Red And White Lesions Of Oral Cavity

Question 1

What are red and white lesions?

Answer 1

Abnormal areas of the oral mucosa that have a white or reddish appearance. They may present as patches or plaques on the soft tissues inside oral cavity

Question 2

What are the causes of White lesions?

Answer 2

Increased production of keratin (hyperkeratosis)

Increase in thickness of one or more of epithelial layers.

Abnormal character of keratin

Abnormal permeability of epithelium that cause intra and extracellular accumulation of fluid in the epithelium may also result in clinical whitening

Microbes, particularly fungi, can produce whitish pseudomembranes consisting of sloughed epithelial cells, fungal mycelium, and neutrophils, which are loosely attached to the oral mucosa .

Question 3

What are the causes of RED LESIONS?

Answer 3

Atrophic epithelium

Reduction in number of epithelial cells

Increased vascularization

Blood vessels enlargement

Presence of blood in tissues

Increased hemoconcentration

Question 4

Classification Of Red And White Lesions?

Answer 4

Hereditary
1- Leukoedema
2- White Sponge Nevus
3- Hereditary
Intraepithelial Dyskeratosis
4- Dyskeratosis Congenita

Infectious
1- Oral Hairy Leukoplakia
2- Koplik’s spots
3- Candidiases
4- Mucous Patches
5- Parulis

Premalignant lesion
Leukoplakia
Erythroplakia
Oral Submucous Fibrosis

Autoimmune
1- Oral Lichen Planus
2- Lichenoid Reactions
3- Lupus Erythematosus

Reactive/Inflammatory
1- Line Alba (White Line)
2- Frictional (Traumatic) Keratosis
3- Check Chewing
4- Chemical Injuries of the Oral Mucosa
5- Uremic Stomitis
6- Actinic Keratosis (Cheilitis)
7- Smokeless
8- Nicotine Stomatitis

Miscellaneous Lesions
1- Fordyce’s Granules
2- Geographic Tongue
3- Hairy Tongue (Black Hairy Tongue)

Question 5

Local predisposing factors for oral candidiasis and Candida-associated lesions?

Answer 5

Denture wearing
Smoking
Atopic constitution
Inhalation steroids
Topical steroids
Hyperkeratosis
Imbalance of the oral microflora
Quality and quantity of saliva

Question 6

General Predisposing factors for oral candidiases?

Answer 6

Immunosuppressive diseases

Impaired health status

Immunosuppressive drugs

Chemotherapy

Endocrine disorders

Hematinic deficiencies

Question 7

Oral candidiasis is divided into primary and secondary
infections DEFINE THEM?

Answer 7

The primary infections are restricted to the oral and perioral sites
The secondary infections are accompanied by systemic mucocutaneous manifestations.

Question 8

It is recognized as ‘‘CLASSICAL CANDIDA INFECTION’’

Answer 8

Pseudomembranous Candidiases

Question 9

Clinical findings of pseudomembranous candidiases?

Answer 9

The infection typically presents with loosely attached membranes comprising fungal organisms and cellular debris, which leaves an inflamed, sometimes bleeding area if the pseudomembrane is removed.

Question 10

The erythematous form of candidiasis was previously referred to as

Answer 10

atrophic oral candidiasis

Question 11

CF, Site And Predisposing factors of Erythematous Candidiases?

Answer 11

An erythematous surface reflect atrophy by increased vascularization.

The lesion has a diffuse border, which helps distinguish it from erythroplakia with sharp demarcation.

The oral sites involved are palate and the dorsum of the tongue of patients

Predisposing factors are
Inhalation steroids

Smoking and Broad-spectrum antibiotics.

Question 12

a white plaque, which may be indistinguish- able from an oral leukoplakia is which type of candidiases?

Answer 12

Plaque type / Nodular candidiases

Question 13

Moderate to severe epithelial dysplasia has been observed in these ——— both types of candidiases thats why
can be associated with malignant transformation

Answer 13

1.Nodular Candidiases
2. Plaque-Type Candidiases

Question 14

Site and types of DENTURE STOMATITIS?

Answer 14

The most prevalent site for denture stomatitis is the denture-bearing palatal mucosa
classified into three different types.

Type I localized to minor erythematous sites caused by trauma from the denture.

Type II affects a major part of the denture-covered mucosa

Type III has a granular mucosa in the central part of the palate.

Question 15

Management Of Type 3 Denture Stomatitis?

Answer 15

Surgical excision of type III denture stomatitis is sometimes advised to eradicate microorganisms present in the deeper fissures of the granular tissue.

Question 16

Management Of Denture Stomatitis?

Answer 16

Treatment of denture stomatitis
Involves improved denture hygiene to remove nutrients, including desquamated epithelial cells

Recommendation not to use the denture while sleeping.

Denture should be stored in antimicrobial solution during the night.

Different solutions, including alkaline peroxides, alkaline hypochlorites, acids, and disinfectants, have been suggested.

