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2. Principles of Oral Diagnosis: Gary C. Coleman John F
. Principles of Oral Diagnosis: Gary C. Coleman John F. Nelson st Ed (1993),page
I-White lesions of superficial materials
Pseudomembranous candidiasis
Hyperplastic candidiasis
(white lesion of epithelial thickning )
Angular chelitis
Chemical mucosal burns
Oral ulcers
II- White lesions of submucosal change
Fordyces granules
Scar
Submucous fibrosis
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3. I-WHITE LESIONS OF SUPERFICIAL MATERIAL
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4. Opaque and rough or grainy.
White material, soft or friable and rubbing  an ulcer or erythematous
Frequent burning & discomfort sensation.(food remnants, a dense accumulation of materia alba, or plaque  painless, mucosa appears normal.
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5. The differential diagnosis is simple after removal of the white material
( white surface coagulum ).therefore the differential diagnosis shifts to the ulcerative lesions category .
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6. 1-Pseudomembranous Candidiasis
Acute superficial mucosal infection.
Infants & immune compromised.
systemic corticosteroid therapy, chemotherapy, AIDS, or acute debilitating illness.
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7. Clinical features
Diffuse, patchy, or globular white thickened plaques.
Tongue, soft palate & buccal mucosa.
Can be wiped off  erythematous, atrophic, or, ulcerated mucosa.
Mild burning pain  severe when coagulum scraped.
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8. Pseudomembranous candidiasis on the palate
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9. Thrush
White patch and flecks that rubbed off(patient complained of a burning mouth )
More extensive pseudomembranous lesions associated with erythematous base
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10. Differential diagnosis
C.F + resistance  diagnosis.
Chemical burns (white fibrinoid surface thinner and delicate , more focal + pt. HX. )
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11. Management Culture or exfoliative cytology.
Spread to orophayngeal and esophageal surfaces.
Medical referral.
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12. 2-Hyperplastic Candidiasis. (White lesions of epithelial thickening )
Superficial infection of the oral mucosa by the fungus Candida albicans and less common species of the same genus.
* Predisposing factors,
( poor oral hygiene,xerostomia,recent antibiotic treatment,dental appliance,)
* Compromised Immune system.
( early infancy,AIDS,corticosteroid,anemia,diabetes mellitus,)
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13. Hyperplastic candidiasis
Epithelial thickening that do not rub off.
Pseudomembranous candidiasis.
Atrophic candidiasis.
Chronic infection,red patch thined→red lesion
Angular chilitis: labial commissures (non healing fissures).
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14. Chronic Hyperplastic Candidosis ( candidal leukoplakia )
It appears as a thick,white leathery plaque of irregular thickness with rough surface (identical leukoplakia clinically )
The white patch is seen as triangular patch on buccal mucosa , lip commissure
Bilateral distribution
In some cases erythematous areas are located within the white patch ( producing feature of speckled leukoplakia )
Candidal leukoplakia is often associated with angular cheilitis
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15. Candidal leukoplakia a chronic form of candidiasis in which firm red white plaques form
In the cheek
In the palate opposite a tongue lesions ( kissing lesions
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16. Chronic hyperplastic candidasis.
Chronic hyperplastic candidasis presenting as multiple wartilke growths on the patient’s lower lip
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18. 3-angular cheilitis labial commissures
characterized by nonhealing fissures
two, three, or even all four forms.
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21. Clinical features Hyperplastic candidiasis
multiple or diffuse variably thick, patchy, do not rub off vague borders
tongue.
Other forms
Hyperplastic most resistance.
vaginal itching and discharge indicative of vaginal candidiasis.
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22. Differential diagnosis
The combination and underlying condition (resistance).
Lichen planus-striae & skin lesions.
Hairy leukoplakia treatment  no response  ?? other lesion.
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23. Management decisions A working diagnosis Topical antifungal -1 week.
exolifative cytology
culture.
Topical antifungal -1 week.
Resistant  systemic antimycotic.
Clean mucosa  brush or scrap
Dentures  1/2 teaspoon of bleach in 1 cup or in topical antimycotic
Medical referral.
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24. 4-chemical Mucosal Burns
corrosive chemicals( aspirin tablet. Iatrogenic chemical injury )
Wiped away  painful central ulceration.
Thin, membranous appearance Adherent patches on periphery.
The lesions may be categorized as ulcerative rather than white if the superficial white material has been abraded away before examination
Pt. HX.
Differential diagnosis
Diffuse & multifocal  candidiasis.
Treatment :- remove the cause
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31. 5-Oral Ulcers white  superficial fibrinoid coagulum.
Bulla( separation of the epithelium from the connective tissue )
Wiped away
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41. Differential diagnosis
Epithelial thickening.
Candidiasis.
Chemical burn.
Clinically :
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42. II-WHITE LESIONS OF SUBMUCOSAL CHANGE
It appear pale because the normally vascular mucosal connective tissue has been replaced by less vascular tissue .
Smooth, translucent, don't rub off
Non painful
Fordyce granules, scarring,submucous
fibrosis
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43. 1-Fordyce Granules
Ectopic Sebaceous glands located within the oral mucosa ( variation of normal ).
Increase in prominence with age.
Buccal, labial mucosa
Treatment , no treatment or follow up.
Clinically ,,,,,,,,,,,,
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44. Fordyce’s granules on the buccal mucosa
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Fordyce’s granules on the buccal mucosa

45. Clinical features. Small (1 to 2 mm) ovoid yellowish-white
Bilaterally symmetric distribution .
Differential diagnosis
Characteristic appearance
Management:
No treatment or observation.
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46. 2-Scar
Healing and repair of soft tissue injuries with dense collagenous connective tissue or scar often produces a pale appearance as compared with adjacent, normal tissues.
( ?The hard palate and gingiva).
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47. Clinical features.
Focal, homogeneous, pale, smooth and sharply delineated borders.
No pain, or other symptoms.
Pit or fissure depressions ( if the injury or surgical procedure resulted in poor tissue apposition )
Stellate pattern of pale lines radiating from the depression between the tonsillar pillars that represent healing follwing a tonsillectomy .
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48. Differential diagnosis.
Submucous fibrosis
Management
None or observation.
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49. 3-Submucous Fibrosis
Generalized fibrosis of the connective tissue of the oral mucosa in response to habitual chewing of betal nut & spices
India & southeast Asia .
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50. Clinical features. Generalized yellow- to white discoloration.
Smooth surface
Intensity of the color vary.
Loss of elasticity & firmness.
Soft palate and buccal mucosa.
Severe  trismus
HX.  oral habits.
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51. Generalized oral mucosal fibrosis and history of the oral habit confirm the diagnosis
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52. Differential diagnosis.
systemic sclerosis,
Radiotherapy.
Management
Discontinue habit,
Fibrosis is irreversible.
Stretching exercises +corticosteroid
clinical reexamination.( is mandatory because approximately one third eventually develop squamous cell carcinoma )
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