White and red patches

• candida albicans - harmless commensal oral infection, 50% population is carriers
• local factors of oral candida:

  • denture
  • smoking
  • xerostomia
  • antibiotic
  • topical steroid therapy
• systemic factors of oral candida?

  • diabetes
  • haematinic deficiency
  • immunosupression
  • drugs
  • endocrinopathy
• variants of oral candida:

  • Acute pseudomenbranous candidiasis
  • acute atrophic candidiasis
  • chronic atrophic denture stomaitits
  • chronic hyperplastic candidiasis
  • chronic erythematous - median rhomboid glossitis
  • chronic mucocutaneous candidiasis
  • angular cheilitis
• thrush:

  • Acute pseudomembranous candidiasis
  • white papules on surface of oral muscos
  • milky apearance
  • can be wipes off
  • antibiotics, steroid use, xerostiomic
  • systemic disease in no local factors
• Acute pseudomembranous candidiasis

  
• Acute pseudomembranous candidiasis

  
• Acute atrophic candidiasis

  • asthma inhalors
  • broad spectrum antibiotics
  • can be painful
• acture atrophic candidiasis

  
• chronic atrophic-denture stomatitis:

  • denture bearing area
  • asymptomatic
  • acrylic and colbalt chrome
  • not removing at night
• chronic atrophic-denture stomatitis

  
• chronic hyperplastic candidiasis:

  • candidal leukoplakia
  • buccal mucosa just inside commissures
  • less common on tongue
  • high risk of developing SCC
• Chronic hyperplastic candidiasis

  
• Chronic hyperplastic candidiasis

  
• investigation of candidial infections?

  • clinical diagnosis
  • swab and culture
  • FBC, haematinic, RBG
  • histopathology studies after treating with antifungals
  • reactive dysplasia
• treatment of candidal infections?

  • remove factorstopical antifungals:topical antifungals:
  • topical antifungals: chx 0.2% mw, nystan oral suspension, miconazole gel 2%
  • systemic antifungals: Fluconazol, Itraconazol, Voraconazol
• white sponge nevus:

  • rare autosomal dominant disorder
  • soft, white, spongy plaque in oral mucosa
  • hereditary
  • early childhood, adolescence
  • benign course
  • treatment
• white sponge nevus

  
• smoker's keratosis

  • hard palate
  • not premalignant
  • from tobacco smoking
  • long term drinking of very hot drinks
• smokers keratosis

  
• smokers keratosis

  
• smokers keratosis

  
• frictional keratosis:

  • common
  • regular friction, teeth/dentures
  • linea alba or discrete white patch anywhere in mouth
  • disappear when irritation removed
• frictional keratosis

  
• frictional keratosis

  
• frictional keratosis

  
• tx of frictional keratosis?

  • remove cause
  • symptomatic relief if required
  • biopsy if no improvement
• oral lichen planus:

  • chronic autoimmune, mucocutaneous disease
  • affected oral/genital mucosa, skin, scalp, nails
  • middle-ages
  • F > M
  • uncommon in children
  • unknown aetiology
  • t-cell mediated
• OLP - clinical variants

  • reticular
  • erosive
  • atrophic
  • papular
  • plaque-like
  • bullous
• extra oral lichen planus lesion

  
• Reticular oral lichen planus

  
• Atrophic oral lichen planus

  
• ulcerative oral lichen planus

  
• plaque like oral lichen planus

  
• plaque like lichen planus that became malignant

  
• lichenoid reactions lichen planus

  
• what causes lichenoid reactions?

  • dental material: amalgam/composite
  • antimalarians: chloroquine
  • antihypertensives: metildopa, captopril, enalapril, propanolol
  • non steroidal antiinflams: ibuprofen
• tx of OLP:

  • identify and remove cause
  • symptomatic relief - difflam
  • topical steriors - prednisolone, betamethasone, fluocinolone, fluticasone propionate
  • topical immunosupressants - tacrolimus 0.1% - 0.03%
  • systemic immunosupressants - prednisolone, azathioprine, dapsone
• complications of OLP?

  • chronic disease - oral disease is lifelong
  • 0.1%-2% malignant transformation
• leukoplakia?


  white patch that cannot be removed from surface and does not fit into any other histological or morphological diagnosis