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1Section I :Differential Diagnosis of Oral Lesions
2WhitelesionSiribang-onPiboonniyomKhovidhunkit-Pseudomembranouscandidiasis-Chemicalburn-Fooddebris(materiaalba)-Detachedke...
3CandidalleukoplakiaWhiteplaquecannotberubbedoff,usuallypresentsbilaterallyontheanteriorbuccalmucosaclosetocommissuralarea...
4RedlesionSiribang-onPiboonniyomKhovidhunkitErythematouscandidiasisDenture-inducedstomatitisErosive(atrophic)lichenplanuso...
5RedandwhitelesionSiribang-onPiboonniyomKhovidhunkitOralcandidiasisofmixedpseudomembra-nousanderythema-toustypesLichenplan...
6Erosion(apartiallossofepitheliumpresentingasasingleormultipleredpatches)Siribang-onPiboonniyomKhovidhunkitMultipleunilate...
7UlcerativelesionSiribang-onPiboonniyomKhovidhunkitUlcerswithspontaneoushealingRecurrentulcersPersistentulcersUnilateralmu...
8NonwhitelesionSiribang-onPiboonniyomKhovidhunkitExtrinsicfactorsIntrinsicfactorsGeneralizeddiffuseorpatchypigmentation-Ra...
9Addison’sdiseaseAssociatedwithsignsandsymptomsofAddison’sdisease,e.g.,weakness,fatigue,perioralandcutaneouspigmentation.S...
10Softtissueswelling/massSiribang-onPiboonniyomKhovidhunkitReactivehyperplasiaDiseasesofsalivaryglandBenignsofttissuelesio...
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9749740330967

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9749740330967

  1. 1. 1Section I :Differential Diagnosis of Oral Lesions
  2. 2. 2WhitelesionSiribang-onPiboonniyomKhovidhunkit-Pseudomembranouscandidiasis-Chemicalburn-Fooddebris(materiaalba)-Detachedkeratin-Dentifrice-associatedepithelialsloughSinglewhitelesionsthatcannotberubbedoffMultiplewhitelesionsthatcannotberubbedoff-Frictionalkeratosis-Lichenoidcontactreaction-Idiopathicleukoplakia-Oralsquamouscellcarcinoma-Whitelesionsassociatedwithsmokelesstobacco-CandidalleukoplakiaBilateralwhitelesions-Lineaalbabuccalis-Whitespongenevus-Hairyleukoplakia-Lichenplanus-Lichenoiddrugreaction-Leukoedema-CandidalleukoplakiaGeneralizedwhiteplaque-Idiopathicleukoplakia-Lichenplanus-Lupuserythematosus-ProliferativeverrucousleukoplakiaWhitelesionsthatcanberubbedoffWhitelesionsthatcannotberubbedoff
  3. 3. 3CandidalleukoplakiaWhiteplaquecannotberubbedoff,usuallypresentsbilaterallyontheanteriorbuccalmucosaclosetocommissuralareaChemicalburnHistoryofdirectapplicationofsomemedicationssuchasaspirinorchemicalagentstooralmucosaDentifrice-associatedsloughHistoryofusingdentifricewithstrongdetergentorflavoringcompoundsFrictionalkeratosisWhiteplaqueadjacenttocontributingfactorssuchassharptoothorpoorlyfittingdenturesHairyleukoplakiaAsymptomaticwhitelesionscannotberubbedoff,usuallylocatedonlateralbordersofthetongueinHIV-infectedsubjectsorotherimmunocompromisedpatients,associatedwithEpstein-Barrvirus(EBV)infectionIdiopathicleukoplakiaWhiteplaquecannotberubbedoffinapatientwithahistoryofsmoking,alcoholconsumptionorbetelnutchewinghabitLeukoedemaDiffuse,filmysurface,translucentwhiteplaqueonbilateralbuccalmucosawithdissipationofwhiteplaqueuponstretchingLichenplanusPresentswithwhitestriation(Wickham’sstriae)onbilateralbuccalmucosaLichenoidcontactreactionPresentswithwhitestriation