NON KERATOTIC LESION

AND NORMAL
VARIATIONS
Hafshah Samrotul Mahabbah 1206256610
Hanny Faizah
1206249214

Non Keratotic Lesions

Cheek chewing
Also known as Morsicatio Buccarum

Mostly located on the buccal mucosa and the lateral

border of the tongue

Mostly prevalence in people who under stress or
exhibit psychologic conditions (stress can be a
predisposing factor).
Etiologi chronic iritation because of chewing

procedures (repeated cheek sucking, nibbling,

chewing)

Clinical Features
Lesion mostly found bilaterally or may be unilaterally on anterior
buccal mucosa
Thickened with shredded white areas, infrequently combined with

erythema, erosions, or traumatic ulcerations

Irregular ragged surface

Cont
Treatment
No treatment required
For patient who desire treatment : oral acrylic shield
Several authors have suggested psychoteraphy as treatment of choice

Chemical Burn
Chemical injuries in the mouth can cause clinically

significant damage
Etiologi:
Many chemicals and drugs :

Aspirin
Hydrogen Peroxide
Sodium Hypoclhorite
Formocresol
Dental cavity varnishes
Acid etch materials
Eugenol
Phenol , etc

Clinical Features:
Usually located on the mucobuccal fold area and gingiva.
The injured area is irregular in shape, white, covered with a

pseudomembrane, and very painful.

Short exposures : superficial white, wrinkled appereance
Long exposures : epithelium becomes separated from underlying

tissue and can be descuamated easily -> red, bleeding

Cont

Treatments:
The best treatment is prevention : potentially caustic drugs

-> instruct the patient to swallow not allow it to remain in

oral cavity
Local symptomatic therapy aimed at keeping the mouth
clean, such as sodium bicarbonate mouth rinses with or
without the use of systemic analgesics, is appropriate.
Alcohol-based commercial mouth rinses should be
discouraged because of their drying effect on the oral
mucosa.
Temporary pain relief : Topical dyclonine HCL
Large area of necrosis : surgical debridement & antibiotics

Candidiasis
Definition : Most prevalent opportunistic infection

affecting oral mucosa.

Etiology : Fungal infections (Candida albicans and
other Candida species: C.tropicalis, C.glabrata)
Candidiasis : Acute and Chronic Lesions
Predisposing Factor : Local and General

Cont

Acute Candidiasis

Pseudomembranous
Candidiasis/Thrush
An acute form of candidiasis and recognized as classic
Candida infection
Predisposing factors: immunodeficiency condition,
predominantly patient medicated with antibiotics,
immunosuppresant drugs, or a disease that suppresses
the immune system
Clinical Features:
presence of adherent white plaques that resemble cottage

cheese or curdled milk.

Easily wiped off leave inflamed area : erythematous,
atrophic, or ulcerated mucosa

Cont
Histopathological features : inflammatory response,

and ulceration covered by fibrin

Location : buccal mucosa, palatum, dorsal tongue
Differential diagnosis : Lichen Planus, hairy
leukoplakia, leukoplakia, fordyce granules
Management:
Control of any local cause thrush to resolve
If not, a course of nystatin or amphotericin should allow

the oral microflora to turn to normal

Failure of response to topical antifungals suggest immune
deficiency. In such patients, candidiasis may respond to
fluconazole or itraconazole.

Erythematous candidiasis
Patient complain burning sensation because of diffuse loss of

the filliform papillae of the dorsal tongue.

Clinical features : red macules, Reddened bald appereance
of the tongue, diffused border, no white flecks, Erythematous
surface reflects atrophy and increased vascularization
Location : Posterior hard palate, buccal mucosa, dorsal
tongue
Predisposing factors : smoking, treatment with broadspectrum antibiotic, iron deficiency anemia, inhalation steroids
DD: erythroleukoplakia
Treatment:
Treat any predisposing cause
Antifungals such as nystatin oral suspension, pastilles, amphotericin

lozenges, miconazole gel, tablets or fluconazole tablets

Chronic Candidiasis

Denture Stomatitis
Is a varying degrees of erythema, sometimes

accompanied by petechial hemorrage, localized to

the denture-bearing areas of maxillary removable
prothesis
Usually caused by microorganism living beneath
the denture of improper design of the denture,
allergy to denture base.
Clinical features: red and asymptomatic
Location: Confined to palatal denture which face
to mucosa
DD: Erythematous candidiasis
Treatments:

CIE : Improve denture hygene, not to use denture while

sleeping,, store the denture in antimicrobial solutions

Antifungal treatment

Angular Cheilitis
Lesion on fissures of the commissures of the mouth,

usually surrounded by erythema.

