WHITE LESIONS

PART - I

INTRODUCTION
&
CLASSIFICATION
 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 adjacent normal tissue
 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
 ALTERED MUCOSA
 DUE TO
 EPITHELIAL THICKENING
 SURFACE DEBRIS
 SUBEPITHELIAL
 Fibrosis
 Fordyces granule
 EPITHELIAL SURFACE
THICKENING DEBRIS
 Hyperkeratosis
Epithelial dysplasia
Candidiasis


 Carcinoma - in – situ 
 Squamous cell
carcinoma  Burn
 Lichen planus
 Nicotina stomatitis  Fibrin clot
 Hairy tongue
 Hairy leukoplakia
 Geographic tongue
 CAUSES FOR WHITISH
DISCOLORATION:
 TRAUMA
 CHEMICAL INJURY
 IMMUNOLOGICAL PROCESS
 RACIAL/GENETICALLY DETERMINED
 TOBACCO USE
 MUCOCUTANEOUS DISEASE
CLASSIFICATION - 1
1. Normal Variations:
Leukoedema / Linea Alba / Fordyce Granules

2. Nonkeratotic Lesions:
Cheek bite / Burns / Candidiasis

3. Keratotic Lesions:
Nicotina Stomatis / White spongy Nevus / Geographic
tongue / Hairy Tongue

4. Lesions with precancerous potential:

OSMF / Leukoplakia
 CLASSIFICATION - 2
1. Scrapable Lesions
 Candidiasis
 Mucosal Burns
 Radiation mucositis
2. Non Scrapable
 Leukoplakia
 OSMF
 Leukoedema
 White Spongy Nevus
 LEUHOEDEMA
 Use of tobacco
 Male predliction 2 : 1
 Bilaterally on buccal mucosa, lip
 Normal softness & flexibility with
greyish white slightly folded opalescent
appearance
 Epithelium covered with diffuse
edematous film
 Disappears by stretching of mucosa
 D/D:
 LEUKOPLAKIA
 CHEEK BITE
 WHITE SPONGE NEVUS

 NO TREATMENT
LENIA ALBA
 Line of keratinization parallel to line of
occlusion
 Frequent frictional contact with food &
teeth
 Effect of smoking
 Buccal mucosa
FORDYCES GRANULE
 Heterotropic collection of sebacious
glands covered with intact mucosa
 Any age
 Bilateral
 Small yellow spots
 Smooth surface with cheesy consistancy
 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
 D/D:
 White sponge nevus
 Chemical burn
 Candidiasis

 Rx:
 Diazepam 5 to 10 mg at bed time
 Occlusal night guard
 BURNS
 THERMAL BURNS:
 Hot food
 Pain last for short duration

 Ant 1/3
rd of tongue & palate

 Produce coagulation necrosis of tissue

 Rarely ulceration & stripping of

mucosa
 Surface layer of epi is disquamated
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
 CHEMICAL BURNS
Caustic chemical
agents
Coagulation
necrosis of epi
Inflammation
 Aspirin, clove oil, ethyl alcohol, Vit C tabs
 Irregular white pseudomembrane covered
lesion
 painful
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
STOMATITIS NICOTINA PALATI/ SMOKERS PALATE

STOMATITIS NICOTINA
 Pipe ,cigarette, cigar & reverse
smoking
 Middle & elderly adults
 Palatal mucosa
 Stage I, II, III
 Mucosa is reddened

Grayish white thickened & fissured

Wrinkeled irregular

Multinodular appearance

 D/D:
 Papillary hyperplasia
 Rx:
 Reversible
 CANNANS DISEASE  Described by cannon in 1935

WHITE SPONGE NEVUS

WHITE FOLDED GINGIVOSTOMATITIS
CONGENITAL LEUKOKERATOSIS

 Commonly in childrens
 Cheek, palate, gingiva, floor of the
mouth, tongue
 Mucosa appears thickened & folded
 D/D:
LEUKOEDEMA
LEUKOPLAKIA
LICHEN PLANUS
HAIRY TONGUE
 Generally caused by
broad spectrum
antibiotic and steroids.
 Intense smoking and
H&N radiotherapy.
 Contaminated filliform
papillae.
 Basal cell hyperplasia .
 GEOGRAPHIC
TONGUE
 Unknown cause
 Associated with
Psoriasis.
 Mostly affects Females
and rarely in children
TRAUMATIC KERATOSIS
 Local irritants
 Ill fitting denture
 Sharp cusp
 Site : Lip & Buccal mucosa
 Thickened whitish area
 Rx: remove the cause / biopsy iii