Decision Tree of Oral Lesions PDF

Decision Tree of Red and white lesions Decision Tree of Oral ulcers Prof. Nahed Attia Oral medicine, Periodontology, Diagnosis and Oral Radiology, Department. Decision Tree of White Oral Lesions Red and White Oral Lesions Congenital / Genetic Lesions Leukoe...

Decision Tree of Red and white lesions Decision Tree of Oral ulcers Prof. Nahed Attia Oral medicine, Periodontology, Diagnosis and Oral Radiology, Department. Decision Tree of White Oral Lesions Red and White Oral Lesions Congenital / Genetic Lesions Leukoedema A common normal variation of oral mucosa. Clinically: diffuse, grey to white, non-scrapable, milky opalescent transformation of the oral mucosa. Disappears after gentle stretching of the mucosa, which reappears after quitting the manipulation  Acquired and can be scrapped off Superficial Oral Burn Pseudomembranous Candidiasis Morsicatio (habitual biting of cheek, lips and tongue) Superficial Oral Burn Thermal or chemical Result from ingestion of hot foods or beverages hot coffee, iatrogenic from contact of hot instruments. Site: palatal mucosa, Pizza burn posterior buccal mucosa, and the anterior part of the tongue.  Superficial Oral Burn Chemical: Aspirin burn. Aspirin tablets can be directly placed on the painful tooth and adjacent mucosa to relieve pain and avoid dental visits. Aspirin is acidic in nature and its protein coagulation effects can cause severe chemical burns to the surrounding mucosa when placed directly. Pseudomembranous Candidiasis Most common oral fungal infection caused by candida albicans. Seen in infants, elderly patients, immunocompromised patients. Wiped off with leaving erythematous bleeding area. Treatment by antifungal medication.  Morsicatio Chronic mucosal chewing. Caused by self-induced injury and chronic tissue irritation like habitual chewing of buccal mucosa, lip biting, lateral border of the tongue.  Acquired and cannot be scrapped off With specific Pattern Oral Lichen Planus Lichenoid reaction  Oral Lichen PLanus Common chronic mucocutaneous disease. Due to multifactorial, autoreactive T lymphocytes, stress. Reticular OLP Various clinical manifestations papular Arrow shows annular form reticular, plaque-like, bullous, erythematous, and ulcerative features. Fine white lines or striae (Wickham’s striae). Plaque like OLP  Oral Lichenoid reaction Similar to lichen planus, reaction due to drugs or dental restorative materials. OLR due to dental restorative Drug induced OLR materials  Acquired and cannot be scrapped off Without specific Pattern Frictional Keratosis Oral Leukoplakia Nicotinic stomatitis  Frictional keratosis Frictional (traumatic) keratosis is defined as white plaques with a rough and frayed surface clearly related to an identifiable source of mechanical irritation. Includes linea alba, and cheek, lip, and tongue chewing. Once the irritant is removed the lesion must resolve within two weeks. Biopsy is mandatory to rule out a dysplastic lesion.  Oral leukoplakia White patch or plaque that cannot be attributed to any clinically or histologically definite lesion. It is potentially malignant. Related to tobacco, betel nut chewing. Irreversible non-scrapable slightly raised white plaques, wrinkled leathery appearance.  Oral Hairy leukoplakia Immunosuppressed patients infected with Epstein-Barr Virus in HIV patients. White non-scrapable velvety plaques, involve borders of the tongue unilaterally or bilaterally. Plaques varies from slight, white vertical bands to thickened, furrowed areas.  Suspiscious Oral White Plaque (Leukplakia) Remove any source of trauma If completely resolved likely Persistent white frictional keratosis or reactive Follow p in 2-4 weeks plaque lesion No intervention Biopsy or refer for required biopsy Hyperkeratosis (not reactive) Moderate to severe Mild dysplasia dysplasia/OSCC Excision or follow up every 3-6 Excision months, rebiopsy if clinical changes occur  Red Plaque (Erythroplakia) Biopsy or Refer for Biopsy Dysplasia/ OSCC No Dysplasia/ OSCC Treat with Topical steroids and Excision re-biopsy any residual lesion. Follow up every three months and biopsy as necessary Decision Tree of Oral Ulcers Acute Chronic Recurrent Solitary Multiple  Acute ulcer lasts < than two weeks, typically painful. Recurrent ulcers present with a history of similar episodes with irregular healing. Chronic ulcer may last for > than two weeks. Key Points 1. Most common causes of oral ulcerations Trauma. Recurrent aphthous stomatitis (RAS). 2. Any ulcer that does not heal within 2 weeks Should be biopsied. 3. Some ulcers are manifestations of systemic disease. 4. Drug induced oral ulcers. 5. Blistering disease produce oral ulcers as Pemphigus vulgaris (PV). 6. Malignancy may present as oral ulcer. Acute Oral Ulcerations Acute Solitary Oral Ulcerations  Traumatic Ulcer Most common. Single lesion with erythematous, non-everted margins, with a clean base covered with a pseudo membrane. Usually painful, caused by mechanical, chemical, thermal trauma. Disappear in 7–10 days following elimination of the cause. Acute Multiple Oral Ulcerations  Primary herpetic gingivostomatitis A manifestation of herpes simplex virus type 1 (HSV-1) Characterized by high-grade fever and painful oral lesions. Occurs in children before the age of 5. Usually disappear within two to three weeks without treatment. Chronic Ulcerative Lesions  Chronic Solitary Oral Ulcerations Long-standing traumatic ulcer. Ulcerative squamous cell carcinoma Ulcerative squamous cell carcinoma Usually at the initial stages it is painless but may develop a burning sensation or pain when it is advanced. Common sites for OSCC to develop are on the tongue, lips and floor of the mouth.  Chronic Multiple Oral Ulcerations Pemphigus vulgaris (PV) Lichen planus.  Pemphigus vulgaris Is an autoimmune disorder characterized by blistering of your skin and oral mucosa. Involves painful sores and blisters on your skin and in your mouth.  Lichen planus Is a rare, chronic, inflammatory autoimmune skin and mucous membrane disease. LP most commonly presents as itchy, shiny, reddish-purple spots (lesions) on the skin (cutaneous LP) or as white- grey straiations in the mouth or on the lips (oral LP).  Recurrent Solitary / Multiple Oral Ulcerations Recurrent aphthous Stomatitis. Cyclic neutropenia. Bechet's disease. Recurrent aphthous Stomatitis. A common condition of the oral mucosa in patients who are otherwise healthy. Recurrent episodes of round or ovoid ulcers with circumscribed erythematous margins and a greyish-yellow base. Similar presentations of recurrent oral ulceration (aphthous-like ulceration) may occur associated with systemic disease. Cyclic Neutropenia Cyclic neutropenia is a rare hematological disorder consisting of recurrent episodes of aphthous stomatitis and skin infections caused by a periodic decrease in blood neutrophil counts.