Classification Of Red And White Lesions Of Oral Cavity Pdf

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The lesion appears white due to changes in the epithelium which can be caused by an increase in the keratinization of normal keratinized mucosa, keratinization of non keratinized mucosa or thickening of the epithelium. The reduced vascularity or fibrosis of mucosa can also lead to the whiteness of the oral mucosa.

White and Red Lesions of the Oral Mucosa

Yellowish lesions of the oral cavity. Suggestion for a classification. Facultad de Medicina. Universidad de Oviedo. The colour of a lesion is due to its nature and to its histological substratum. To the best of our knowledge, there is no such a classification for yellow lesions. So, a suggestion for a classification of yellowish lesions according to their semiology is made with the following headings: diffuse macular lesions, papular, hypertrophic, or pustular lesions, together with cysts and nodes.

This interpretation of the lesions by its colour is the first step to diagnosis. It should be taken into account that, as happens with any other classification, the yellowish group of lesions includes items with different prognosis as well as possible markers of systemic disorders.

Key words: Yellow lesions, differential diagnosis, classification. Changes in colour have been classically used to catalogue and classify the mucosal and soft tissue pathology of the oral cavity. However, and to the best of our knowledge, yellow lesions and conditions of the oral cavity have not been organized and recognized as a separate group Isolated reports recovering yellowish lesions within the oral cavity have been published from time to time.

The yellow set of lesions has a wide prognostic spectrum and represents a very heterogeneous group of lesions, acting some of them as occasional markers for systemic disorders From a semiological point of view, these disorders can emerge as diffuse macular lesions hypercarotenemia and hyperbilirubinemia , papular lesions Fordyce condition, accessory lymphoid aggregates, verruciform xanthoma, lipoid proteinosis and amyloidosis , hypertrophies yellow hairy tongue , pustular lesions pyostomatitis vegetans cysts dermoid and lymphoepithelial cysts and nodes lipoma and liposarcoma 1, The interpretation of these elementary lesions is a previous step to diagnosis of the disorder.

Thus, an attempt was made to classify yellowish lesions in several categories of elementary lesions attending to the most frequent and characteristic elementary lesion. However, several pathologies may present multiple elementary lesions and, in these situations, a number of differential diagnoses should be considered This classification criterion discloses that the subepithelial accumulation of lymphoid tissue, adipose tissue, purulent or sebaceous materials, pigment accretion, amyloid or lipoprotein deposits, or even lipid-loaded histiocytes are responsible for the yellow colour of these lesions.

This is a condition characterized by an excess of bilirubin in plasma and its accumulation within the tissues, resulting in a uniform, diffuse yellowish colour of the skin, mucosa and the sclera of the eye. The intensity of the yellow coloration varies with the bilirubin serum level.

In the oral mucosa, the discolouration is more frequently found at the junction between hard and soft palate, ventral surface of the tongue and cheeks, due to the affinity of the elastic fibres for bilirubin 12 Figure 1. This condition is due to a high plasma concentration of carotenes, mostly diet-related carrots, oranges, etc. Its clinical presentation is as a yellowish pigmentation in the palate and, occasionally, in palms, soles and nasolabial fold. The absence of sclerae pigmentation and the carotene serum level permit a differential diagnosis with jaundice Papules are solid lesions resulting from the hyperplasia of the cellular elements of the oral mucosa epithelial hyperplasia, connective tissue infiltration and metabolic deposits.

The colour is a key element in the recognition of papular lesions. Is defined by the emergence of small, multiple heterotopic sebaceous glands in the oral mucosa and red lip. It is more prevalent among adults probably due to hormonal factors This concerns normal lymphoid tissue located in the soft palate, floor of the mouth and tonsillar arches.

The diagnosis is generally established relying on the clinical features 15, 16 Figure 2. Is an asymptomatic papular lesion with a well defined, mainly yellowish, verrucous surface that can be found on the alveolar ridge and gingivae. It does not seem to have any relationship with metabolic disorders and its aetiology and pathogeny are not fully understood 17, 18 Figures 3 and 4. Is an inherited lesion that arises during childhood due to extracellular deposits of glycoproteins and lipids in lip mucosa, tongue, lingual fraenum, palate, pharynx, larynx and skin.

