Fordyce granules are normal sebaceous glands that are found in the oral mucosa.

Fordyce is granules affect most of the adult population, as much as 80%. They are rarely found in children.

Intraoral: Fordyce granules are appears as superficial yellowish to yellowish white, slightly elevated spots/ they are found mainly on lower lip, buccal mucosa, and often bilaterally symmetrical.

Treatment and prognosis: They are normal anatomic finding that require no treatment.

Leukoedema is sufficiently common that most authorities consider it a variant of normal rather than pathologic condition.

It shows a predilection for black and other darker skinned individuals, but also occur in white individuals. It affects male and females equally. Leukoedema is a common mucosal anomaly characterized by intracellular edema and whiteness.

Intraoral: Produces a white opaqueness, sometime with fine wrinkles, of the mucosa. It is often found on the buccal mucosa and often seen as bilaterally symmetrical. It does not rub off and characteristic disappear when the mucosa is stretched.

Treatment and prognosis: No treatment is indicated. The healthcare practitioner can teach the patient about the oral cancer self exam and point out variation from normal such as leukoedema.

GT is a common mucosal disorder affecting as many as 2-3% of population. It is rarely seen in children. GT is an inflammatory condition and cause of inflammation is unknown.

Intraoral: Patterns change—usually visible on the dorsal and ventral tongue areas. Atrophic, denuded patches. Concentric rings (yellow or white)
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Dental implication: GT can be confused with other pathologic conditions. Patient may be alarmed by the condition when they first notice it.

Treatment and prognosis: GT is not a premalignant condition. Asymptomatic patient do not require treatment; symptomatic patients are generally treated with topical corticosteroids to alleviate symptoms.

Physical irritation of the oral mucosa may produce whitish plaque know as Frictional keratosis (FK).Adaptive response is a callus (over production of keratin) against physical injury.

Intraoral: FK presents as a variably sized, whitish plaque that does not rub off.

Dental implication: The cause of these lesions should be identified and eliminated. Factitious injuries are sometimes associated with psychiatrics disorders. Lesions that do not resolve may be confused with other pathologic conditions such as leukoplakia.

Treatment and prognosis: Because FK is an adaptive response, the hyperkeratosis will resolve once irritant is identifies and removed.

Physical irritation (Frictional Keratosis) causes the lesion associated with cheek or lip chewing.

Lesion are associated with overproduction of keratin and damage to the epithelium as a reaction to physical injury.

Intraoral: Chronic cheek induces hyperkeratosis and continued chewing abrades the tissue, leaning white, irregular surface. lesion are often bilateral and acute injury can produce areas of redness.

Dental implication: Disruptive oral habits, such as cheek biting, should be discouraged. Long term inflammation is detrimental to any mucosal tissue

Treatment and prognosis. The diagnosis can be made from clinical features and confirmed by a patient history of cheek biting. The clinical tissue changes are not considered premalignant; therefore no treatment is indicated. The patient should be educated about the lesion and encourage to stop the habit.

Caustic chemicals cause burns on mucosa. Examples include aspirin placed on a tooth to relieve the pain, home remedies, phenols, silver nitrate, and hydrogen peroxide.

Chemical burns causes necrosis of the epithelium which causes a white color.

Extraoral: burn can occur on the extra oral skin. Intraoral: Most chemical and thermal burns manifest as white plaque of variable sized. Early or mild lesions do not rub off, while more severe lesions can be often removed with pressure from a tongue blade, leaving a raw and occasionally a bleeding base.

Dental implication: These lesions may be confused with other pathological conditions. In addition, the patient should be educated about the proper use of medication such as aspirin.

Treatment and prognosis: The lesion will heal once the offended chemical is withdrawn and/or more hot substances don not traumatize tissue.

Cause by species candida, usually albicans. Predisposing factors of infected individuals: Systemic board spectrum antibiotic therapy, smoking, xerostomia, immune system disorders, diabetes and corticosteroid use.

Candidiasis is an infection, it is not highly transmissible. It is considered an opportunistic infection

Candidiasis has a worldwide distribution and is commonly found in immunocompromised individuals and the elderly who have predisposing factors. Also, called thrush which is the clinical characteristic form of yeast infection.

Extraoral: Candidiasis can occur in any epithelial surface of the body but more commonly In areas that are warm and moist such as the feet, where hair overlaps, where fat tissues overlap each other commonly for over weight individuals. Intraoral: Acute pseudomembranous candidiasis manifest as multiple, raised, whitish, cordlike plaque with variable surrounding erythema. The plaque is always multiple and it is not uncommon for large areas of the oral mucosa to be infected.

Dental implication: Candidiasis is a infection that need to be diagnosed and treated. The tendency for the infection to favor immunocompromised individuals should prompt the clinician to review the medical history for signs of undiagnosed systematic problems.

Treatment and prognosis: Once the diagnosis is establish a variety of antifungal medication are used for treatment. Many clinician treat the infection with topical medication such as nystatin oral suspension or clotrimazole troche. Effective systemic medication is also available, such as fluconazole.

WSN is an inherited condition caused by the mutation of certain keratin genes. It is usually apparent in childhood but is sometimes not noticed until adolescent.

This is a rare condition. The disorder involves an autosomal dominant trait, and a diagnosis is made rapidly when a family history already exists.

Extraoral: Rarely, WSN affects the upper aerodigestive tract mucosa and anogenital areas. Intraoral: WSN tends to spread wide spread keratinization of the buccal mucosa and often the labial mucosa. the lesions don not rub off.

Dental implication: Occasionally, these lesion present as a cosmetic problem.

Treatment and prognosis: Once a diagnosis of WSN is confirmed, no other treatment is needed, and the prognosis is excellent.

Leukoplakia Historical, chronic irritation was thought to be the etiological factor in many leukoplakias. However, it has never been determined that irritation leads to malignancy. Therefore leukoplakia should not be diagnosed as irritation rather as frictional keratosis.

Leukoplakia has a worldwide distribution and is found commonly where tobacco used is prevalent and acceptable. Men are more frequently affected but with social acceptance of smoking in women, more women are affected today. Leukoplakia arises from genetic mutations of the to the epithelial cells following exposure to carcinogens. Leukoplakia is considered a premalignant lesion.

Intraoral: Speckled leukoplakia exhibits both red and white components. May have redness, ulceration, or a pebbly appearance. Proliferative Verrucous Leukoplakia: aggressive form of leukoplakia, High incidence of oral cancer, progressive and tendency to form on the gingiva

Treatment and prognosis: Biopsy should be performed on leucoplakias since the microscopic examination is the only way to accurately assess the presence of epithelial dysplasia. The odds are in the patient's favor, as most leukoplakia are nondysplastic, but a biopsy is mandatory to detect ones that are dysplastic. Treatment decisions are best made following a biopsy and determination of clinical findings. With smoking cessation, approximately 50% of patient experience of leukoplakia associated with smoked tobacco, and over 95% of those who spit tobacco regress. Any person that has been treated for premalignant lesion has a significantly increased chance of developing additional lesions over time; therefore, continued clinical follow-up is mandatory.

Delong, L & Burkhart, N. (2019). General and Oral Pathology for the Dental Hygienist. Third Edition. Philadelphia: Wolter Kluwer.