Showing posts with label Oral mucosal lesions. Show all posts
Showing posts with label Oral mucosal lesions. Show all posts

Oral Lichen Planus

Oral Lichen Planus on left mucosa [1]

Question: What is oral lichen planus?

Answer: It is a chronic inflammatory condition that affects the skin, nails, hair, and mucous membranes, characterised by purplish, itchy, flat eruptions.

Question: How common is the condition?

Answer: It is a common condition in India. Its cases are reported more than 10 lakh per year in India. 

Question: How much time does it need for recovery?

Answer: It can last several years or remains lifelong.

Question: Is the condition treatable? 

Answer: Treatments can help manage conditions. There is no known cure present. 


Question: Does diagnosis require lab tests or imaging? 

Answer: Its diagnosis rarely requires lab tests or imaging. 




Condition Highlights 

  1. It commonly occurs for ages 35-50. 
  2. It is more common in females. 
  3. Family history may increase likelihood to occur. 


Assessment of oral mucosal disease

Oral mucosal lesions are common. They can be due to physiological changes or a local disease. They may also be an oral manifestation of a skin condition, an adverse drug reaction or systemic disease, for example, gastrointestinal disease. To manage an oral mucosal disease successfully one requires an accurate diagnosis.

Now the question arises, how will we get an accurate diagnosis?

The correct answer is, by a thorough assessment of oral mucosa for a lesion.

Assessment for an oral mucosal lesion involves taking a full patient history. This includes a medication history too. Next we need to perform a thorough extraoral and intraoral examination and use diagnostic investigations where appropriate. One should have a high index of suspicion for oral cancer.

To recognise oral cancer one should be familiar with the risk factors for oral cancer. You can see the “Oral Cancer” topic to know about risk factors for oral cancer. You should also thoroughly know the red flag features of oral cancer. If any 'red flag' features are present or the diagnosis is not clear or the patient has not responded to initial treatment, early referral to an appropriate specialist is required.  An oral medicine specialist is the most appropriate specialist to diagnose and manage oral mucosal disease, but may not be accessible. Therefore,  an oral surgeon, dermatologist or otorhinolaryngologist are other options.

Failure to respond to initial treatment, an unclear diagnosis or the presence of any suspicious features could indicate malignancy and warrant early referral.

‘Red flag’ features of oral mucosal disease

  1. oral ulcers that have lasted for more than 2 weeks 

  2. orals ulcers that recur

  3. nontraumatic oral ulcers in children 

  4. pigmented lesions on the oral mucosa

  5. red, white or mixed red and white lesions on the oral mucosa of unknown origin or with features of potentially malignant disease, such as: induration, ulceration with rolled margins, fixation to underlying tissues, lesions in high-risk sites (eg lateral tongue, floor of mouth)

  6. facial or oral paraesthesia

  7. persistent oral mucosal discomfort with no obvious cause 

  8. lumps or swellings, including lymphadenopathy

  9. swelling, pain or blockage of a salivary gland, suggestive of salivary gland disease 

  10. suspected allergy or adverse reaction to dental materials for example oral lichenoid lesion, dry mouth that is not adequately relieved with artificial salivary products and nonpharmacological methods and dry mouth caused by systemic disease

  11. suspected oral manifestations of systemic disease, for example, syphilis, Behçet syndrome, HIV, inflammatory bowel disease, lichen planus, pemphigoid

  12. lesions occurring in immunocompromised patients, for example, patients with neutropenia or HIV infection

Some oral mucosal diseases are associated with significant morbidity and mortality, particularly oral potentially malignant disorders and oral cancer. Oral potentially malignant disorders include:

  1. oral leukoplakia 
  2. oral erythroplakia
  3. chronic hyperplastic candidiasis 
  4. actinic cheilitis
  5. oral lichen planus
  6. oral submucous fibrosis
  7. discoid lupus erythematosus 
  8. dyskeratosis congenita 
  9. epidermolysis bullosa

Oral potentially malignant disorders can become malignant at the site of the lesion, but also predict an increased risk of cancer at other sites in the mouth, even in clinically normal appearing oral mucosa.

The following conditions can be managed in general practice, provided there are no 'red flag' features present that would warrant referral:

  1. recurrent aphthous ulcerative disease

  2. traumatic oral ulcers

  3. oral candidiasis

  4. angular cheilitis

  5. oral mucocutaneous herpes simplex virus

  6. dry mouth

  7. oral mucositis

  8. amalgam tattoo

  9. geographic tongue

  10.  hairy tongue.

There are physiological causes of oral mucosal discolorations, for example, Fordyce spots which are ectopic sebaceous glands and leukoedema, that do not require active management.



Therapeutic guidelines (oral & dental) 2019

Oral Leukoplakia

Oral leukoplakia (OL) is a clinical term for a nonremovable white lesion that is not easily recognisable as any particular condition and therefore requires further investigation.

Oral leukoplakia manifests as patches that are bright white and sharply defined. The surfaces of the patches are slightly raised above the surrounding mucosa.

Oral leukoplakia may be homogenous (uniform lesion often with a fissured surface), or nonhomogeneous (with surface irregularity and textural or colour variation for example speckled-see below given photograph.