn that are symmetric
! Hot liquids are more likely to burn the tongue or the soft
palate ! Resulting to tissue damage, followed by scarring &
reduction in the size of the oral opening
! erythematous
! Surface of these lesions tends to be: thickened slough that
extends deep into the surrounding tissue

Mucosal Burns white lesions

histopathology

Chemical & thermal burns

! Epithelial component show coagulative necrosis through

its entire thickness

! Fibrinous exudate is evident

! Intensely inflamed underlying connective tissue

Electrical burns

! Deep extension of necrosis, often into muscle

Mucosal Burns white lesions

Mucosal Burns white lesions

differential dx treatment

! Proper knowledge of the history of the lesion is Thermal & chemical burn
characteristic
! Local symptomatic therapy with or without the use of
systemic analgesics

! Topical therapy: hydrocortisone acetate with or without

benzocaine

! Application of dilute solutions of topical anesthetic

Mucosal Burns white lesions
Fordyce’s Granules white lesions

treatment etiology

! Electrical burns ! Ectopic sebaceous glands or sebaceous choristomas

( normal tissues in an abnormal location)
! May need the services of pediatric dentist, oral
maxillofacial surgeon and the plastic surgeon ! Developmental in nature

Fordyce’s Granules white lesions

Fordyce’s Granules white lesions

clinical features

! Multiple, seen in aggregates

! buccal mucosa & vermillion of the upper lip

! Lesions are symmetrically distributed

! Male

! Appear post-pubertal

Fordyce’s Granules Fordyce’s Granules

white lesions

Histopath

! Microscopic, lobules of
sebaceous glands
aggregated around or
adjacent to excretory ducts

! The heterotopic glands are

well formed and appear
functional
Fordyce’s Granules
treatment
white lesions

Ectopic Lymphoid Tissue white lesions

! May be found in numerous oral

! No treatment indicated locations
! Posterolateral aspect of the
! Glands are normal in character tongue
! Soft palate
! Do not cause any untoward effects ! Floor of the mouth
! Tonsillar pillars

! Yellow or yellow-white color

clinically

! Produces small, dome-shaped

elevations

! No treatment is needed

Parulis white lesions

! Gum boil, soft tissue abscess Parulis

! Derived from an acute infection either at the base of the
occluded periodontal pocket or at the apex of a non-
vital tooth

! The path is of the least resistance

! Pain is typical until the escapes of the pus to the surface

Parulis associated with periapical abscess

SEAT WORK WHITE LESIONS

! How does an ill fitting denture produce a focal
hyperkeratosis on the residual ridge mucosa

! A patient who has stopped reverse smoking for 3 years

presented with multiple white papule lesion that coalesce
at some areas forming plaque on the hard palate. She
claims that that rough white lesion was there for as far as
she can remember

! outline how nicotine stomatitis develop

! what would be your course of management for this

case

! what would be the prognosis for this case