White lesions of the oral mucosa
Introduction :
White lesions express a defect in keratinization of the epithelium of the oral mucosa.
Easy to diagnose in general
Various etiological diagnostic discussion.
Overall, white lesions are divided into 2 types of lesions: false white lesions which take on a banal (detachable) character, such as candidiasis,
Non-keratotic white lesions: false white lesions
The epithelium in its histological structure is normal.
- Detachable by scratching
- May be encouraged by prolonged antibiotic or corticosteroid therapy as well as by certain pathological conditions (diabetes), among these non-keratotic white lesions we can cite acute candidiasis (thrush)
Keratotic white lesions: real
* the epithelium is altered
*not removable when scraped
- Their evolution is rather chronic
- Some of these lesions are considered potentially malignant lesions showing signs of dysplasia which may transform into carcinoma.
- Some white aspects of the oral mucosa have no pathological significance:
- Like the LINEA ALBA: which is a raised line of the normally bilateral jugal mucosa extending from the commissure to the last maxillary molar, we also cite FORDYCE’S GRAINS: which are heterotypic sebaceous glands located in the jugal mucosa in the normal state, their distribution is often symmetrical.
- What to do when faced with a patient presenting with a white lesion of the oral mucosa:
- The interrogation: Will inform us about
- Age
- Sex
- Personal and family background
- Alcohol and smoking habits
- General condition
- Medication currently being taken or previously taken
- Concept of taking medication
- Date of appearance of the lesion and its mode of evolution
- Associated functional signs: burning pain, swelling
- The psychological state of the patient.
The exo-oral clinical examination will essentially look for associated skin lesions, or lesions found in the rest of the body as in Behçet’s disease.
- The endo-oral clinical examination: very methodical, allows the entire oral mucosa to be explored by vision and touch.
- Examine the lesion closely: note whether the lesion is detachable when scraped with a tongue depressor; note whether it is regular or irregular in shape, whether it has a budding, linear, punctiform or sheet-like appearance, and whether the edges are limited or diffuse.
- Assess salivary quantity and viscosity.
From the questioning, from the clinical examination, we can distinguish at this stage the false white lesions from the true white lesions.
- Acute lesions: Canker sores and aphthous ulcers = false white lesions:
- Etiology unknown but poor oral hygiene , as well as oral and dental infectious foci, promote the appearance of mouth ulcers!
- Painful ulceration +++
- Isolated can be part of aphthosis affecting other organs (BEHCET) of a recurring nature
- Treatment :
oral hygiene+++
HEXALYSE: topical use CP to suck 6 to 8 / 24H.
General: treatment of the cause.
We should consider referring the patient to internal medicine, because the ophthalmological prognosis is reserved, risk of blindness!
- Candidiasis
- Non-keratotic white lesions: removable by scraping!
- Favored by prolonged antibiotic or corticosteroid therapy
- The diagnosis will be confirmed by a mycological examination.
- Treatment: Alkaline BB
- Antifungals: 1.5 to 2 g/day, for 3 weeks on average
B) keratotic white lesions: true white lesions.
1) traumatic injuries:
- Frequency +++
- Regular appearance + ulceration
- Matching the shape of the local irritant
- Clinical diagnosis / identification of etiology
- Treatment: removal of traumatic factor
Mouthwashes help with healing
If the lesion persists or does not improve: a biopsy is required!
- Tobacco leukoplakia:
Leukoplakia: white lesion of my MB that cannot be detached by scraping and that cannot be attributed to another identifiable cause other than the possible use of tobacco.
Clinically, leukoplakias must be distinguished according to their clinical appearance, correlated with very different prognostic notions. It is currently agreed to distinguish homogeneous leukoplakias, which have a good prognosis, from inhomogeneous leukoplakias, which generally have a poor prognosis when they are not treated immediately.
Treatment: depending on size, location, and histology.
Homogeneous form
(removal of the irritant factor (tobacco) + rigorous clinical monitoring)
Inhomogeneous form (smoking cessation + surgical excision
clinical and histological monitoring).
- Lichen planus:
Chronic inflammatory disease, usually benign.
- functional signs: tingling, burning
- Stress factor +++
- Can take several clinical forms
- Diagnosis: pathological anatomic.
- Treatment: oral hygiene +++
Stop: tobacco, alcohol.
Prescription of Axiolytic.
c) Dysplastic keratoses and carcinoma in situ:
These are extreme cases of keratoses that have already degenerated into carcinoma.
The diagnosis is histological: it is anatomo-pathological.
Treatment: surgical + strict monitoring!
- 90% of squamous cell carcinomas
- Incriminated factor: TOBACCO +++
- Appearance of ADP +++
- Preferentially develop on a potentially malignant lesion of the oral mucosa (inhomogeneous leukoplakia)!
- The induration and possible bleeding should alert you!!
Noticed :
Any change in texture, appearance, lymphadenopathy and pain should suggest malignant degeneration.
Good oral hygiene Regular scaling at the dentist Dental implant placement Dental x-rays Teeth whitening A visit to the dentist The dentist uses local anesthesia to minimize pain