4. Wide spectrum of pink colors varying from a dark
pink(reddish) to a very pale pink(almost white) 1. Lining mucosa
--- Reddish pink 2. Masticatory mucosa--Light pink Protective layer
of keratin Dense sub epithelial connective tissue
5. Deep dusky red in color contrast to light red color of
surrounding tissue. Painless red macular bands may present Richer
blood supply Individual normal variation
6. Vascularity Thickness & degree of keratinization
Presence of pigmentation Presence of inflammation
7. Duration Associated with pain Associated with habit Other
systemic manifestations Any known cause
11. Vascular dilations from a. Inflammation (Erythema) b.
Congenital defects(e.g. hemangioma) Extravasations of blood (e.g.
trauma hemostatic disease or both) Atrophy or erosion of mucosa
Marked increase in hemoglobin concentration of circulating
blood
12. Inflammation (Erythema) Mechanical trauma Thermal trauma
Chemical trauma Infections Ulcer with inflamed rim Congenital
defects(e.g. hemangioma)
13. Erythematous macule Erosion The purpuric macule
Granulomatous stage of inflammatory hyperplasia
14. Etiology --Produce by low grade, usually chronic physical
insult Sharp margins of teeth & restorations Ill-fitting
prosthesis Self inflected trauma Habits
15. Clinical feature (c/f) Erythematous macule are on Anterior
& lateral border of tongue Cheek mucosa Lip mucosa Margins may
or may not be sharply defined
16. Mild tenderness Digital pressure may cause blanching
Regress quickly after removal of cause
17. H/P Inflamed lamina propria Slightly thinned or Eroded
stratified Squamous epithelium
18. D/D Purpuric macule h/o trauma Purpuric macule of oral sex
Macular hemangioma Atrophic Candidiasis Mononucleosis Herpangina
(not transient)
19. Caused due to blunt trauma which is sufficient force to
cause the extravasations of blood. Soon after the traumatic damage,
lesion is red afterwards converts into blue color. Borders are
poorly demarcated Blanching on pressure does not usually occur May
also have secondary inflammatory component.
20. Slight extravasations of blood .
21. The purpuric macule due to oral sexual practices. Reddish
Elliptical Purpuric macule Occurring on palatal mucosa near the
junction of the hard & soft palate. Disappear within 2 to 3
days Judicial history with confidential setting revel the true
identity.
22. D/D Traumatic Erythematous macule h/o Purpuric macule of
oral sex trauma Macular hemangioma Atrophic Candidiasis
Mononucleosis Herpangina
23. Traumatic origin Prolonged chronic physical stimulus can
induce the production of granulation tissue
24. Mass of inflamed granulation tissue & clinically
appears as soft & vary red. Reversible lesion up to this
stage.
25. H/P Granulomatous tissue Covering epithelium is usually
intact
27. Excisional biopsy Elimination of irritant (priority depends
on clinical judgment)
28. Caustic drugs or hot foods or beverages Depends on duration
& intensity of stimuli Stimuli may produce coagulative necrosis
of superficial tissues that appears white After scraping off that
white layer it may produce clinically appreciable red lesion
29. Ulceration & properly stripping off mucosa Tender to
painful May blanch on pressure Size & shape varies depend on
stimuli.
31. Other names Leukokeratosis nicotina palati, Smokers palate,
Nicotine palatinus
32. Conventional smokers Is seen primarily on the palate of
pipe smokers. Also seen in bidi smoker Does not having premalignant
nature It develops in response to heat rather than tobacco.
33. Appears red in initial stage In later keratotic stage minor
salivary duct orifices appear red Men , 4-5 decade
34. H/p Hyperkeratosis Acanthosis Squamous metaplasia Chronic
inflammation of subepithelial connective tissue Inflammatory
exudate within duct
36. Erythroplakia Commonly seen on buccal mucosa , floor of
mouth, tongue Definition Persistent velvety red patch that can not
be identified as any other specific red lesion such as inflammatory
Erythema or those produce by blood vessel anomalies or
infection.
