White Lesions of the Oral Cavity or Mouth and their Clinical Features

White Lesions of the Oral cavity is the pathological change in color of the Soft tissue in the Oral cavity, these lesions can be seen on Tongue, Buccal Mucosa, Floor of the mouth, Palate, Back of the mouth etc. Most White lesions of the Oral cavity are Benign and in most cases are Precancerous conditions which require immediate treatment. The White lesions are sometimes congenital or developmental such as white spongy nevus, Fordyce granules, keratosis follicularis etc. Some White lesions such as Materia alba on the gingiva or tongue, keratotic lesions like hairy tongue do not require intervention.

So most of the White lesions being Precancerous, it is important to properly diagnose the disease which it is associated with and to know the cause of the lesion so it can be treated. For this, it is important for the Dentist to know the Clinical features of every White Lesion associated with Oral cavity.

Clinical Features of White Lesions of the Oral cavity:

1. Lichen Planus – Clinical Features

  • Bilateral – seen on both sides of the oral cavity
  • Asymptomatic most of the times, except when there is erosion of the lesion
  • Buccal mucosa is the most common location, tongue, gingiva and palate are the less common locations
  • White Striae are seen
  • Skin lesions are seen on forearm and lower leg as purple, pruritic papules
  • Most common age group affected – Middle Age

Classification and Staging of Leukoplakia

2. Candidiasis – Clinical Features

  • Elevated white plaques seen on the Tongue, buccal mucosa, palate etc which can be scrapped off leaving eroded, bleeding surface
  • Painful or Symptomatic
  • Seen in Immunocompromised patients, poor hygiene, prolonged use of systemic antibiotics, systemic diseases, reduced immune response, chronic infections
  • Seen in patients with poorly fitting prosthesis as well

3. Leukoedema – Clinical Features

  • Filmy opalescence of the mucosa seen in the early stages of lesion
  • Grayish-white cast with a coarsely  wrinkled surface in later stages of lesion
  • Asymptomatic, Bilateral, Whitish gray in appearance with semitransparent macule on the buccal mucosa
  • Located mostly on buccal mucosa extending up to lips along the occlusal line from bicuspid (premolars) to Molars.
  • Leukoedema disappears when the cheeks are stretched – typical feature to distinguish this lesion from others

4. Hairy Leukoplakia – Clinical Features

  • A Filiform / Hairy or Flat White patch seen on the lateral surface of the tongue
  • Is note scrappable
  • It comes with Systemic Symptoms due to underlying condition

5. White Spongy Nevus – Clinical Features

  • Asymptomatic
  • Bilateral
  • Location mostly in Buccal Mucosa
  • White to Grey in color
  • Generalized opalescence on the surface of the lesion

6. Frictional Hyperkeratosis – Clinical Features

  • Asymptomatic
  • Location is the Edentulous ridge, buccal mucosa or tongue
  • White patchy appearance
  • Not Scrapable

7. Hereditary benign intraepithelial dyskeratosis

  • Asymptomatic
  • White lesions seen on Buccal Mucosa and Tongue
  • Appear diffuse without clear border and shaggy
  • White plaques are seen in the Eye

8. White lesions due to Smokeless Tobacco – Clinical features

  • Asymptomatic
  • Location – around the area where the tobacco is placed regularly
  • Lesion is seen as White folds
  • Most common location is Labial and Buccal folds

9. Nicotine Stomatitis – Clinical Features

  • Asymptomatic
  • Location is Palate – Due to heat and smoke from the cigarette
  • Appears as Generalized opacifications of the palate with red dots (Salivary gland orifices)
  • Also called as Smokers palate

10. Solar Cheilitis – Clinical Features

  • Seen in Lower Lip with Swelling, Redness, and Soreness
  • Ulceration and crusting is seen along with fissuring of the lower lip
  • Poorly defined margins of Vermillion border
  • Local zones of keratosis or white thickened patches
  • Lip Folds and Lip lines are prominent

11. Idiopathetic Leukoplakia – Clinical Features

  • Asymptomatic
  • Males are affected more than Females
  • Appears as a White patch
  • Lesions are not Scrappable

12. Hairy Tongue – Clinical Features

  • Asymptomatic
  • Filiform papillae are elongated giving a White patch like appearance

13. Geographic Tongue – Clinical Features

  • White annular lesions whit atrophic red centers
  • The pattern appears to migrate across the dorsum of the tongue
  • The Lesion is spontaneously painful
  • The Lesion varies in intensity

14. Fordyce Granules – Clinical Features

  • Asymptomatic
  • Multiple in number
  • Yellow in color
  • Flat or slightly elevated spots usually in the Lip or Buccal Mucosa

These are some of the White lesions seen in the Oral Cavity most of which as you can see are Asymptomatic and Benign and some of these can be Pre Malignant like Lichen Planus or Leukoplakia etc.

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