Chlorhexidine may also be used.
Surgical excision of type III denture stomatitis is sometimes advised to eradicate microorganisms present in the deeper fissures of the granular tissue.

Question 17

Angular chelitits?

Answer 17

Angular cheilitis is infected fissures of the commissures of the mouth, often surrounded by erythema
The lesions are frequently coinfected with both Candida and Staphylococcus aureus. Vitamin B12, iron deficiencies.
loss of vertical dimension have been associated with this disorder
Dry skin may promote the development of fissures in the commissures, allowing invasion by the microorganisms.
Atrophy may also be seen

Question 18

Clinically characterized by an erythematous lesion in the center
of the posterior part of the dorsum of the tongue
The lesion has an oval configuration.
The erythema results from atrophy of the filiform papillae and the surface may be lobulated.

Which Lesion is this?

Answer 18

Median Rhomboid Glossitis

Question 19

These lesions have mixed: Bacterial as well as microbial flora?

Answer 19

Angular chelitis

Median Rhomboid Glossitis

Question 20

More than 90% of acquired immune deficiency syndrome (AIDS) patients have had________ during the course of their HIV infection.

Answer 20

Oral Candidiases

Question 21

The most common types of oral candidiasis in conjunction with HIV are __________

Answer 21

pseudomembranous candidiasis, erythematous candidiasis, angular cheilitis, and chronic hyperplastic candidiasis.

Question 22

Whats Secondary Candidiases?

Answer 22

a heterogeneous group of disorders, which, in addition to oral candidiasis, also affect the skin, typically the nail bed and other mucosal linings, such as the genital mucosa
The face and scalp may be involved, and granulomatous masses can be seen at these sites.

Question 23

hyperparathyroidism and Addison’s disease.
Chediak-Higashi syndrome
Severe combined immunodeficiency syndrome.
can cause Secondary Candidiases(Chronic mucocutaneous candidiases) T/F?

Answer 23

TRUE

Question 24

Superficial mucosal infections are often best treated with ________
chronic hyperplasic types will respond best to ___________

Answer 24

topical antifungals.

systemic therapy

Question 25

Managemet Of Fungal Infections

Answer 25

Treatment for fungal infections, which usually includes antifungal regimens. Rule out predisposing factors. Reduce or eradicate the local factors. In smokers, cessation of the habit Superficial mucosal infections are often best treated with topical antifungals. chronic hyperplasic types will respond best to systemic therapy. The most commonly used antifungal drugs belong to the groups of polyenes or azoles .

Question 26

________is the second most common HIV- associated oral mucosal lesion

Answer 26

Hairy Leukoplakia

Question 27

______ strongly associated with Epstein-Barr virus (EBV) and with low levels of CD4 + T lymphocytes

Answer 27

Hairy Leukoplakia

Question 28

Prevalence of HL in AIDS pts?

Answer 28

In patients who develop AIDS, the prevalence may be as high as 80%. The prevalence in children is lower compared with adults and has been reported to be in the range of 2%. The condition is more frequently encountered in men

Question 29

Any lesion on the tongue has more potential to transform into malignancy because?

Answer 29

Tongue is highly vascular

Question 30

Which kinda lesions are difficult to treat? Red/White/Mixed?

Answer 30

Mixed`

Question 31

CF of Hairy Leukoplakia?

Answer 31

The disorder is frequently encountered on the lateral borders of the tongue but may also be observed on the dorsum and in the buccal mucosa. The typical clinical appearance is vertical white folds oriented as a palisade along the borders of the tongue. The lesions may also be displayed as white and somewhat elevated plaque, which cannot be scraped off

Question 32

Management Of Hairy Leukoplakia?

Answer 32

HL can be treated successfully with antiviral medication, May respond to antiherpetic drugs such as valaciclovir

Question 33

Whats Leukoplakia?

Answer 33

Leukoplakia is a condition characterized by thickened, white patches or plaques that develop on the mucous membranes of the mouth, gums, tongue, or other parts of the body, such as the genitals. These patches are typically non-scrapable and can vary in size, shape, and texture. Leukoplakia is often associated with chronic irritation, such as tobacco use, but can also occur without an identifiable cause. While usually benign, leukoplakia can sometimes be a precursor to oral cancer, necessitating regular monitoring and, in some cases, medical intervention.

Question 34

Most oral leukoplakias are seen in which kinda patients?

Answer 34

pts over the age of 50 and infrequently seen below the age of 30. More common in men

Question 35

Sites Of Oral leukoplakia in smokers and non smokers?

Answer 35

Oral leukoplakia may be found at all sites of the oral mucosa. Nonsmokers have a higher percentage of leukopla- kias at the border of the tongue compared with smokers.

Question 36

High risk sites for malignant transformation Of Oral leukoplakia are?

