White Patches & Other Coloured Lesions

Question 1

Developmental white lesions

Answer 1

• rare
• autosomal dominant trait
• bilateral shaggy or sponges white lesions
• buccal mucosa affected, sometimes tongue
• white sponge neavus

Question 2

Acquired white lesions

Answer 2

• transient - burns, cheek biting, thrush
• persistent - keratoses, candida in HIV
• lichen planus
• lupus erythematosis
• carcinoma

Question 3

Cheek biting - lesions

Answer 3

• abrasion of superficial epithelium leaving whitish fragments
• lesions located on buccal mucosa near occlusal line or lower labial mucosa
• treatment - stop habit

Question 4

Chemical burns

Answer 4

• common
• often to relive toothache
• white sloughing lesion of buccal and mucosal surfaces
• stop habit lesion is self limiting

Question 5

Candidal infections

Pseudomembranous candisiasis thrush

Answer 5

• disturbed oral microflora by antibiotics, corticosteroids
• white creamy plaques that can be wiped off to leave a red base

Treatment
- treat predisposing cause
- antifungals - topical

Question 6

Candidal leukoplakia

Answer 6

• Candida albicans
• frequently speckled
• affects buccal commissaries and lateral borders of tongue
• associated with smoking
• may have malignant potential
• may respond to anti-fungals and smoking cessation

Question 7

Smokers keratosis

Answer 7

• pipe smokers - heat and smoke
• red spots on white background as small salivary glands appear through the widespread white patch
• lesion is benign but carcinoma may develop nearby

Question 8

Other tobacco related keratosis

Answer 8

• tobacco chewing, brutal leaf etc
• keratosis can be pre malignant
• lesion benign but carcinoma may develop

Question 9

Hairy leukoplakia

Answer 9

• corrugated appearance
• affects margins of tongue
• seen in HIV infection and immune compromised
• benign
• may respond to aciclovir

Question 10

Syphilitic leukoplakia

Answer 10

• feature of tertiary syphilis
• affects dorsum of tongue
• rare
• high malignant potential

Question 11

Sublingual keratosis

Answer 11

• keratosis of floor of mouth and tongue
• unknown aetiology
• high malignant potential
• treatment - laser cryoprobe

Question 12

Lichen planus

Answer 12

• common
• no aetiological factor
• minority due to drugs, filling materials (lichenoid)
• asymptomatic sometimes
• white striated lesions common
• erosions less common
• small potential for malignancies

Common sites
- buccal mucosa
- tongue
- gingival margins - can cause desquamative gingivitis
- skin lesions may be present

Question 13

Pigmented naevi

Answer 13

• common
• brownish or blue macula
• less than 1cm diameter

Treatment - biopsy rule out malignancies

Question 14

Racial pigmentation

Answer 14

• common
• brown pigmentttaion gingiva or tongue

Question 15

Sturge Weber syndrome

Answer 15

• congenital angioma in triage minal region
• haemangioma (port wine naevus) in trigeminal region of face, oral mucosa and underlying bone
• as haemangioma involves underlying bone avoid extractions

Question 16

Kaposis sarcoma

Answer 16

• early lesions are red, purple or brown maculae’s
• usually affects palate or maxillary gingiva
• other site may be involves
• seen mainly as a a feature of HIV infection
• malignant neoplasm of the endothelial cells

Question 17

Malignant melanoma

Answer 17

• malignant tumour or melanocytes
• rare intra orally compared to skin lesions
• heavily pigmented
• often affects palate
• early metastatic spread
• treatment - wide excisio but poor prognosis if not treated early

Question 18

Haemangioma

Answer 18

• benign tumour of vascular tissues
• red or blue, painless soft swelling
• blanch on pressure
• common on lip tongue or buccal mucosa
• treatment 0 observation if no symptomatic otherwise cryosurgery laser or embolisation