Program Pendidikan S pesialis Dokter Gigi

Departemen Ilmu Penyakit Mulut FKGUI

Yuniardini S Wimardhani
200
LES I PUTI H

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De,elopmental -hite lesion

Gingi,al and palatal .yst o/ ne-0orn and

adult

Mis.ellaneous lesions
HEREDI TARY WHI TE
LES I ON

Un.lear etiology

(ormal ,ariation
Features1

2ilateral3 0u..al
mu.osa

Faint3 -hite3 di//use3

/ilmy appearan.e3
/olded-rinkling
mu.osa

4s.rapped o//3
/ade+disappear on
stre.thing

%symptomati.3 no
malignant .hange
Mi.ros.opi.ally1

$hi.kening epith
parakeratosis

"dema intra.ellular at
stratum spinosum
$reatment1

(o treatment

#are autosomal disorder

5a//e.t non6.orni/ied epith

Identi/ied at 0irth3 5 intense

at pu0erty

#elated -ith K7 and K89

gene distur0an.es
Features

White lesion3 ele,ated3

irregular /issures pla:ue

2u..al mu.osa

Dysphagia i/ esophagus
in,ol,ed

DD+ -ith leukoplakia3

pla:ue type .andidiasis
Mi.ros.opi.ally1

'0,ious intra.elullar
edema o/ 55stratum
spinosum

Pyknoti. nu.lei

(o+mild in/iltration o/
in/lammation .ells
Management1
(o treatment

2enign .ondt;n

%nti0ioti. in se,eral
studies no .onsistent
results

< Witkop;s disease

#are autosomal
dominant disorder
Features1

$hi.k3 .orrugated3
asymptomati. -hite
spongy pla:ue o/
0u..al=la0ial mu.osa

Dete.ted at 8
st
year o/
li/e3 55intense until
teens

2ul0ar .on>u.ti,a
lesion

'..ular irritation3
photopho0ia3 0lindness
Mi.ros.opi.ally1

Parakeratinised

S tratum spinosum
thi.kening -ith
dyskeratoti. /eatures
Management1
'ral lesion1 no treatment
'..ular lesion
opthalmologist

#are ?6linked Genodermatosis

'ral .hanges erythro+leukoplakia

Dysthropi. nails3 hyperpigmentation o/

skin @/a.e3 ne.k3 .hestA

!aematologi. .hanges

)ar.inoma in early adulthood

REACTI VE/I NFLAMMATORY
WHI TE LES I ON
&inea al0a3 /ri.tional keratosis3 .heek
.he-ing3 .hemi.al in>uries o/ oral mu.osa3
a.tini. keratosis3 smokeless to0a..o
indu.ed keratosis3 ni.otine stomatitis3
sanguinaria indu.ed leukoplakia

a -hite horiBontal
streak on the 0u..al3
o..lusal plane

asso.iated -ith
pressure3 /ri.tional
irritation3 su.king
trauma

5 in C o,er>et
Management1

(o treatment

May disappear
spontaneously

a -hite pla:ue3 rough

sur/a.e3related to
me.hani.al irritation
usually resol,e on
elimination o/ the irritant
@rough or malad>usted
dentures3sharp .usps
and edges o/ 0roken
teethA

DD+ leukoplakia
Mi.ros.opi.ally1

!yperkeratosis

%.hantosis
Management1

"limination o/ irritant

2iopsy /or 2 -eeks non

healing lesion a/ter agent
remo,al

.hroni. irritation su.king3

ni00ling3 or .he-ing
thi.kened3 s.arred3 and
paler mu.osa

stress or in psy.hologi.al
situations ha0itual
.heek 0iting

&ateral tongueDD+
'!&

DD+WS (3 0urns3
.andidiasis
Mi.ros.opi.ally1

hyperparakeratosis
and a.anthosis

shaggy and ragged

keratin -+ adherent
0a.terial
Manangement1

a plasti. o..lusal
night guard

&a0 in,est D '!&

$ransient non6
keratoti. -hite
lesions a result o/
.hemi.al in>uries
.austi. -hen
retained in the mouth
/or long periods

aspirin3 sil,er nitrate3

/ormo.resol3 sodium
hypo.hlorite3
para/ormaldehyde3
dental .a,ity
,arnishes3
a.idet.hing materials3
and hydrogen
peroEideF

premalignant
epithelial lesion

long6term sun
eEposure

2iopsieslesions
repeatedly ul.erate3
.rust o,er3 -ith
thi.kened -hite areaF

People -+outdoor
o..upations3 and+or
/air .ompleEions
Mi.ros.opi.ally1

%trophi. epithelium

&amina propria1
elastosis+0asophili.
homogenous
amorphous alteration
o/ the .ollagen