Clinically, this disorder reveals yellowish granules and papular lesions that evolve resulting in a scarring aspect. Hoarseness is a frequently and early symptom of this disease Is a deposit of amyloid protein in the skin, heart, kidney, digestive tract, liver, larynx and trachea. Rounded or irregular yellowish papules in the oral cavity are an early sign of the disease, along with nodes, ulcerations or bristles with a haemorrhagic content.

A typical sign of this disorder is the presence of mucous folds by the corners of the mouth that cause difficulties for chewing, swallowing or talking. The prognosis is serious 6, 7, 20, Is an ill defined lesion, located in the two anterior thirds of the tongue, with a hairy appearance as a consequence of the lengthening of the filiform papillae due to tobacco, fungi, food impaction and the overgrowth of chromogenic bacteria 22 Figure 5.

Is a chronic, pustular, mucocutaneous disorder. Oral lesions can be found in the buccal mucosa, lip, palate and gingivae. These lesions show small papillary vegetations, pustules and small superficial ulcerations on an erythematous surface.

Typically, they are not painful and constitute a very specific oral mucosal marker for the existence of inflammatory bowel disorders, particularly ulcerative colitis 10, Is a developmental cyst made of a fibrous wall layered by a stratified epithelium with dermal adnexal structures hair follicles, sweat and sebaceous glands.

They are usually located over the mylohyoid muscle, causing a swelling in the floor of the mouth Is a slow growing, asymptomatic, small sized cyst usually less than a cm , most frequently found in the floor of the mouth and ventral surface of the tongue Is an asymptomatic, mesenchymal benign tumour made of mature adipose tissue with a slow growth rate. Its most common intraoral locations are the cheeks, floor of the mouth and the tongue.

Due to its clinical similarity with benign submucous cysts lymphoid and lymphoepithelial cysts , the diagnosis can be established by a puncture that shows the presence of mature adipose tissue This malignant mesenchymal tumour is most frequently found in the tongue.

There are four different pathological types, with different biological behaviour and prognosis. It is a rare neoplasia that accounts for a 5. Its presence in the oral cavity is even less frequent The classification and organization of yellow intraoral lesions is relevant because it may ease differential diagnosis within a group of lesions and conditions with diverse clinical meaning and also because it will contribute to the early diagnosis of general disorders, as these lesions occasionally behave as markers of systemic disease.

Reichart PA, Kohn H. Prevalence of oral leukoplakia in Berliners. Oral Dis ; Prevalence study of oral white lesions with special reference to a new definition of oral leucoplakia. Experimental intervention study about recognition of erythroplakia by undergraduate dental students. Int Dent J ; Pyostomatitis vegetans.

Report of two cases and review of the literature. Local primary AL amyloidosis in the palate. A case report. Int J Oral Maxillofac Surg ; Oral involvement in a case of AA amyloidosis. J Periodontol ; Sublingual epidermoid cyst. J Craniofac Surg ; Pyostomatitis vegetans associated with asymptomatic ulcerative colitis: a case report. Oral and Maxillofacial Pathology. USA: WB.

Saunders Company; Lindberg MC. Hepatobiliary complications of oral contraceptives. J Gen Intern Med ; Pierach CA. N Engl J Med ; Treatment of Fordyce spots with CO2 laser. Dermatol Surg ; Oral mucosa: variations from normalcy, part I. Cutis ; Mogi K. Ectopic tonsillar tissue in the mucosa of the floor of the mouth simulating a benign tumour. Case report. Aust Dent J ; Verruciform xanthoma of the oral mucosa.

Report of four cases and a review of the literature. Oral Oncol ; Verruciform xanthoma and concomitant lichen planus of the oral mucosa. A report of three cases. Lipoid proteinosis of the oral mucosa: case report and review of the literature. Pathol Res Pract ; Amyloidosis of the submaxillary gland.

Med Oral ; Primary amyloidosis with severe macroglosia. Taybos G.

