SEMINARPRESENED

BY
FAISALSALAHUDDIN
SUPPERVISED BY DR.AMER ABDALLA
 Cause of white lesion
▪ Hyperkeratosis

▪ Acanthosis

▪ Intra and extracellular accumulation of fluid in the

epithelium
▪ Necrosis of epithelium

▪ Microbes , particularly fungi , produce whitish

pseudomembranes

▪ Reduce vascularity in the underlying lamina propria

 Cause of red lesion

• ▪ Atrophic epithelium (Reduce in the number of epithelial cells)

• ▪ Increased vascularization
• ▪ reduced epithelial keratinization
• ▪ Blood vessels enlargement
• ▪ Presence of blood in the tissue
• ▪ Increased hemoconcentration
• ▪ cellular proliferation signifying a possible malignancy
Leukokeratosis Erythroplakia of the
buccal mucosa
 Classification of red and white lesions
• INFECTIOUS DISEASES
• lesion Oral Candidiasis
• Oral Hairy Leukoplakia
• ORAL POTENTIALLY MALIGNANT DISORDERS
• Oral Leukoplakia
• Proliferative Verrucous Leukoplakia
• Erythroplakia
• Oral Submucous Fibrosis
• IMMUNOPATHOLOGIC DISEASES
• Lichen Planus
• Oral Lichen Planus
• Oral Disease Severity Scoring
• Oral Lichenoid Drug Eruptions
• Lichenoid Reactions of Graft‐versus‐Host Disease
• Lupus Erythematosus
• ALLERGIC REACTIONS
• Oral Lichenoid Contact Reactions
• Reactions to Dentifrice and Chlorhexidine
• TOXIC REACTIONS
• Reactions to Smokeless Tobacco
• Smoker’s Keratosis Smoker’s Palate
• REACTIONS TO MECHANICAL TRAUMA
• Morsicatio (Mucosal Nibbling)
• Frictional Hyperkeratosis
• OTHER RED AND WHITE LESIONS
• Benign Migratory Glossitis (Geographic Tongue)
• Leukoedema
• White Sponge Nevus
• Hairy Tongue
Oral Hairy
Leukoplakia
• ▪ White lesion along the lateral side of
the tongue .
• ▪ Oral hairy leukoplakia is caused by
Epstein-Barr virus (EBV) infection of
the tongue epithelium .
• ▪ OHL found almost exclusively in
human immunodeficiency virus (HIV)–
infected individuals .
Oral Hairy
Leukoplakia
 Clinical Features:
• ▪ Hairy leukoplakia presents as a well-demarcated white lesion that
varies in architecture from a flat and plaquelike to a papillary/filiform or
corrugated lesion.
• ▪ It may be unilateral or bilateral.
• ▪ A vast majority of cases have been located along the lateral margins
of the tongue, with occasional extension onto the dorsal surface.
Rarely, hairy leukoplakia may be seen on the buccal mucosa, the floor
of the mouth, or the palate.
• ▪ In more severe cases, the patient may become visually aware of the
lesion
Treatment :
▪ No specific treatment is available for hairy leukoplakia.

This Photo by Unknown author is licensed under CC BY-NC-ND.

Smookless tobacco

This Photo by Unknown author is licensed under CC BY-SA.

 Clinical Features

• ▪ The most common area of involvement is the mucobuccal fold of the

mandible in the incisor or the molar region
• ▪ The mucosa develops a granular to wrinkled appearance
• ▪ an erythroplakic or red component may be admixed with the white
keratotic component
• ▪ The lesions are generally painless and asymptomatic, and their
discovery is often incidental to routine oral examination
Treatment:

• ▪ With discontinuation of smokeless tobacco

use, some lesions may disappear after several
weeks.
• ▪ A long period of exposure to smokeless
tobacco increases the risk of transformation
to verrucous or squamous cell carcinoma,
although this risk is probably low.
 lichen planus
• ▪ Lichen planus is a relatively common, chronic dermatologic disease that
often affects the oral mucosa.
• ▪ Similarly, foreign material that becomes inadvertently embedded in the
gingiva may elicit a host response that is termed lichenoid foreign body
gingivitis
• ▪ Most patients with lichen planus are middle age adults. It is rare for children
to be affected
• ▪ Women predominate in most series of cases, usually by a 3 : 2 ratio over
men.
• ▪ Essentially there are two forms of oral lesions: reticular and erosive.
▪ Reticular lichen planus is much more common than the
erosive form but the erosive form predominates in several
studies.

This is probably because of referral bias (because the

erosive form is symptomatic and, therefore, the patient is
more likely to be referred to an academic center for
evaluation).
The reticular form usually causes no symptoms and
involves the posterior buccal mucosa bilaterally.

Other oral mucosal surfaces may also be involved

concurrently, such as the lateral and dorsal tongue, the
gingivae, the palate, and vermilion border

Reticular lichen planus is thus named because of its

characteristic pattern of interlacing white lines
Sometimes the atrophy and ulceration are confined to the
gingival mucosa, producing the reaction pattern called
desquamative gingivitis § If the erosive component is severe,
epithelial separation from the underlying connective tissue may
occur.
This results in the relatively rare presentation of bullous lichen
planus
Treatment

• Reticular lichen planus typically

produces no symptoms, and no
treatment is needed.
Occasionally, affected patients
may have superimposed
candidiasis, in which case they
may complain of a burning
sensation of the oral mucosa.
Antifungal therapy is necessary
in such a case. Some
investigators recommend annual
reevaluation of the reticular
lesions of oral lichen planus
 Treatment

• Erosive lichen planus is often

bothersome because of the open
sores in the mouth. Because it is an
immunologically mediated condition,
corticosteroids are recommended.
The lesions respond to systemic
corticosteroids, but such drastic
therapy is usually not necessary. One
of the stronger topical corticosteroids
(e.g., fluocinonide, betamethasone, or
clobetasol gel) applied as a thin film
several times per day to the most
symptomatic areas is usually
sufficient to induce healing within 1 or
2 weeks
Erosive lichen •Reticular lichen
planus planus
Erythroplakia

• ▪ Erythroplakia is an atypical, painless, slow-growing red patch or

lesion on the mucous membranes of the oral cavity
• ▪ Erythroplakia is characterized by decreased epithelial cells and
increased vascularization, which gives it its red color and increased
friability.
• ▪ Erythroplakia and leukoplakia are generally considered to be
potential precancerous conditions oPrecancerous lesionf the mouth.
Precancerous lesions are known as dysplasia
Erythroplakia
What causes
erythroplakia?
• Erythroplakia is most commonly
caused by heavy smoking, chewing
tobacco, and excessive alcohol use.
Additional risk factors for developing
erythroplakia include poor oral health,
longterm trauma to the oral cavity (e.g.,
poor fitting dentures), advanced age,
and infection with human papilloma
virus (HPV).
 ▪ Erythroplakia
is commonly
diagnosed by a
healthcare
provider upon
visual
inspection of
the oral cavity.

This Photo by Unknown author is licensed under CC BY-NC-ND.

▪ How is
erythroplakia ▪ How is erythroplakia
treated?
treated?
 ▪ Erythroplakia may be treated through a variety of approaches,
including cessation of modifiable risk factors with close clinician
follow-up, radiation, laser surgery, cryosurgery, or surgery.
Treatment decisions are commonly based on size and location of
the lesion(s), biopsy findings, individual risk factors, and medical
history.
This Photo by Unknown author is licensed under CC BY-SA-NC.