CASE BASE LEARNING

Time duration: 60 minutes

Study Year: 2023
Date: 19.04.23
Any Pre reading material provided: YES.
Learning objectives:
 Students must be able to

 Construct the decision tree of oral white lesion.

 Explain the risk factors etiology of leukoedema.
 Describe clinical , pathophysiological &
histopathological aspects of leukoedema.
 Discuss appropriate management of leukoedema.

Case description:
A 27-year-old male patient complains of greyish-white
patch on the left and right buccal mucosae. He gave a
history of smoking six cigarettes per day for 6 years.
The patch was noticed accidentally while brushing
teeth. The general physical examination was non-
contributory, and the lesion was asymptomatic. Lesion
was non-scrapable and persisted after stretching the
mucosa.

Discussion questions:

 Demographic distribution.
 Any sex predilections associated.
 Location .
 Signs/symptoms associated with the
condition.
 Management options.

Case analysis:
 Patient gives no past dental history.
 Impacted tooth with carious lesion on 35.
 No radiographs needed.
 An Incisional biopsy specimen was obtained
which reveals hyperparakeratosis and acanthosis
of surface epithelium. Cells of the spinous layer
show intracellular edema. Cells appear pale and
have pyknotic nucleus and no features dysplasia
were observed.

Summary:
Leukoedema is the normal anatomic variant of the oral
mucosa which has clinical appearance like potentially
malignant white lesions such as leukoplakia and lichen
planus. Clinically it presents as a diffuse, grey to
white, non-scrapable and veil-like condition, which
can be described as a milky and opalescent
transformation of the oral mucosa. In more prominent
cases, leukoedema is characterized by mucosal folds
along with wrinkles or whitish streaks. This condition
usually disappears temporarily after gentle stretching
of the mucosa, which reappears after quitting the
manipulation It is more distinct in smokers, but its
association remains controversial.