WHITE LESIONS OF THE ORAL MUCOSA

LICHEN PLANUS
- A disease of the skin but is of particular interest to
LEUKODEMA
the dentist because involvement of the oral mucosa
commonly precedes the appearance of the skin
Etiology: Unknown, maybe attributed to poor oral
lesions.
hygiene, abnormal masticatory pattern; more prevalent
in people with dark skin.
Etiology: Unknown, although can be attributed to
emotional stress, overwork, anxiety or mental strain.
Location: Buccal mucosa
Location: Cheek mucosa, palate, tongue, lip, alveolar
CF:
mucosa, gingiva and floor of the mouth.
 Bilateral whitish gray lesion with a folded or
coarsely wrinkled surface on buccal mucosa
ORAL LICHEN PLANUS MAY BE PRESENT IN ONE OF
extending onto the oral surface of the lips which
THREE FORMS:
partially disappears when the cheeks are stretched.
A. RETICULAR FORM
 Mostly noticeable along the occlusal line in the
- Most common type
bicuspid and molar region.
- Presence of numerous Wickham’s striae that
 Discovered accidental; asymptomatic
produce an annular or lacy pattern or as smaller
papules
TX: Requires no treatment
- Buccal mucosa is the most common site
- Also found on tongue, gingiva, lips and palate
LEUKOPLAKIA
- A clinical term indicating a white patch or plaque of
B. BULLOUS FORM
the oral mucosa that cannot be rubbed off and
- Presents as fluid filled vesicles which project from
cannot be characterized clinically as any other
the surface
disease
- Disease of the older persons (5th and 6th decades of
C. EROSIVE FORM
life)
- Central area of the lesion is ulcerated covered by a
fibrinous plaque or pseudomembrane
Etiology:
- Usual site is the buccal mucosa adjacent to the
o Extrinsic factors such as tobacco and alcohol
mandibular molar teeth
o Trauma or local chronic irritation such as
malocclusion causing cheek biting, ill-fitting
TX: Currently there is no cure but there are certain
dentures, sharp or broken down teeth constantly
types of medicines used to reduce the effects of the
irritating the mucosa
inflammation. Lichen planus may go into a dormant
o Systemic or predisposing factors such as vitamin
state after tx. There are also reports that lichen planus
deficiency, endocrine dysfunction, history of syphilis
can flare up years after it is considered cured.
Location:
CANDIDIASIS / CANDIDOSIS / MONILIASIS / YEAST
 Frequent sites: tongue, mandibular mucosa and
INFECTION / THRUSH
buccal mucosa
- Most common oral mycotic infection
 Infrequent sites: floor of the mouth, angle of the
- Seen anywhere on the oral mucosa
mouth, palate, lip and alveolar ridge
- Oral lesions occur at 2 extremes of life, debilitated
due to alcoholism, leukemia or diabetes; px
CF:
receiving prolonged therapy with antibiotics and
 First lesion is characterized as smooth bluish white
corticosteroids
or milky patch or plaque which progresses to a
pearly or slightly silvery
Etiology: Candida (monilial) albicans
 Maybe localized or cover a large area
CF:
TX: Elimination of irritating factors, discontinuation of
 Presence of thrush which can be wiped off or
tobacco, correction of malocclusion, replacement of ill-
stripped, leaving raw, painful, bleeding surfaces
fitting dentures
 White or gray white patches resembling curdled
milk
TX:
 Control cause of debilitation
 Discontinue use of antibiotics
 Swabbing newborn infant’s mouth with mother’s
saliva to promote growth of organisms other than
Candida, and administration of nystatin
WHITE SPONGE NEVUS / WHITE FOLDED /
GINGIVOSTOMATITIS / CANNON’S DISEASE /
HEREDITARY LEUKOKERATOSIS
Etiology: Hereditary, may be congenital or it may
appear in childhood and the lesions reach their
maximum severity in adolescence
Location: Entire mucosa; cheek mucosa always involved
CF:
 Appears white, thickened and parboiled
 Soft and spongy to touch
 Appears folded and may show areas of
desquamation
 Asymptomatic
TX: No tx needed
NICOTINE STOMATITIS
Etiology: Smoking (pipe smoking being most harmful)
Location: Palate, common in men over 45 y/o
CF:
 Initially, redness and inflammation of the palate
 Whitish, thickened, nodular appearance with a
small red spot in the center of each nodule
corresponding to the orifices of the palatal salivary
gland ducts
TX: Elimination of smoking
GEOGRAPHIC TONGUE / WANDERING RASH /
GLOSSITIS MIGRANS / MIGRATORY GLOSSITIS /
CONTINENTAL TONGUE
Location: Tongue
Etiology: Unknown, may have an allergic basis such as
asthma and rhinitis or emotional stress
CF:
 One or more areas of desquamation of the tongue
 Absence of filiform papillae in the bald spots, but
the fungiform papillae remain in the form of small,
elevated red dots
 Borders of desquamation areas are outlined by thin,
yellowish white line or band
 Map like appearance
TX: Administration of vitamin B
WHITE HAIRY TONGUE / LINGUA VILLSA ALBA
Etiology: Dehydration, poor oral hygiene, physiologic
xerostomia of old age
CF:
 Elongation of the filiform papillae
 White hairy appearance of the dorsal surface of the
tongue
 Hypertrophy of the tongue
 Asymptomatic
TX: Daily brushing and scraping of the tongue
DENTAL LAMINA CYST / EPSTEIN’S PEARL / BOHN’S
NODULE
- Seen in newborn infants
- Lesions are on the crest of the alveolar ridges
(DENTAL LAMINA CYST)
- Lesions are along the buccal and lingual aspects of
the alveolar ridges (BOHN’S NODULE)
- May be found scattered on the hard palate from
minor salivary glands (BOHN’S NODULE)
- Lesions are along the midline of the palate
(EPSTEIN’S PEARL)
- Caused during the development of the palate by
entrapped epithelium (FISSURAL CYST) <EPSTEIN’S
PEARL>
Location: Midline of the palate, alveolar crest of mx &
md, buccal & lingual aspects of mx and mx ridges
CF: Multiple, small, whitish yellow fluid filled rice like
nodules which appear on the gums or hard palate of
new born babies
Cause: Odontogenic cysts that arise from the dental
lamina
TX: None because they spontaneously “shed” within 1
to 2 weeks of birth because of their superficial location
PERLECHE / ANGULAR CHEILITIS / ANGULAR CHEILOSIS FORDYCE’S DISEASE
- Not a disease of the oral mucosa but a
Location: Angles of the mouth developmental anomaly

