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White Lesions, Resources: Color Atlas (pg. 238-239) General and oral…

- - - - Characteristics: White yellowish slightly elevated granules clustered in plaques located on buccal mucosa (bilaterally), labial mucosa, retromolar pad, lip, attached gingiva, tongue, and frenum. Lesions are nontender and rough to palpation and do not rub off.
        
        Dental Implications: N/A
        
        Treatment & Prognosis: They are normal anatomic finding and require no treatment.
- - - - Characteristics: Opaque whitness of the buccal mucosa that disappears when the tissue is stretched, Lesions are nontender adn smooth to palpation and do not rub off.
        
        Dental Implications: None
        
        Treatment & Prognosis: No treatment is indicated.
- - - - Characteristics: Depapillated areas located on the dorsal or lateral surfaces of the tongue and are either erythematous or pink, surrounded by yellowish white lines that form margins.
        
        Dental Implications: Can be confused for other pathologic conditions and patients may be alarmed by the appearance when they first see it.
        
        Treatment & Prognosis: Asymptomatic patients do not require treatment, but symptomatic patients use topical corticosteriods to alleviate symptoms.
- - - - Characteristics: Variably sized, whitish plaque that does not run off.
        
        Dental Implications: Cause of lesions should be identified and eliminated. Self- inflicted injuries are sometimes associated with psychiatric disorders.
        
        Treatment & Prognosis: Its an adaptive response, it will resolve once irritant is identified and removed.
- - - - Characteristics: Linear white line along the occlusal plane of the buccal mucosa. Bilaterally, visibly raised, and ocacasionally scalloped
        
        Dental Implications: None
        
        Treatment & Prognosis: No treatment is indicated
- - - - Characteristics: White cobblestoned papules located on hard palate, excluding the anterior third. Papules have red centers, are nontender, and do not rub off.
        
        Dental Implications: Lesions itself are not premalignant, but its presence can alert the clinician the increased risk of oral caner. This allows the clinician to provide education about tobacco and offer tobacco cessation assistance.
        
        Treatment & Prognosis: Palatal changes will resolve with smoking cessation. Patients should be encouraged to stop smoking because the habits increase the overall risk of oral caners.
- - - - Characteristics: Elongated filiform papillae and discolored surface of the tongue (whitish, brown or black).
        
        Dental Implications: None
        
        Treatment & Prognosis: Physical debridement with a toothbrush or tongue scrapper. Antimicrobial mouth rinses such as chlorhexidine gluconate are prescribed. If candidal infection is present, antifungal therapy should be given.
- - - - Characteristics: Localized white plaques of variable sizes.
        
        Dental Implications: Lesions may be confused for other pathologic conditions. Patient should be educated about proper use of medications such as aspirin.
        
        Treatment & Prognosis: Lesions will heal once the offending chemical is withdrawn and/or more hot substances do not traumatize the tissue.
- - - - Characteristics: Multiple, raised, whitish, corklike plaques with variable surrounding erythema.
        
        Dental Implications: Clinician should carefully review patient's medical history for any sign of undiagnosed systemic problems. Infection should be diagnosed and treated.
        
        Treatment & Prognosis: Antifungal medications, topical medications such as nystatin oral suspension or clotrimazole troches.
- - - - Characteristics: Thickened, often raised whitish plaque that does not rub off. Affect tongue and commissure.
        
        Dental Implications: Lesion is rare, but it is considered premalignant. Chronic forms of candidiasis are also an indication that the person's immune system may be deficient.
        
        Treatment & Prognosis: Systemic antifungals, topical application of vitamin A and B-carotenes, laser surgery, and convectional surgical excision.
- - - - Characteristics: Whitish plaques that do not rub off, usually affecting lateral borders of the tongue, often bilaterally, appear as vertical, raised ridges or sometimes as irregular flattened lesions
        
        Dental Implications: HL is a significant diagnosis because it is a relatively accurate predictor of rapid progression form HIV latent infection to AIDS.
        
        Treatment & Prognosis: Antiviral therapy often produces improvement or resolution of the lesion, however recurrence is not common.
- - - - Characteristics: Swelling of the ginigva,
        
        Dental Implications: When pus is encountered the source should be determined and treated.
        
        Treatment & Prognosis: Infection should be treated
- - - - Characteristics: Purplish, raised papules with a keratotic white surface pattern of very fine interlacing lines. White lesions, red lesions, and ulcers.
        
        Dental Implications: Often confused with other pathologic conditions. Symptomatic patients require diagnosis and treatment. Lesions should be carefully monitored.
        
        Treatment & Prognosis: Patients usually do not require treatment unless the disease becomes erosive and symptomatic. Lesions showing growth or mass effect should have a biopsy performed.
- - - - Characteristics: Widespread of white plaques on the buccal and labial mucosa that do not rub off.
        
        Dental Implications: Occasionally, lesions present as a cosmetic problem
        
        Treatment & Prognosis: Once a diagnosis of WSN is confirmed, no other treatment is needed, and prognosis is excellent.
- - - - Characteristics: various shapes and sizes affecting virtually any mucosal surface. Lesions rage from mm to several cm and most are single lesions. Most lesions are soft on palpation and some feel leathery.
        
        Dental Implications: None
        
        Treatment & Prognosis: Biopsy with tobacco cessation.
- - - - Characteristics: Fibrous brands of tissue that form in the buccal and labial mucosa resulting in a white marble like appearance. Floor of the mouth becomes lathery and the gingiva becomes fibrotic and pale.
        
        Dental Implications: Patients who habitually chew betel nut should be encouraged to stop the habit, have regular oral exams, and receive appropriate education related to the complications of OSF.
        
        Treatment & Prognosis: No effective treatment and the process is irreversible. Advise patient to stop chewing betel nut, steroid injections may slow down the progression, surgery, and supplements such as alpha lipoic acid in conjunction with intralesional steroids and hyaluronidase.