37. It appear red because Absences of surface keratin layer
Connective tissue papillae, containing enlarge capillaries, project
close to the surface.
38. C/F- Velvety red or granular red macules. Varies greatly in
size Borders may be well defined Painless Drying of the mucosa will
intensify the red colour
39. Types Homogenous erythroplakia Erythroplakia interspread
with patches of Leukoplakia Speckled erythroplakia
40. The lesion may have an irregular, red granular surface
interspersed with white or yellow foci, which may be described as
granular erythroplakia. There may be numerous, small irregular foci
of leukoplakia dispersed in the erythroplakic patch, and this has
been called speckled leukoplakia.
41. Oral erythroplakia is soft to palpation and does not become
indurated or hard until an invasive carcinoma develops.
42. Histopathologically erythroplakia almost always show
dysplasia, carcinoma in situ or invasive squamous cell carcinoma.
Epithelium is frequently atrophic with lack of keratin production.
The connective tissue demonstrates chronic inflammation.
43. If the lesion persist for more than 21 days after all local
trauma & infections foci have been eliminated, biopsy is
mandatory.
45. Malignant epithelial neoplasm exhibiting Squamous
differentiation as characterized by formation of keratin & / or
presence of intercellular bridges (pinborg JJ 1997)
46. Annually, nearly 30,000 new cases of oral and oropharyngeal
cancer are expected to occur in men and women in the United Sates.
The ratio of cases in men and women is now about 2 to 1.
47. Tobacco, Typically mixed with areca (betel) nut, Slaked
lime, All forms of tobacco smoking Reverse smoking Alcohol Poor
nutritional status HPV 16 & 18 has some role in the development
of OSCC. Ultraviolet (UV) light
48. A compromised immune system Chronic irritation
49. The first is loss of cell cycle control through increased
proliferation and reduced apoptosis. The second stage is increased
tumor cell motility, leading to invasion and metastasis.
50. Carcinoma of the Lips: Carcinomas of the lower lip are far
more common than upper lip lesions. Pipe smoking, uv light
exposure. The growth rate is slower for lower lip Favorable
prognosis Account for 25% to 30% of all oral cancers
51. Lesions arise on the vermilion surface Appear as a chronic
non healing ulcer (Exophytic ,verrucous type may present) Deep
invasion -- later in the course of the disease. Metastasis to local
submental or Submandibular lymph nodes is uncommon
52. One of the most common intraoral malignancy. Predilection
for men (6-8th decade) However, lesions may uncommonly be found in
the very young.
53. Exhibit a particularly aggressive behavior. Lingual
carcinoma is typically asymptomatic. As deep invasion occurs, pain
or dysphagia may be a prominent patient complaint.
54. Appear in one of four ways: indurated, nonhealing ulcer, a
red lesion, a white lesion, a red-and-white lesion.
55. The neoplasm may occasionally have a prominent exophytic,
as well as endophytic, growth pattern
56. The most common location of cancer of the tongue is the
posterior-lateral border. Specific reason is due to chronic
irritation because of tooth Approximately 1/4th of tongue cancers
occur in the posterior one third or base of the tongue.
57. Metastases from tongue cancer are relatively common. The
first nodes to become involved are the submandibular lymph node.
Uncommonly, distant metastatic deposits may be seen in the lung or
the liver.
58. Second most common intraoral location of squamous cell
carcinomas. Predominantly in older men,
59. Painless, nonhealing, indurated ulcer. It may also appear
as a white or red patch. May widely infiltrate the soft tissues of
the floor of the mouth, Decreased mobility of the tongue.
Metastasis to Submandibular lymph nodes is common
60. Predominantly in Men Clinical appearance varies from a
white patch to a nonhealing ulcer to an exophytic lesion.
