Oral white and red lesions

Oral white and red lesions
Fordyce’s granules
(ectopic sebaceous glands)
They are sebaceous glands without hair follicles
Aetiology: A developmental anomaly
Fordyce’s granules
Fordyce’s granules
Diagnosis: Clinically diagnosed and no biopsy is needed
Treatment:
 Eventually they go away
 Tretinoin gel or cream alone, or with alpha hydroxyacid agent
 Trichloroacetic acid (TCA) chemical peel
 Vaporising laser (CO2 laser) or electro desiccation
 Pulse dye laser (expensive)
 Surgical diathermy or cryotherapy
Leukoedema
A normal anatomic variation
Aetiology: A common developmental anomaly of the
buccal mucosa
Leukoedema
Leukoedema
Diagnosis:
 Clinical examination
 Histological
Treatment:
 No treatment is necessary
 Doesn’t change with age
 If stop smoking, the lesion becomes less pronounced
White sponge naevus
(Cannon's disease)
A relatively rare lesion
Aetiology: A developmental anomaly inherited as an
autosomal dominant trait
White sponge naevus
Linea alba buccalis
A common finding on the buccal mucosa
Aetiology: A frictional keratosis due to sucking trauma
Linea alba buccalis
Diagnosis
 It is usually present bilaterally
 It is restricted to dentulous areas
Treatment
 No treatment is required
Lip and cheek biting
A relatively common and occurs as an unconscious habit
Aetiology: A self-inflected injury, may genetic component
Lip and cheek biting
Lip and cheek biting
Lip and cheek biting
Diagnosis: Clinical
Treatment
 The patient should be encouraged to
stop the habit
 Chlorhexidine or hexitidine MW
Leukoplakia
It is a potentially malignant oral disorder
Aetiology:
 Tobacco use (smoked or chewed)
 Chronic irritants (sharp edges of teeth, HPV,
candida albicans, alcohol consumption)
 Bloodroot (sanguinaria)
Homogenous leukoplakia
Homogenous leukoplakia
Homogenous leukoplakia
Sublingual keratosis
Sublingual keratosis
Proliferative verrucous leukoplakia
Verrucous carcinoma
Speckled leukoplakia
Candidal leukoplakia
Candidal leukoplakia
Smokeless tobacco leukoplakia
Diagnosis:
 Serum vitamin A, B12, C, and folic acid
 Staining with toluidine blue for incisional biopsy
 Oral brush biopsy
 VELscope
Treatment
 Stop tobacco use
 Oral beta-carotene (vitamin A)
 Oral antifungal therapy in candidal leukoplakia
 Excise lesion if precancerous changes or cancer
 Cryotherapy and laser ablation
 Follow up at intervals of 3-6 months
Erythroplakia
(Erythroplasia)
A rare, asymptomatic, isolated flat red lesion
Aetiology
 Unknown cause.
 Associated with smoking and alcohol consumption
Erythroplakia
Erythroplakia
Erythroplakia
Diagnosis: Biopsy
Treatment:
 Complete excision
 Recurrence is common
 Long-term follow up
Nicotine stomatitis
(smoker's palate)
It appears in the hard palate as a white lesion
Aetiology:
 Pipe and reverse cigarette smoking
 Heat and chemical irritation from tobacco use
 Dentures protect the palate
Early nicotine stomatitis
Advanced nicotine stomatitis
Reverse smoking and malignancy
Diagnosis:
 Clinical
 May punch biopsy (5mm)
 Stained teeth
Treatment: the lesion resolves after 1-2
weeks of smoking termination
Oral submucous fibrosis
A chronic debilitating disease of the oral cavity
Aetiology:
 Areca nut chewing (betel quid)
 Red chillies, genetic and immunologic processes,
and iron and vitamin deficiency
Oral submucous fibrosis
Diagnosis:
 Early stage- reversible
 Moderate to severe- irreversible
 Oral biopsy
Treatment:
 Avoid tobacco use
 Vitamin A, B-complex, C, and iron supplements
 Antioxidant lycopene (16 mg/day)
 Moderate- topical steroid or steroid and hyaluronidase
 Advanced- pentoxifylline (400 mg 1x3/day)
 Intralesional injection of autologous stem cells
 Surgical treatment if severe trismus or dysplastic changes