BY : ZUHAIB AHMED

Oral leukoplakia is defined by the WHO as a white patch or plaque that cannot be scrapped off and also characterized clinically or pathologically as any other disease.

Chemical: alcohol, tobacco mechanical: sharp tooth or crown margins, irritating denture clasps

Premalignant epithelial changes

Candida Albicans

Ultraviolet radiation
Trauma

Toothpaste or mouth rinses (sanguinaria)

Acute candidiosis

Thrush Acute antibiotic stomatitis

Chronic

Denture induced stomatitis Chronic hyperplasia or mucocutaneous candidiosis Erythematous candidiosis

1.

2.
3. 4. 5. 6.

Affects 1.5 12% of total population It usually affects people over the age of 40 years (average age is 60 years). Prevalence increases rapidly with age particularly in males. Approximately 8 % of the males over the age of 70 years are reportedly affected. 17-25 % carcinoma in situ. 5.4% may develop squamous cell carcinoma in smokers it rises to 16%

Lateral and ventral tongue floor of the mouth alveolar ridge mucosa corner of the mouth less frequently:

soft palate lip

Site

% of leukoplakia at this site

% of leukoplakia at this site that show dysplasia or carcinoma

14.6 16.5 14.8 18.8 24.0 42.9 24.2

Mandibular mucosa and sulcus Buccal musosa Maxillary mucosa and sulcus Palate Lips Floor of the mouth tongue

25.2 21.9 10.7 10.5 10.3 8.6 6.8

retromolar

5.9

11.7

None 80% Mild 12% severe 5% Carcinoma 3%

Early or Thin Leukoplakia Thick Leukoplakia Granular Leukoplakia Verruciform Leukoplakia Proliferative Verrucous Leukoplakia

Homogenous

Non Homogenous (speckled)

Uniform flat appearance that may exhibit shallow cracks and has a smooth, plaque like, wrinkled or corugated surface with a consistent texture throughout

A predominantly white or white and red lesion (erythroleukoplakia). Area of redness and ulceration Irregularly flat, nodular thickening and exophytic Nodular lesions have raised, rounded red and or white excrescences

HOMOGENOUS LEUKOPLAKIA

NONHEMOGENOUS LEUKOPLAKIA

Although leukoplakia is not associated with a specific histopathologic diagnosis, it is considered to be a premalignant lesion for the risk of malignant transformation is greater in a leukoplakic lesion than that associated with normal or unaltered mucosa.

Overall - 1 5% Homogenous - 0% Non Homogenous - 26%

Hyperkeratosis Acanthosis Atrophy Atypia Dysplasia Inflammation

Reactive
Hyperkeratosis

Neoplastic Epithelial dysplasia Carcinoma in situ Squamous cell carcinoma

Infections Chronic hyperplastic candidiosis Hairy leukoplakia Syphilitic mucous patch

Immune mediated Lichen planus

Heriditary

Idiopathic

Leukoedema Hairy tongue White sponge nevus

Geographic tongue

Acanthosis

Lupus erythematosus

Actinic Chelitis

Snuff dipperss Verrucous keratosis Carcinoma Nicotine stomatitis

Removable:
Acute Pseudomembraneous Candiosis Chemical burns Plaqueand food debris Smoken tobacco keratosis

Fixed
Frictional (traumatic) keratosis Lichen planus Leukoplakia Smokers keratosis Chronic hyperplastic White sponge

Most white patches are harmless. If a patch persists, it may contain pre-cancerous or cancerous cells. The prognosis will depend on what type of cancer it is and whether it has spread.