61. It is slow growing Usually well differentiated, Rarely
metastasizes, Has a favorable prognosis
62. Palatal squamous cell carcinomas generally present as
asymptomatic red or white plaques or as ulcerated and keratotic
masses
63. 1. Well differentiated: It consists of sheets and nests of
cells of squamous epithelium. Cells are large and show distinct
cell membrane but intercellular bridges or tonofibrils are not
seen. Pleomorphic nuclei and becomes hyperchromatic.
64. Mitotic figures are seen but not numerous. Individual cell
keratinization and formation of numerous keratin pearl. Group of
cells invades underlying connective tissue.
65. Shape of cells and their arrangement may be altered. The
growth rate of individual cells is more rapid and this is reflected
in the greater numbers of mitotic figures. Keratin pearl formation
may or may not be seen.
66. More pleomorphic cells. Loss of keratinization and keratin
pearl. Loss of individual cell differentiation. Increase mitotic
figures.
68. Coxsackie virus A4 -cause a majority of cases of
Herpangina, Types A1 to A10, A16 to A22 Herpangina may be seen more
than once in the same patient. Herpangina frequently occurs in
epidemics The majority of cases affect young children
adolescents.
69. Clinical Manifestations. After a 2- to 10-day incubation
period, The infection begins with generalized symptoms of fever,
chills, and anorexia.
70. The fever and other symptoms are generally milder than
those experienced with primary HSV infection. The patient complains
of sore throat, dysphagia, and occasionally sore mouth.
71. Lesions start as punctate macules, which quickly evolve
into papules and vesicles involving the posterior pharynx, tonsils,
faucial pillars, and soft palate. Lesions are found less frequently
on the buccal mucosa, tongue, and hard palate.
72. Within 24 to 48 hours, the vesicles rupture, forming small
1 to 2 mm ulcers. The disease is usually mild and heals without
treatment in 1 week.
73. Definition Infectious mononucleosis is an acute,
self-limited infectious disease that primarily affects children.
Etiology EpsteinBarr virus transmitted through saliva transfer,
Cytomegalovirus (CMV) CMV is the major cause of non-Epstein-Barr
virus infectious mononucleosis in the general population.
74. The oral manifestations are early and common, and consist
of palatal petechiae, uvular edema, tonsillar exudate, gingivitis,
rarely ulcers
75. Generalized lymphadenopathy, hepatosplenomegaly,
maculopapular skin rash, sore throat are common. Prodromal symptoms
such as anorexia, malaise, headache, fatigue, and later fever occur
before the clinical manifestations.
77. Caused by Nonpyogenic bacteria Prepyogenic Postpyogenic
state
78. It is the infection with yeast like fungus Candida albicans
Earlier termed moniliasis Types ACUTE CHRONIC Psuedomembranous
Hyperplastic Atrophic Mucocutaneous Atrophic Candidiasis
79. clinical type Appearance Erythematous Red Atrophic Red
Hyperplastic White, red raised Mixed Red/ white keratotic / white
necrotic Mucocutaneous Lip/ angles Psuedomembranous White
lesion
80. ACUTE ATROPHIC
81. Acute atrophic Candidiasis/Antibiotic sore mouth Painful
mucosa due to broad spectrum antibiotics Angular Cheilitis-
Erythema, fissuring of angles of mouth
82. D/D- Chemical burn Drug reactions Syphilitic mucous patches
Necrotic ulcers Traumatic ulcer Contact allergy
83. CHRONIC ATROPHIC
84. Due to denture cuts off the underlying mucosa from the
protective action of saliva. The erythema is sharply limited to the
area of mucosa occluded by a well-fitting upper denture or even an
orthodontic plate.
86. It is red colored unraised area usually present on buccal
mucosa. It is usually capillary type, Also occur as port wine stain
on skin.
87. History of long duration It is non tender Even no
inflammatory component Absence of recurrent traumatic episode
88. References- Text book of oral and maxillofacial pathology-
Neville Differential diagnosis of oral lesions by- Wood and Goaz,
Fifth Edition Shafers textbook of oral pathology 6th edition .
Textbook of oral medicine Burkait 10th edition .