Age group: Children, adults, edentulous px
Causes:
o Loss of vertical dimension due to overclose of the
jaws such as those occurring in edentulous px or in
px with artificial dentures
TX: Increase vertical height of dentures by opening
the bite
Location: Buccal mucosa at the level of the occlusal
plane, lip, and retromolar area
CF:
 Multiple small yellowish white granules that appear
in clusters
 Presence of small yellow spots or granules found on
the cheek mucosa opposite the molar teeth,
representing the collection of sebaceous glands

o Riboflavin deficiency
TX: Administration of vitamin B complex

o Candida albicans (fungal infection)

TX: Use of nystatin ointment

CF:
 Characterized by fissuring, cracking, burning and
dryness at the angles of the mouth
 Maceration of the skin cause by seepage of the
saliva into the cracks

PACHYDERMA ORIS / FOCAL KERATOSIS / BENIGN

HYPERKERATOSIS
- Most common white lesion of the oral cavity
- Occurs in 5th and 6th decades of life

Cause: Habitual cheek or lip biting

Location: in order of frequency of involvement

 Md mucosa, cheek, lip, palate, floor of the mouth,
mx mucosa, tongue

CF:
 Lesions elevated or flat
 Maybe rough, usually single

The white lesions run from the ventral tongue onto the
edentulous ridge. The lesion is thin and translucent;
there is a thicker patch on top of the ridge.

This extensive white lesions (Leukoplakia) is in a high

risk area for squamous cell carcinoma. Happily, biopsy
proved it to be benign hyperkeratosis. Pic

TX: Removal of cause