WHITE LESIONS

By:
Ali, Hajid Aisiah
Escaran, Rona May
Juco, Jenina Sharmaine U.
Lopez, Amadeo
Kabiri, Saleheh

CLASSIFICATIONS OF WHITE
LESIONS
1. HEREDITARY CONDITIONS
2. REACTIVE LESIONS
3. PRENEOPLASTIC AND NEOPLASTIC
LESIONS
4. OTHER WHITE LESIONS
5. NONEPITHELIAL WHITE-YELLOW LESIONS

HEREDITARY CONDITIONS:
LEUKOEDEMA
Etiology: Unknown
Clinically:
Symmetrical, graywhite or milky buccal
mucosa, dissipate
with stretching
Treatment: No
treatment is
necessary.

HEREDITARY CONDITIONS:
WHITE SPONGE NEVUS
Etiology: Hereditary
Clinically:
asymptomatic,
symmetrical, folded and
spongy white lesion
usually appears early in
life.
Treatment: No
treatment is necessary

HEREDITARY CONDITIONS:
HEREDITARY BENIGN INTRAEPITHELIAL DYSKERATOSIS
[WITKOPS DISEASE]

Etiology: Hereditary
Clinically: Oral WL
with conjunctivitis
appear in the 1st year
and increase with age.
Occur anywhere of the
oral mucosa. Blindness
were reported in some
cases.
Treatment: No

HEREDITARY CONDITIONS:
Follicular keratosis [Dariers disease]
Etiology: Hereditary
Clinically: occur between 6 and
20 years. In 13% of cases it
affects the oral cavity. Skin
lesions are small symmetrical
papules over the face, and trunk
which become greasy due to
keratin production; fingernail
changes. Keratinized mucosa is
favored oral sites where it
appears as small whitish papules
which may extend to the
oropharynx.

REACTIVE LESIONS
Frictional hyperkeratosis

Etiology: chronic
friction
Clinically:
adjacent to the
etiologic factor
(cheek and lip
mucosa, lateral
borders the tongue,
alveolar ridges).
Treatment:

REACTIVE LESIONS
White lesion associated with smokeless tobacco
Etiology:
mechanical/chemical irritation
induced by smokeless tobacco

Clinically: asymptomatic
lesion localized in the area
where tobacco is placed, lesion
appears granular, wrinkled or
folded, less often
erythroleukoplakic.

Treatment: Treatment remove

the cause, biopsy in persistent
lesions.

REACTIVE LESIONS
Nicotine Stomatitis

Etiology: Pipe and cigar

or reverse smoking
Clinically: palatal white
plaques with red dots,
which represent
inflammation of the
salivary gland duct.
metaplasia of the ducts.
Treatment: Treatment is
remove the cause

REACTIVE LESIONS
Hairy Leukoplakia

Etiology: - HIV, EBV,

medically induced
suppression,
corticosteroids, few cases
in healthy persons.
Clinically: papillary or
filiform white plaque, the
vast majority occur
bilaterally on the borders
of the tongue.
Treatment: Treatment no
specific treatment,

REACTIVE LESIONS
Hairy Tongue

Initiating Factors
Use of broad-spectrum antibiotics,
systemic corticosteroids, hydrogen
peroxide
Intense smoking
Head and neck therapeutic
radiation

Clinically:
Represents overgrowth of filiform
papillae and chromogenic
microorganisms
Dense hairlike mat formed by
hyperplastic papillae on the dorsal
tongue surface
Usually asymptomatic
May be cosmetically objectionable
because of color (usually black

Treatment:
Identify and eliminate initiating
factor identified and eliminated

REACTIVE LESIONS
Dentifrice-associated slough

Etiology: chemical burn

due to the use of different
brands of toothpaste
Clinically: painless
superficial whitish slough
of the buccal mucosa.
Treatment: Treatment
change the toothpaste

PRENEOPLASTIC AND NEOPLASTIC LESIONS

Actinic cheilitis

Etiology: Ultraviolet light

waves (2900-3200 nm)
Clinically: atrophic silvery
gray glossy, fissured lesion
commonly affect the lower
lip, in some cases erosion or
ulceration can be seen.
Treatment: use of lip
protectors (sunscreen
agents), biopsy is mandated
in aggressive cases. In
cases with atypical changes
vermilionectomy in

PRENEOPLASTIC AND NEOPLASTIC LESIONS

Idiopathic leukoplakia
Etiology: Ultraviolet light waves
(2900-3200 nm)
Clinically: atrophic silvery gray
glossy, fissured lesion commonly
affect the lower lip, in some cases
erosion or ulceration can be seen.
Treatment: use of lip protectors
(sunscreen agents), biopsy is
mandated in aggressive cases. In
cases with atypical changes
vermilionectomy in combination
with cryosurgery or
chemotherapy, - conservative:
remove the cause, vitamins A &
E.
- Surgery: resection, Laser.

OTHER WHITE LESIONS

Geographic tongue
Etiology: unknown
Clinically: asymptomatic
red desquamated and white
keratotic areas, this map
change within few days.
Treatment: No treatment is
necessary

OTHER WHITE LESIONS

Lichen planus
Etiology: Chronic,
inflammatory,
mucocutaneous,
immunologically mediated
process
Clinically: - age and sex, types

OTHER WHITE LESIONS

Lupus erythematosus
Etiology: connective tissue,
autoimmune, mucocutaneous
disease. Systemic and Discoid.
Clinically: DLE: Disk-shaped
erythematous plaques common
on the face and scalp, lip and oral
cavity. SLE: involve multiple
organs, erythematous rash of
butterfly distribution, fever
malaise loss of weight.
Treatment: Treatment is topical
or systemic corticosteroids.

