Oral White and Red Lesions
Oral White and Red Lesions
Fordyce’s granules
ectopic sebaceous glands
Sebaceous glands without hair follicles
Presents as painless, raised, yellowish white spots, 1-3 mm in diameter
Buccal mucosa and vermilion border of upper lip are most common sites
Occasionally seen on retromolar area and anterior tonsillar pillars
Granules become prominent during puberty and increase in no with age
Some patients have hundreds of granules while most have 1 or 2
80% of the population are affected
Aetiology
Developmental anomaly
Fordyce’s granules
Fordyce’s granules
Diagnosis
Clinical examination
Treatment
Leukoedema
Normal anatomic variation
Characterised by a filmy, opalescent to whitish gray tinge of buccal mucosa
Always bilateral and surface tissue exhibit a corrugated folded configuration
May begin as early as 3-5 yrs, but is not noticeable until adolescence
More prevalent in people with dark skin and is more intense in smokers
Patients are usually unaware of its presence since it is asymptomatic
Aetiology
No treatment is necessary
Doesn’t change with age
Has no malignant potential
If stop smoking, lesion becomes less pronounced
White sponge naevus
Cannon's disease
Rare asymptomatic lesion and several family members may be affected
Always presents during childhood with no gender predilection
Presents as thick bilateral white plaque with a spongy texture
Affects buccal mucosa, but may labial mucosa, alveolar ridge, or floor of mouth
Severe cases exhibit corrugated vertical folds that cover most of buccal mucosa
Well demarcated as opposed to poor demarcation of leukoedema
This condition is perfectly benign and often mistaken for leukoplakia
Aetiology
Reassurance
If extends to lip vermilion then surgical removal
Linea alba buccalis
A common finding on buccal mucosa
Presents as asymptomatic, bilateral, linear white line
Begins at mouth corner and extends posterior at the level of
occlusal plane of teeth
Aetiology
Treatment
No treatment is required
Lip and cheek biting
Mild chronic biting of lip or cheek is common
Occurs as an unconscious habit
Most often begins in late childhood or early teens
Lesion produced by repeated rubbing, sucking, or chewing
movements that abrade surface without ulceration
Presents as diffuse irregular small furrows with ragged borders
Asymptomatic, in severe cases may tenderness, swelling, burning
sensation
Aetiology
Treatment
Patient should be encouraged to stop the habit
Chlorhexidine or hexitidine MW
Severe cases - splint or dental guard, psychological evaluation
Leukoplakia
Clinical term that describes adherent white patches of keratosis
Term should never be used once histological information is available
Potentially malignant oral lesion with a prevalence of 3-33% over 10 yrs
Found in 3% of world's population, develops slowly over weeks to months
Defined by WHO as a ‘white patch or plaque that cannot be rubbed off and
cannot be characterised clinically or pathologically as any other disease’
Affects more tongue, mandibular alveolar ridge, and buccal mucosa in 50%
of cases
Clinical types
Homogenous leukoplakia
of low risk
affects BM, mucobuccal fold, oral floor
presents as uniformly raised white patch
Sublingual keratosis
of high risk
affects oral floor and ventrum tongue
presents as bilateral, homogenous, well defined lesion with irregular
border
Proliferative verrucous leukoplaki
affects elderly females
appears as diffuse warty or papillary white lesion
arises on mandibular ridge and vestibular region
spreads laterally
many progress to verrucous carcinoma or speckled leukoplakia
Candidal leukoplakia
hyperkeratotic lesion
infected by candida albicans
high risk for malignant transformation
Smokeless tobacco leukoplakia
due to tobacco chewing
presents as white lesion of mucobuccal fold
rough lesion with undulating or wrinkled surface
progression to invasive carcinoma is rare
Aetiology
Verrucous carcinoma
Speckled leukoplakia
Candidal leukoplakia
Candidal leukoplakia
Smokeless tobacco leukoplakia
Diagnosis
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
Affects hard palate as asymptomatic white lesion
Found more in men over 45 yrs of age
First becomes red then white, thickened, and fissured appearance
Minor salivary glands in palate become swollen and orifices become
prominent, giving tissue a speckled appearance
Although caused by smoking but has no dysplastic or malignant potential
Reverse smoking that causes severe palatal keratosis is an exception as the
concentrated heat and chemicals increase malignant potential
Aetiology
Treatment:
Lesion resolves after 1-2 weeks of smoking cessation
Oral submucous fibrosis
A chronic debilitating disease of the oral cavity
Buccal mucosa is the most commonly involved site
Characterised by inflammation and progressive fibrosis of submucosa
Symptoms include burning sensation followed by oral ulceration
Lesion starts from posterior oral cavity and spreads anteriorly
Initially palpation of oral mucosa causes a wet leathery feeling
Later oral mucosa loses its resilience and becomes blanched and stiff
Eventually inability to open mouth causes difficulty eating and deficiencies
Can transform into malignancy, particularly to squamous cell carcinoma
(SCC)
Occurs more in Southeast Asia and India
Aetiology