Oral Path

White lesions in the mouth can be many things. Oral health professionals make use of information available to them to determine a working diagnosis. Try the following exercise to determine the type of lesion based on the information given. [[Press here to begin]]

On intraoral exam you decide to check whether there are other lesions present. [[This is the only lesion]] [[Multiple lesions are present]]

[[Your patient reports a history of smoking]] [[Your paient reports a history of antibiotic use]] [[Your paient reports no significant health history]]

You decide to ask your patient a few questions about their dental history. Which question would you like to ask most? [[How well the denture fits]] [[History of pain]]

The patient reports that his denture does not fit well and constantly rubs his tissue distal to the 43 area. Considering this information and the description of the lesion, which is the most likely diangosis? [[Oral hairy leukoplakia]] [[Frictional keratosis]]

[[This is the only lesion]] [[Multiple lesions are present]]

Smoking and alcohol use are significant risk factors for oral cancer and precancerous lesions. Which of the following would be considered pre-cancerous and fit the history and description of the lesion? [[erythroplakia]] [[leukoplakia]] [[oral submucous fibrosis]] [[melanoma]]

Candida should always be considered when antibiotics are used because they disrupt the normal balance of oral flora. What specific type of Candida lesion is being referred to in this case if the lesion is: [[Removable]] [[Non-removable]]

You need more information. What next? [[Intra-oral exam]] [[Dental History]]

Pseudomembranous candidiasis. This type of candidiasis is very common. It is soft and curd like. If you remove it with a finger swipe, it leaves a raw, red surface underneath. Treatment typically involves using antifungal medications like nystatin.

Chronic hyperplastic candidiasis presents as a white lesion that cannot be removed easily. It's often mistaken for leukoplakia or squamous cell carcinoma. However, it's important to note that this is an opportunistic fungal infection. A thorough health history, including factors like poorly controlled diabetes, dry mouth (xerostomia), antibiotic use, or immunosuppression, can aid in diagnosis. Fortunately, it responds well to treatment with antifungal medications.

Correct! Leukoplakia is considered a precancerous lesion. It is white and cannot be diagnosed as anything else.

Incorrect. This is a precancerous lesion, it is localized, but generally velvety and red. The prognosis for erythroplakia is worse than leukoplakia.

Incorrect. Though this is a white precancerous lesion, it does not match this description and history. This lesion is related to betel nut use and is not a localized/raised lesion.

Incorrect. Melanoma are cancerous lesions, however they are pigmented oral lesions and often present as black, brown and/or grey. They tend to exhibit change over time and have an extremely poor prognosis. Refer immediately if you suspect an oral lesion is melanoma.

You patient reports they had a toothache recently. In fact, it was so painful, it kept them up all night and they used everything they could to self-medicate and manage it on their own. Considering this information and the lesion, what is the most likely diagnosis? [[Aspirin burn]] [[Contact allergy]]

Correct! Chronic irritation can result in the build up of keratin in the squamous epithelium resulting in raised white tissue. Relining the denture should resolve this issue. Follow-up with your patient to ensure this is the case.

Incorrect. Oral hairy leukoplakia is not related to chronic irritation. Rather it viral infection (Epstein Barr). Though it is painless and presents as white, raised and irregular tissue, most commonly it is located on the sides of the tongue. OHL is most often related to HIV/AIDS.

Incorrect. Contact allergies generally present as red, diffuse and swollen tissue. With longer term contact they can present as sloughing white tissue, however, considering the short term nature and the localized appearance, this diagnosis is unlikely.

Correct! It is not unusual for patients to place aspirin next to the site of a toothache in the hopes of lessening the pain. Unfortunatley, it is not effective, and rather causes a chemical burn which presents as a localized raised white lesion. Traumatic lesions like this should resolve within 2 weeks.

Correct! This systemic condition often presents in many ways. Reticular lichen planus (lace-like) is most common, where as the plaque-like form is quite rare. Treatment is not required for these lesions but can be controlled with steroids when the patient experiences flare ups.

Leukoedema is a variant of normal rather than a pathological lesion. While it does present bilaterally as whitish/opalescent tissue, there is no lace-like pattern. Leukoedema disappears when the tissue has been stretched. It is most common in darker skinned individuals and does not require treatment.

There are many options for a singular localized white oral lesions. You need more information. Where to next? [[Dental History]] [[Health History]]

Intra-orally you note that in fact, this is not the only lesion. There are notable white, lace-like striations bilaterally on the buccal mucosa and gingiva. Considering this information, what is your diagnosis? [[Lichen planus]] [[Leukoedema]]

Your patient comes into the office and upon removal of his partial denture you see a well-defined, localized, white plaque-like lesion (about 5x5mm) on this right mandibular ridge distal to 43. What information do you need to help you make a diagnosis? * [[Intra-oral exam]] * [[Health History]] * [[Dental History]]