Leukoplakia

Leukoplakia is a firmly attached white patch on a mucous membrane which is associated with increased risk of cancer. The cause of leukoplakia is unknown. Leukoplakia is a descriptive term that should only be applied after other possible causes are ruled out. Treatment recommendations depend on features of the lesion. Leukoplakia could be classified as mucosal disease, and also as a premalignant condition.

Diagnosis of oral white lesions might be quite challenging. This review article aimed to introduce a decision tree for oral white lesions according to their clinical features. Related English-language articles published since to , including reviews, meta-analyses, and original papers randomized or nonrandomized clinical trials; prospective or retrospective cohort studies , case reports, and case series about oral diseases were appraised. Upon compilation of data, oral white lesions were categorized into two major groups according to their nature of development: Congenital or acquired lesions and four subgroups: Lesions which can be scraped off or not and lesions with the special pattern or not. In total, more than 20 entities were organized in the form of a decision tree in order to help clinicians establish a logical diagnosis by a stepwise progression method. These lesions represent a wide spectrum of lesions with different etiology and various prognoses. The diagnosis of white lesions varies from benign reactive lesions to more serious dysplastic and carcinomatous lesions.

White Patches of the Oral Mucosa

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An injury to the oral mucosa can result from physical, chemical, or thermal trauma. Such injuries can result from accidental tooth bite, hard food, sharp edges of the teeth, hot food, or excessive tooth brushing. Some injuries can also be caused by iatrogenic damage during dental treatment or other procedures related to oral cavity. In this chapter, oral mucosal trauma and injuries will be examined in four subclasses: physical and mechanical traumas of oral mucosa; chemical injuries of the oral mucosa; radiation injuries; and electrical, thermal burns.

Oral White Lesions: An Updated Clinical Diagnostic Decision Tree

Contemporary Oral Medicine pp Cite as. Whiteness of the oral mucosa can be caused by changes in the epithelium such as keratinization of normally nonkeratinized mucosa such as the buccal mucosa , increased keratinization of normally keratinized mucosa, abnormal keratinization of the epithelium, thickening of the epithelium, and epithelial edema. Some of the more common causes of redness erythema of the oral mucosa include reduced keratinization of the oral epithelium, epithelial atrophy, erosion or inflammation, and vascular dilatation or proliferation. Generally, the prevalence of red and white oral lesions increases with age. A large proportion of red and white lesions are benign. However, the most common premalignant condition in the oral cavity is a white plaque leukoplakia , and this must be managed expeditiously and appropriately. Many conditions can be accurately diagnosed with careful history taking and clinical examination.

Yellowish lesions of the oral cavity. Suggestion for a classification. Facultad de Medicina. Universidad de Oviedo. The colour of a lesion is due to its nature and to its histological substratum. To the best of our knowledge, there is no such a classification for yellow lesions. So, a suggestion for a classification of yellowish lesions according to their semiology is made with the following headings: diffuse macular lesions, papular, hypertrophic, or pustular lesions, together with cysts and nodes.

Classify white lesions of the oral cavity. Describe the aetiology, clinical features and management of leukoplakia. Name some of the white lesions of oral mucosa. Describe the clinical features, differential diagnosis and treatment of leukoplakia of hard palate. What are the keratinizing lesions of the oral cavity?


Diagnosis of oral white lesions might be quite challenging. Oral lesions can be classified into four groups comprising of ulcerations, pigmentations, Red points can also be seen on the white mucosa that are actually widened and swollen Article; |; PubReader; |; ePub (beta); |; PDF (M); |; Cite.


Oral Mucosal Trauma and Injuries

A comprehensive collection of clinical examination OSCE guides that include step-by-step images of key steps, video demonstrations and PDF mark schemes. A comprehensive collection of OSCE guides to common clinical procedures, including step-by-step images of key steps, video demonstrations and PDF mark schemes. A collection of communication skills guides, for common OSCE scenarios, including history taking and information giving.

Leukoedema is a generalized white change of oral mucosa which is probably a variation of normal rather than a disease. The cause is unknown. It occurs much more commonly in blacks than whites. Leukoedema is diffuse and symmetrically distributed on the buccal mucosa and may extend onto the labial mucosa. The appearance is gray-white, opaque, or milky.

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Red and White Lesions of the Oral Cavity: An Update

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