White lesions are the pathological changes seen in the oral cavity involving the soft tissues like buccal mucosa, palatal mucosa, tongue and floor of mouth. Here we can see a list of white lesions which are divided into 2 categories based on their property of being able to scrape of the lesion – Scrapable White Lesions and Non-Scrapable White Lesions and a list of lesions which cannot be scrapped off. White lesions are usually caused due to thickening of Keratotic layer or accumulation of non-keratotic material on the surface of the mucosa. Most white lesions are not cancerous and are most commonly due to repeated Trauma, the treatment for such lesions usually is removal of the source of trauma or its cause.
White lesions which can be scrapped off:
- Pseudomembranous candidiasis: “Milk curd” or “cottage cheese” appearance may leave a red base when rubbed off
- Morsicatio Buccarum: It is a chronic condition of buccal cheek chewing where the white surface appears to be peeling off
- Thermal burns: Food heated in microwaves cause this type of white lesion which are seen in the oral cavity. Because of the foods being cold on the outside and very hot in the inside.
- Sloughing traumatic lesion: It is also called as Cotton roll stomatitis which is caused due to rapid removal of cotton role from the tissue after it has adhered to it or the prolonged exposure of chemicals absorbed into the cotton role when in contact to the oral mucosa.
- Reaction to toothpaste or mouthwash: Filmy whiteness is seen leaving a normal appearance on mucosa when scrapped or rubbed off.
- Chemical burn: Asprin burn is the most common cause of chemical burn which is put in the oral mucosa to relieve tooth pain. Asprin is available in tablet form and also as a powder.
- Secondary Syphilis: Mucous patches are seen on the oral mucosa which are focal areas of intense exocytosis and spongosis of the oral mucosa leading to zones of sensitive whitish mucosa known as mucous patches.
- Diptheria: Gray white pseudomembranous layer seen on mucosa of oropharynx region.
White lesions which cannot be scrapped off:
- Leukoplakia: Benign Hyperkeratosis, epithelial dysplasia seen as white lesion covering the surface of oral mucosa.
- Leukoedema: Milky white lesions seen on the surface of buccal mucosa bilaterally. The white layer disappears when stretched
- Linea Alba: White layer seen along the occlusal line on the buccal mucosa.
- Tobacco pouch keratosis: Usually seen in mandibular vestibule, it is usually associated with use of snuff or chewing tobacco which is place in the buccal vestibule everyday
- Lichen planus: It is also called as Wickhams striae which is a white lesion seen bilaterally on the buccal mucosa.
- Actinic cheilosis: These are Pale, gray white, scaly alterations seen on the lower lip, usually in older men with history of chronic sun exposure, it is a potentially precancerous condition.
- Morsicatio: Most common location of the white lesion is on the anterior buccal mucosa, labial mucosa and lateral border of tongue which exhibits a ragged surface.
- White coated tongue: Dorsal aspect of the tongue is diffusely involved due to many reasons starting from fever to anu viral disease a white layer is seen covering the oral mucosa.
- Nicotine Stomatitis: White lesions seen on the hard palate which is usually associated with pipe smoking.
- Hairy leukoplakia: Leukoplakia which appears as white hairy overgrowth
- Usually seen on the lateral border of tongue, rough surface with vertical fissures are seen associated with hiv infection.
- Hyperplastic Candidiasis: A clinic feature of candidiasis which usually involves the anterior buccal mucosa.
- Lupus Erythematosus: Resembling lichen planus and leukoplakia seen most commonly on the buccal mucosa with skin lesions associated with it.
- Oral submucous fibrosis: Affected mucosa shows a Blotchy, marble like pallor with a progressive stiffness of subepithelial stiffness giving it the white appearance. Caused due to betel quid chewing.
- White spongy nevus: Generalized lesions most commonly involving buccal mucosa which is hereditary and shows onset of lesions in childhood.
- Hereditary benign intraepithelial dyskeratosis: Hereditary onset in childhood generalized lesions are seen more commonly on buccal mucosa
- Pachyonychia congenita: Hereditary onset in children most commonly seen on the Dorsal surface of tongue and in areas of trauma, nail, palmar and plantar changes are also seen.
Diagnosing of White lesions and Identifying them can be life saving in some cases, as some white lesions are pre-cancerous and early diagnosis can help in prevention of the benign lesion turning cancerous.