Dysplasti. /eatures

-hite mu.osal lesion

in the area o/
to0a..o .onta.t

/ound in ha0itual
users o/ smokeless
to0a..oF

%nterior mandi0ular
G posterior

)essationnormal
mu.osal 862-eeks

58mFo0iopsy

2iopsy atypi.al
lesion1 ul.eration3
erythroplakia3 intense
-hiteness3 or a
,erru.oid or papillary

Malignant
trans/ormation 57E
/or .hroni. smokeless
to0a..o usersF

<stomatitis ni.otina
palati3 smoker;s
palate

spe.i/i. -hite lesion

on hard and
so/tpalate o/ hea,y
.igarette3 pipe3 and
.igar smokersF

areas eEposed to
.on.entrated amount
o/ hot smoke

(ot malignant
Features1

(umerous
papules3pun.tate red
.enters @in/lamed3
metaplasti.ally minor
sali,ary gland du.tsA
resol,e 2 -eeks o/
.essation

2iopsy persistent
lesion5 8 month o/
.essation

S anguinaria eEtra.t3
a miEture o/
0enBophenanthridine
alkaloids @/rom
0loodroot plant
S anguinaria
canadensis), used in
oral rinses and
toothpaste sin.e
8H2F @eFg *iadentA

Indu.ing dysplasti.
keratosis

%,oidI

(o regression in
some *iadent6
indu.ed leukoplakias

months a/ter the

.essation o/ *iadent
useF
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)ysti. e.topi. lymphoid tissue @oral

lymphoepithelial .ystA

5posterior lateral 0order o/ the tongue @lingual

tonsilA and Waldeyer;s ringF@ tonsillar tissue
1lingual3 pharyngeal3 palatine tonsilsA

reddish yello- or -hite su0mu.osal dome6

shaped nodulesF

Diagnosed1.lini.al /eaturesF

large enough to re:uire a 0iopsy so/t palate

irritation and it.hingremo,al

multiple sessile dome shaped lesions 2 to

9 mm3 .halk -hite3 maEillary anterior
al,eolar ridge >ust lingual to the .restF

posterior region o/ the >a- on the .rest o/

the ridge o..lusal to the .ro-ns o/ the
molar teeth

seen in ne-0orn or ,ery young in/ants

and disappear shortly a/ter 0irthJ originate
/rom remnants o/ the dental laminaF

<erythema migrans3 0enign migratory glossitis3

erythema areata migrans3 stomatitis areata
migrans

.ommon 0enign .ondition dorsal sur/a.e

tongue

%sso.iation -ith ps orias is

2oth .onditions /eature annular lesions o/ the

tongue -ith slightly depressed atrophi. .enters
@de,oid o/ /ili/orm papillaeA and raised -hite
0orders

.lini.al term<a0normal .oating

dorsal sur/a.e .+ des:uamation o/ .ells
that make up the se.ondary /ili/orm
papilla0uildup o/ keratinhighly
elongated hairs

0la.k .olour 1to0a..o @hea,y smokingA

and psy.hotropi. agents3 0road6spe.trum
anti0ioti.s @peni.illin and the use o/
systemi. steroidsAF

slo-ly progressi,e .hroni. /i0roti. disease

o/ the oral .a,ity and oropharynE3 -+
/i0roelasti. .hange and in/lammation o/
the mu.osaprogressi,e ina0ility to open
the mouth3 s-allo-3 or speak

*ery resistant to treatment

0e a premalignant .ondition

oral .an.er de,eloped in KFLM o/ patients

malignant trans/ormation rate -as 7 to
89M