(Wickham’sstriae)adjacenttometalcontainingproductssuchasamalgamrestorationormetalcrownLichenoiddrugreactionHistoryofusingmedicationssuchasantihypertensivedrugsthatcaninducelichenoidlesiononbilateralbuccalmucosaLineaalbabuccalisWhitelinesonbilateralbuccalmucosaadjacenttotheocclusalplaneofupperandlowerteethOralsquamouscellcarcinomaWhiteplaquecannotberubbedoffinapatientwithahistoryofsmoking,tobaccouse,alcoholconsumptionorbetelnutchewinghabitPseudomembranouscandidiasisWhiteplaquecanberubbedoffleaningared,raw,orbleedingsurface.Usuallypresentswithpredisposingfactorssuchasimmunocompromisingconditions,long-termuseofsteroidsorantibiotics,orhyposalivationProliferativeverrucousleukoplakiaWhiteplaquecannotberubbedoffongingivawithcauliflowerlikesurface,usuallygrowsrapidlyandcanbetransformedtoverrucouscarcinomaWhitelesionsassociatedwithWhiteplaquecannotberubbedoffinapatientwithahistoryofusingsmokelesstobaccosmokelesstobaccoWhitespongenevusPresentsasasymptomaticfoldedbilaterallesionsofbuccalmucosathattendtobethickenedandhaveaspongeconsistencyLesionsKeycharacteristicsofthelesions
  4. 4. 4RedlesionSiribang-onPiboonniyomKhovidhunkitErythematouscandidiasisDenture-inducedstomatitisErosive(atrophic)lichenplanusorLichenoidreactionDesquamativegingivitisMedianrhomboidglossitisErythroplakiaSquamouscellcarcinoma-Redareawithburningsensationtospicyfood-Historyofusinglong-termantibioticsorcorticosteroids-Patientswithimmuno-compromisedcondition,e.g.,HIVinfection-Erythematouslesionondenturebearingarea-Historyofwearingdentureatnightorpoororalhygieneandpoordenturecondition-Immunocom-promisedpatients-Patientswithhyposivation-Erosiveareawithburningsensationtospicyfood-Historyofusingmedicationsforsystemicdiseases,e.g.hypertension,diabetesmellitus,gout,dyslipidemia-Maypresentadjacenttodentalrestorations,e.g.,amalgam,compositeresin,ormetalcrown-Generalizederosiveareaonattachedgingiva-Canbeseenin•Lichenplanus•Pemphigus•Pemphigoid-Depapillationoncentralposteriordorsumofthetongue-Associatedwithcandidalinfection-Red-whitelesionafterexclusionofallotherpossiblediagnoses-Premalignantlesionassociatedwithhistoryofsmoking,tobaccouse,betelnutchewingand/oralcoholabuse-Usuallydemonstratesdysplasticchangesontheredarea-Malignantlesionassociatedwithhistoryofsmoking,tobaccouse,betelnutchewingand/oralcoholabuse
  5. 5. 5RedandwhitelesionSiribang-onPiboonniyomKhovidhunkitOralcandidiasisofmixedpseudomembra-nousanderythema-toustypesLichenplanusorLichenoidreactionCheekortonguebitinghabitGeographictongueNicotinicstomatitis(Stomatitisnicotina)ErythroleukoplakiaSquamouscellcarcinoma-Whiteplaquecanberubbedoff,leavingredareaorbleeding-Historyofusinglong-termantibioticsorcorticosteroids-Patientswithimmunocom-promisedconditions,e.g.,HIVinfectionorusingimmuno-suppressants-Patientswithhyposalivationfromradio-therapyoforalcancer-Erosiveareawithwhitestriation(Wickham’sstriae)-Burningsensa-tiontospicyfood-Historyofusingmedicationsforsystemicdiseases,e.g.hypertension,DM,gout,dyslipidemia-Maypresentadjacenttodentalrestora-tion,e.g.,amalgam,compositeresin,orcrown-Redareaswithwhiteshreddedsurfaceonlateralsurfaceofthetongueorbuccalmucosa-Historyofcheekortonguebitinghabit-Reductionofthelesioncanbeobtainedaftertheabstinenceofsuchhabit-Redordepapillatedareawithwhiterimonthetongue-Burningsensationifcandidalsuperinfection-Morecommoninindividualswithallergicdiseases;e.g.atopy,asthma,andcontactallergy-Redpapuleonwhiteplaquethatcannotberubbedoff-Presentsontheposteriorpalateinindividualswithhistoryofheavysmoking-Red-whitelesionsafterexclusionofallotherpossiblediagnoses-Premalignantlesionasso-ciatedwithsmoking,tobaccouse,betelnutchewingand/orheavyconsumptionofalcohol-Usuallydemonstratedysplasticchangesontheredarea-Malignantlesionassociatedwithhistoryofsmoking,tobaccouse,betelnutchewingand/oralcoholabuse
  6. 6. 6Erosion(apartiallossofepitheliumpresentingasasingleormultipleredpatches)Siribang-onPiboonniyomKhovidhunkitMultipleunilateralerosionsorclusterofsmallpainfulerosionsonthehardpalateorattachedgingivaGeneralizedwidespreaderosionsSingleormultiplelocalizederosionRecurrentherpessimplexvirusinfectionRecurrentherpeszostervirusinfectionAcuteonsetChroniconset-Primaryherpeticgingivostomatitis-Erythemamultiforme,e.g.,afterusingsomemedicationsorafterherpesvirusinfection-Lichenplanus(usuallypresentswithwhitestriations,i.e.,Wickham’sstriae)-Pemphigus/pemphigoid/othervesiculobullousdiseases-Lichenplanus/Lichenoidreaction-Traumaorburnofaknowncause-Precancerouslesionsuchaserythroplakia-Carcinoma-Bullousdiseasessuchaspemphigus,pemphigoid
  7. 7. 7UlcerativelesionSiribang-onPiboonniyomKhovidhunkitUlcerswithspontaneoushealingRecurrentulcersPersistentulcersUnilateralmultipleulcersGeneralizedmultipleulcersSingleulcerMultipleulcers-Traumaticulcer(checkthecauseandeliminateit.Ifnoresponse,performabiopsy)-Recurrentaphthousulcers(RAU)•MinorRAU•MajorRAU•HerpetiformRAU-Recurrentaphthousulcers(RAU)•MinorRAU•MajorRAU•HerpetiformRAU-Recurrentintraoralherpessimplexvirusinfection-Recurrentherpeslabialis-RecurrentherpeszostervirusinfectionSingleulcerMultipleulcers-Traumaticulcer-Infections-Tuberculosis-Deepfungalinfection-Viralinfection-Squamouscellcarcinoma-Salivaryglandneoplasm•Benign•Malignant-Vesiculobullousdiseases•Pemphigus•Pemphigoid•LinearIgAdisease-Lichenplanus-Lichenoidreaction-Lupuserythemato-sus(LE)•Systemiclupuserythematosus(SLE)•Discoidlupuserythematosus(DLE)-Erythemamultiforme(EM)-Recurrentintraoralherpessimplexvirusinfection-Recurrentherpeslabialis-Recurrentherpeszostervirusinfection-Primaryherpessimplexvirusinfection-Primaryherpeszostervirusinfection-Hand-foot-mouthdisease-Herpangina-Catscratchdisease-Rubella
  8. 8. 8NonwhitelesionSiribang-onPiboonniyomKhovidhunkitExtrinsicfactorsIntrinsicfactorsGeneralizeddiffuseorpatchypigmentation-Racialpigmentation-Inflammatorypigmentation-Addison’sdisease-Peutz-Jegherssyndrome-Drug-inducedpigmentation,e.g.,minocline,tetracycline-Smoker’smelanosis-MelanoacanthomaMelaninpigmentationBloodandblood-derivedpigmentation-Amalgamtattoo-Decorativetattoo-Chlorhexidinestaining-Heavymetalsulphides(checkforoccupationalexposure)-BlackhairytongueBlanchesonpressure(discolorationisduetobloodinvessels)-Hemangioma/vascularmalformation-Varix(varicosity)NoblanchingonpressureRed,blue,brown,yellow,oryellowbrownpigmentation-Hemorrhage-Kaposi’ssarcoma-Pyogenicgranuloma-BenignandmalignantvascularneoplasmsDiscreteflatpigmentationpatches-Benignmelanoticmacule-Pigmentednevus-Melanoma/melanomainsituAssociatedwithtumormass-Pigmentedneuroectodermaltumorofinfancy-Melanoma