NON- EPITHELIAL WHITE-YELLOW LESIONS

Candidiasis
Etiology: mainly C. albicans,
predisposing factors: Immunodeficiency - Endocrine
disturbances: - Diabetes mellitus Pregnancy - Hypo pituitarism &
parathyroidism - Corticosteroid
therapy - Long-term antibiotic
therapy - Malignancies and their
therapy - Xerostomia and bad oral
hygiene
Clinical features: - Acute: - Thrush Erythematous - Chronic: Erythematous - Hyperplastic Mucocutaneous: - Localized - Familial
- Syndrome associated

NON- EPITHELIAL WHITE-YELLOW LESIONS

Mucosal Burns

Etiology:
The most common form of superficial
burn of the oral mucosa is associated
with topical applications of chemicals,
such as aspirin or caustic agents.
Topical abuse of drugs, accidental
placement of phosphoric acid-etching
solutions or gel by a dentist, or overly
fastidious use of alcohol-containing
mouth rinses may produce similar
effects.
Clinical features: Thermal burns are commonly noted on
the hard palatal mucosa and generally
are associated with hot, sticky foods.
Hot liquids are more likely to burn the
tongue or the soft palate.
Such lesions are generally
erythematous rather than white

NON- EPITHELIAL WHITE-YELLOW LESIONS

Mucosal Burns
Treatment:
Management of chemical, thermal, or
electrical burns is varied.
For patients with thermal or chemical
burns, local symptomatic therapy
aimed at keeping the mouth clean, such
as sodium bicarbonate mouth rinses
with or without the use of systemic
analgesics, is appropriate.
Alcohol-based commercial mouth rinses
should be discouraged because of their
drying effect on the oral mucosa.
For patients with electrical burns,
management may be much more
difficult.

NON- EPITHELIAL WHITE-YELLOW LESIONS

Submucous fibrosis
Etiology:
Contributing Factors: General
nutritional or vitamin deficiencies and
hypersensitivity to various dietary
constituents
Primary Factor: Chewing of areca (betel
nut)
Clinically:
- Oral submucosa fibrosis presents as a
whitish yellow change that has a
chronic, insidious biological course. It is
characteristically seen in the oral
cavity, but on occasion it may extend
into the pharynx and the esophagus

NON- EPITHELIAL WHITE-YELLOW LESIONS

Submucous fibrosis
Clinically:
Oral submucous fibrosis presents
as a whitish yellow change that has
a chronic, insidious biological
course. It is characteristically seen
in the oral cavity, but on occasion
it may extend into the pharynx and
the esophagus
Treatment:
Eliminating causative agents
Therapeutic measures include local
injections of chymotrypsin,
hyaluronidase, and
dexamethasone, with surgical

NON- EPITHELIAL WHITE-YELLOW LESIONS

Fordyces granules

Etiology:
Fordyces granules represent
ectopic sebaceous glands or
sebaceous choristomas (normal
tissue in an abnormal location).
This condition is regarded as
developmental and can be
considered a variation of normal

Clinically:
Fordyces granules are multiple and
often are seen in aggregates or in
confluent arrangements

Treatment:
No treatment is indicated for this
particular condition because the

NON- EPITHELIAL WHITE-YELLOW LESIONS

Ectopic lymphoid tissue

Etiology: chronic infection
Clinically:
Found in the posterolateral aspect
of the tongue, it is known as lingual
tonsil. Aggregates of lymphoid
tissue are commonly seen in the
soft palate, floor of the mouth, and
tonsillar pillars
Lymphoid tissue appears yellow or
yellow-white clinically and typically
produces small, dome-shaped
elevations.

NON- EPITHELIAL WHITE-YELLOW LESIONS

Gingival cyst
Etiology:
Gingival cysts of odontogenic
origin occur in adults, as well
as in infants (Bohns nodules).
In infants, relative frequency is
greatest in the neonatal phase.
They occur along the alveolar
ridges and involute
spontaneously or rupture and
exfoliate.
Another eponym, Epsteins
pearls, has been commonly
used to designate
nonodontogenic neonatal cysts
that occur along the palatal
midline (fusion of palatine

NON- EPITHELIAL WHITE-YELLOW LESIONS

Gingival cyst
Clinical Features:
Gingival cysts in a neonate appear
as off-white nodules approximately
2 mm in diameter. Cysts ranging in
number from one to many are
evident along the alveolar crests.

NON- EPITHELIAL WHITE-YELLOW LESIONS

Gingival cyst
Treatment:
- No treatment is indicated for
gingival or palatal cysts of the
newborn because they spontaneously
rupture early in life. Treatment for
gingival cyst of the adult is surgical
excision.

NON- EPITHELIAL WHITE-YELLOW LESIONS

Parulis

Etiology:
A parulis, or gum boil, represents
a focus of pus in the gingiva. It is
derived from an acute infection at
the base of an occluded
periodontal pocket or at the apex
of a nonvital tooth.
Clinical Feature:
The lesion appears as a yellowwhite gingival tumescence with an
associated erythema.
Pain is typical, but once the pus
escapes to the surface, symptoms
are temporarily relieved.

NON- EPITHELIAL WHITE-YELLOW LESIONS

Parulis

Treatment: Treatment of the

underlying condition (periodontal
pocket or nonvital tooth) is required
to achieve resolution of the gingival
abscess.

NON- EPITHELIAL WHITE-YELLOW LESIONS

Lipoma

Lipoma appears as a yellow or

yellow-white uninflamed
submucosal mass of adipose
tissue.
Tumor of adipose tissue