By:
Ali, Hajid Aisiah
Escaran, Rona May
Juco, Jenina Sharmaine U.
Lopez, Amadeo
Kabiri, Saleheh
CLASSIFICATIONS OF WHITE
LESIONS
1. HEREDITARY CONDITIONS
2. REACTIVE LESIONS
3. PRENEOPLASTIC AND NEOPLASTIC
LESIONS
4. OTHER WHITE LESIONS
5. NONEPITHELIAL WHITE-YELLOW LESIONS
HEREDITARY CONDITIONS:
LEUKOEDEMA
Etiology: Unknown
Clinically:
Symmetrical, graywhite or milky buccal
mucosa, dissipate
with stretching
Treatment: No
treatment is
necessary.
HEREDITARY CONDITIONS:
WHITE SPONGE NEVUS
Etiology: Hereditary
Clinically:
asymptomatic,
symmetrical, folded and
spongy white lesion
usually appears early in
life.
Treatment: No
treatment is necessary
HEREDITARY CONDITIONS:
HEREDITARY BENIGN INTRAEPITHELIAL DYSKERATOSIS
[WITKOPS DISEASE]
Etiology: Hereditary
Clinically: Oral WL
with conjunctivitis
appear in the 1st year
and increase with age.
Occur anywhere of the
oral mucosa. Blindness
were reported in some
cases.
Treatment: No
HEREDITARY CONDITIONS:
Follicular keratosis [Dariers disease]
Etiology: Hereditary
Clinically: occur between 6 and
20 years. In 13% of cases it
affects the oral cavity. Skin
lesions are small symmetrical
papules over the face, and trunk
which become greasy due to
keratin production; fingernail
changes. Keratinized mucosa is
favored oral sites where it
appears as small whitish papules
which may extend to the
oropharynx.
REACTIVE LESIONS
Frictional hyperkeratosis
Etiology: chronic
friction
Clinically:
adjacent to the
etiologic factor
(cheek and lip
mucosa, lateral
borders the tongue,
alveolar ridges).
Treatment:
REACTIVE LESIONS
White lesion associated with smokeless tobacco
Etiology:
mechanical/chemical irritation
induced by smokeless tobacco
Clinically: asymptomatic
lesion localized in the area
where tobacco is placed, lesion
appears granular, wrinkled or
folded, less often
erythroleukoplakic.
REACTIVE LESIONS
Nicotine Stomatitis
REACTIVE LESIONS
Hairy Leukoplakia
REACTIVE LESIONS
Hairy Tongue
Initiating Factors
Use of broad-spectrum antibiotics,
systemic corticosteroids, hydrogen
peroxide
Intense smoking
Head and neck therapeutic
radiation
Clinically:
Represents overgrowth of filiform
papillae and chromogenic
microorganisms
Dense hairlike mat formed by
hyperplastic papillae on the dorsal
tongue surface
Usually asymptomatic
May be cosmetically objectionable
because of color (usually black
Treatment:
Identify and eliminate initiating
factor identified and eliminated
REACTIVE LESIONS
Dentifrice-associated slough
Candidiasis
Etiology: mainly C. albicans,
predisposing factors: Immunodeficiency - Endocrine
disturbances: - Diabetes mellitus Pregnancy - Hypo pituitarism &
parathyroidism - Corticosteroid
therapy - Long-term antibiotic
therapy - Malignancies and their
therapy - Xerostomia and bad oral
hygiene
Clinical features: - Acute: - Thrush Erythematous - Chronic: Erythematous - Hyperplastic Mucocutaneous: - Localized - Familial
- Syndrome associated
Mucosal Burns
Etiology:
The most common form of superficial
burn of the oral mucosa is associated
with topical applications of chemicals,
such as aspirin or caustic agents.
Topical abuse of drugs, accidental
placement of phosphoric acid-etching
solutions or gel by a dentist, or overly
fastidious use of alcohol-containing
mouth rinses may produce similar
effects.
Clinical features: Thermal burns are commonly noted on
the hard palatal mucosa and generally
are associated with hot, sticky foods.
Hot liquids are more likely to burn the
tongue or the soft palate.
Such lesions are generally
erythematous rather than white
Mucosal Burns
Treatment:
Management of chemical, thermal, or
electrical burns is varied.
For patients with thermal or chemical
burns, local symptomatic therapy
aimed at keeping the mouth clean, such
as sodium bicarbonate mouth rinses
with or without the use of systemic
analgesics, is appropriate.
Alcohol-based commercial mouth rinses
should be discouraged because of their
drying effect on the oral mucosa.
For patients with electrical burns,
management may be much more
difficult.
Submucous fibrosis
Etiology:
Contributing Factors: General
nutritional or vitamin deficiencies and
hypersensitivity to various dietary
constituents
Primary Factor: Chewing of areca (betel
nut)
Clinically:
- Oral submucosa fibrosis presents as a
whitish yellow change that has a
chronic, insidious biological course. It is
characteristically seen in the oral
cavity, but on occasion it may extend
into the pharynx and the esophagus
Submucous fibrosis
Clinically:
Oral submucous fibrosis presents
as a whitish yellow change that has
a chronic, insidious biological
course. It is characteristically seen
in the oral cavity, but on occasion
it may extend into the pharynx and
the esophagus
Treatment:
Eliminating causative agents
Therapeutic measures include local
injections of chymotrypsin,
hyaluronidase, and
dexamethasone, with surgical
Fordyces granules
Etiology:
Fordyces granules represent
ectopic sebaceous glands or
sebaceous choristomas (normal
tissue in an abnormal location).
This condition is regarded as
developmental and can be
considered a variation of normal
Clinically:
Fordyces granules are multiple and
often are seen in aggregates or in
confluent arrangements
Treatment:
No treatment is indicated for this
particular condition because the
Gingival cyst
Etiology:
Gingival cysts of odontogenic
origin occur in adults, as well
as in infants (Bohns nodules).
In infants, relative frequency is
greatest in the neonatal phase.
They occur along the alveolar
ridges and involute
spontaneously or rupture and
exfoliate.
Another eponym, Epsteins
pearls, has been commonly
used to designate
nonodontogenic neonatal cysts
that occur along the palatal
midline (fusion of palatine
Gingival cyst
Clinical Features:
Gingival cysts in a neonate appear
as off-white nodules approximately
2 mm in diameter. Cysts ranging in
number from one to many are
evident along the alveolar crests.
Gingival cyst
Treatment:
- No treatment is indicated for
gingival or palatal cysts of the
newborn because they spontaneously
rupture early in life. Treatment for
gingival cyst of the adult is surgical
excision.
Etiology:
A parulis, or gum boil, represents
a focus of pus in the gingiva. It is
derived from an acute infection at
the base of an occluded
periodontal pocket or at the apex
of a nonvital tooth.
Clinical Feature:
The lesion appears as a yellowwhite gingival tumescence with an
associated erythema.
Pain is typical, but once the pus
escapes to the surface, symptoms
are temporarily relieved.