Answer 36

The floor of the mouth and the lateral borders of the tongue are high-risk sites for malignant transformation.

Question 37

CF of Homogenous leukoplakia?

Answer 37

The typical homogeneous leukoplakia is clinically characterized as a white, well-demarcated plaque with an identical reaction pat- tern throughout the entire lesion The surface texture can vary from a smooth thin surface to a leathery appearance with surface fissures sometimes referred to as “cracked mud.”

Question 38

The demarcation of _____ is usually very distinct, which is different from an oral lichen planus (OLP) lesion, where the white components have a more diffuse transition to the normal oral mucosa.

Answer 38

Oral Leukoplakia

Question 39

Non Homogenous Leukoplakia?

Answer 39

White patches or plaque intermixed with red tissue elements Due to the combined appearance of white and red areas, the nonhomogeneous oral leukoplakia has also been called erythroleukoplakia and speckled leukoplakia.

Question 40

T/F If the surface texture is homogeneous but contains verrucous, papillary (nodular), or exophytic components, the leukoplakia is also regarded as nonhomogeneous

Answer 40

T

Question 41

Oral leukoplakias, where the white component is domi- nated by papillary projections, similar to oral papillomas, are referred to as ________

Answer 41

verrucous or verruciform leukoplakias.

Question 42

Proliferative verrucous leukoplakia (PVL).

Answer 42

Oral leukoplakias with SAME clinical appearance Of Verrucous Leukoplakia but with a more aggressive proliferation pattern and recurrence rate

Question 43

This lesion may start as a homogeneous leukoplakia but over time develop a verrucous appearance containing various degrees of dysplasia. ____ is usually encountered in older women, and the lower gingiva is a predilection site. The malignant potential is very high, and verrucous carcinoma or squamous cell carcinoma may be present at the primary examination. This Explaination suggests that the lesion is "_________''

Answer 43

Proliferative Verrucous Leukoplakia

Question 44

When Cold knife excision is important?

Answer 44

Cold knife surgical excision is a precise, scalpel-based method often used when tissue integrity is crucial for diagnosis or when clean margins are needed, such as in premalignant or suspicious lesions.

Question 45

Management Of Leukoplakia?

Answer 45

The cause, such as a sharp tooth cusp or restoration, should be eliminated. If healing does not occur in 2 weeks, biopsy is essential to rule out malignancy. Discontinuation of habits Cold-knife surgical excision, as well as laser surgery, is widely used to eradicate leukoplakia. Reexamine the premalignant site irrespective of surgical excision every 3 months for the first year Following 5 years of no relapse, self-examination

Question 46

Q: What is the first-line treatment for leukoplakia ?

Answer 46

A: Topical antifungal agents such as clotrimazole (Candid cream), thrice/day for 1 week.

Question 47

Q: What should be done if the leukoplakia lesion reduces in size after 1 week of antifungal treatment?

Answer 47

A: Continue the topical antifungal agent for 1 month.

Question 48

Q: What is the next step if there is no response to antifungal treatment?

Answer 48

A: Assess lesion size: Less than 1 cm: Excisional biopsy 1 cm or more: Incisional biopsy

Question 49

Q: What is done if dysplasia is absent after biopsy?

Answer 49

A: Apply Retinol-A (Vitamin A analog) ointment twice daily for 1 month.

Question 50

Q: What is the recommended treatment if dysplasia is present and the lesion is excisable?

Answer 50

A: Total excision of the lesion with graft.

Question 51

What are the treatment options if excision is not possible in dysplastic lesions?

Answer 51

A. Lycopene capsules 4 mg twice daily or 8 mg once daily for 3 months B. Antioxidant capsules with selenium twice daily for 6 months C. Topical bleomycin 1% w/v three times a day for 15 days

Question 52

Erythroplakia, Its site, CF, Symptoms?

Answer 52

**ERYTHROLAKIA** - ERYTHROPLAKIA IS A TERM USED TO DESCRIBE A RED PATCH OR PLAQUE THAT DEVELOPS ON THE MUCOUS MEMBRANES OF THE ORAL CAVITY, PARTICULARLY ON THE TONGUE, FLOOR OF THE MOUTH, OR SOFT PALATE - IT COMPRISES AN IRREGULAR RED LESION THAT IS FREQUENTLY OBSERVED WITH A DISTINCT DEMARCATION AGAINST THE NORMAL-APPEARING MUCOSA, SOMETIMES WITH VELVETY GRANULAR SURFACE TEXTURE. - ERYTHROPLAKIA IS USUALLY ASYMPTOMATIC, SOME PATIENTS MAY EXPERIENCE A BURNING SENSATION IN CONJUNCTION WITH FOOD INTAKE.

Question 53

t/f? Erythroplakia is considered to be LESS concerning than leukoplakia as it has a LESSER association with dysplasia (abnormal cell growth) and a LESSER likelihood of being precancerous or indicative of oral cancer.

Answer 53

false