Clinical features:
As a roughly triangular area of erythema and oedema at

the commonly at both angles of the mouth

Linear furrows or fissures radiating from the angle of the
mouth

Predisposing factors:
Dry skin
Candidia or staphylococcus aureus
Vit. B12, phosphate andiron deficinecy

DD: Exfoliative cheilitis, Actinic cheilitis

Treatments: Antifungal cream (usually miconazole) or
other antifungal therapy, application of moisturizing cream, a
course of oral iron or vit B supplements may be helpful

Median Rhomboid Glossitis

Clinically characterized by an erythematous lesion

in the center of posterior part of the dorsum of the

tongue
The area of erythema resulting from atrophy of the
filiform papillae
Etiology: C. albicans and much less commonly by
other species of Candida
Predisposing factors: Smokers, denture weares,
and patient who use inhalation steroids
Location: Involve the posterior dorsum of the
tongue

Cont
Clinical features:
erythematous lesion in the center of posterior part of

the dorsum of the tongue or

Flat or nodular, red, or red and white
Lesion -> oval configuration
Asymptomatic
DD:
Geographic tongue
White lesions chemical burns, traumatic
ulcerations, and white keratotic lesions.
Red lesions drug reactions, erosive lichen planus
Treatments:
Elimination of predisposing factors
Antifungal therapy (Nystatin oral suspension, cream)

Hyperplastic Candidiasis
Clinical features:
White plaques that are not removable, irregular
Asymtomatic
Histopathologic epithelial hiperplasia

Location: Anterior buccal mucosa, but also can be

found at dorsum of the tongue, palate, labial

commisures
Predisposing factors:

Smoking
Nutrition deficiency
Immunodeficiency
Denture-wearers
HIV patient
Chronic iritations

Cont
DD:
Leukoplakia
Candidiasis

pseudomembranous
Lichen planus
Treatments:
Elimination of predisposing

factors
Consumption of vegetable
and fruits
Vitamin A
Antifungal therapy

Fordyces granule
Manifestations of ectopic

sebaceous glands
Clinical finding : appear white
to yellow in color, either
discreetly separated/forming
plaques, may be slightly
raised, size 1-2mm
Location : commonly noted
within buccal mucose and
labial mucose altough can be
found on any mucosal oral site

Leukoedema
Clinical findings :
white veil-like, diffuse, and filmy

apperance.
Leukoedema is less clinically evident
after streching the mucosa and cant
be scrapped off
Location :
bilaterally in the buccal mucosa
(frequent site),
border of the tongue, soft palate &
floor of the mouth (rare site)
Differential diagnosis : Lichen
planus, white sponge nevus, cheek
biting

White sponge nevus

Clinical findings : white lesion

with an elevated and irreguler

surface comprising fissures or
plaque formations
Ethiology : autosomal
dominant developmental
anatomaly link with genes
mutation
Location :
buccal mucosa,
other sites: parakeratinezed
or nonkeratinized ephitelium
in oral cavity,
may involve extraoral sites ->
esophagus and anogenital
mucosa

Geographic Tongue/Benign Migratory

Glossitis/Erythema Migrans
Clinical findings : Irregularly shaped

erythemathous macules with

surronding elevated white borders.
(map like apparence)
Location :
Dorsum of the tongue,

Fissured tongue
Clinical findings :
presence of fissured and grooves

along the dorsal surface 2-6 mm,

severe case : numerous fissures cover
entire dorsal surface and divide the
tongue papilae into multiple islands
Location : anterior dorsum of the
tongue

Linea Alba
Common alteration of the

buccal mucosa that is most

likely associated with pressure,
fricitional irritattion, or sucking
trauma
Clinical findings : irreguler,
shaggy, white line running
along the inside of the cheek
bilaterally.
Location : buccal mucosa
Treatment : elimination of
predisposing factor
Diferential diagnosis :
1.Frictional keratosis
2.Cheek biting

Torus and Exostoses

Clinical findings : Benign,

developmental bony growth.

Covered by
keratinized/nonkeratinezed mucosa
Location :
Maxillary tori occur in the midline of
hard palate
Mandibular tori decelop along the
lingual aspect
Exostoses appear clinnicaly identical
to mandibular tori on the buccal
surface of the mandible or maxilla
Treatment : No treatment needed. If
denture fabrication is required, tori
can be surgically removed

 Bruch, Jean M and Nathaniel S Treister. Clinical Oral Medicine And

Pathology. New York: Humana Press, 2010. Print.

Burket, Lester W et al. Burket's Oral Medicine. Hamilton, Ont.: BC
Decker, 2008. Print.
Kim, June Woo et al. "Leukoedema Of The Oral Mucosa". Annals of
Dermatology 18.1 (2006): 21. Web.