  9. 9. 9Addison’sdiseaseAssociatedwithsignsandsymptomsofAddison’sdisease,e.g.,weakness,fatigue,perioralandcutaneouspigmentation.Serumcortisollevelsshouldbeinvestigated.AmalgamtattooUsuallypresentsadjacenttoalargeamalgamfillingorcrown;mostcommononedentulousridgeBenignmelanoticmaculeUsuallyexistssincechildhoodasbrownflatlesionwithnochangeinsizeorlocationCanbesolitaryormultipleandmostcommonlypresentsonupperorlowerliporpalateBlackhairytongueBlackordarkbrownpigmentlocalizedtothedorsumofthetonguewithorwithoutovergrowthoffiliformpapillaeUsuallypresentsinpatientswithhyposalivation,andahistoryofusingantibioticmedicationorotherherballozengesDecorativetattooHistoryoftattooapplicationDrug-inducedpigmentationHistoryofusinglong-termmedication,e.g.,minocycline,tetracycline,anti-retroviralmedicationsHeavymetalsulphidesHistoryofoccupationalexposure,e.g.,workinginafactorywithchemicalsubstancethatcontainsheavymetalHemangioma/vascularmalformationPresentssincechildhood,ifthelesionislarge,pulsationcanbeobtainedHemorrhageHistoryoftraumaortakinganticoagulantmedicationInflammatorypigmentationHistoryofchronicinflammation,e.g.,patientwithlichenplanusKaposi’ssarcomaIrregularmassassociatedwithimmunocompromisedcondition,e.g.,HIVinfection,patientswhoareonimmunosuppressivemedicationMelanoacanthomaAcuteonsetwithgeneralizedpigmentationoftheoralcavityMorecommoninAfrican-AmericanorIndianpopulationMelanoma/melanomainsituMostfrequentlyseenonpalateorgingivaasbrowntoblackmaculeormasswithirregularbordersPeutz-JegherssyndromeAssociatedwithintestinalpolyposisorpresentswithgastrointestinalproblemsPigmentednevusUsuallyexistssincechildhoodassolitarysmallbrown,blackorblueelevatedpapuleornodulePigmentedneuroectodermaltumorPresentsininfantlessthan6monthsofageandoccurstypicallyinmaxillaofinfancyPyogenicgranulomaHistoryoftraumaorirritation,mostcommonongingiva,canbeassociatedwithpregnancyorauseofcontraceptivemedicationRacialpigmentationGeneralizedhomogeneouspigmentationontheattachedgingiva;bilaterallysymmetry,commonindark-skinnedpatientsSmoker’smelanosisHistoryofsmoking,presentsaspigmentationmostoftenfoundonanteriorgingivaVarix(varicosity)Morecommoninelderlypatients,mostcommononupperorlowerlip,ventralsurfaceofthetongueLesionsKeycharacteristicsofthelesions
  10. 10. 10Softtissueswelling/massSiribang-onPiboonniyomKhovidhunkitReactivehyperplasiaDiseasesofsalivaryglandBenignsofttissuelesionsMalignantsofttissuelesionsAcuteinflammatoryenlargementPapillaryenlarge-mentofsurfaceepithelium-Pyogenicgranuloma-Irritationfibroma-Peripheralossifyingfibroma-Peripheralgiantcellgranuloma-Mucocele-Ranula-Benignsalivaryglandtumor•Mixedtumor-Malignantsalivaryglandtumor•Mucoepidermoidcarcinoma•Adenoidcysticcarcinoma-Lipoma-Granularcelltumor-Neuroma-Squamouscellcarcinoma-Non-Hodgkin’slymphoma-Abscessfromdentalorigin-Pericoronitis-Squamouspapilloma-Verruciformxanthoma

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