8leukoplakiaWhite patch in mucosa that does not rub off & cannot be clinically identifiedMost are asymptomatic,only 20% show evidence of dysplasia or carcinoma.Buccal mucosa and oral commissures are most common sitesMostly fourth decade, male>female
10Management Proper history Prevention of cause Surgical excision of small lesionTopical chemotherapy and radiation
11Erythroplakia Red lesion that cannot be classified as another entity. 91% shows signs of dysplasiaFlat, macular, velvety appearance and may be speckled with white spots representing foci of keratosisMost common site-lower alveolar mucosa, gingivobuccal sulcus
13Types:- A)Homogenous type: appears as bright red soft velvety lesions and extensive in size.commonly found-buccal mucosa and soft palate.B)Speckled type:soft red lesions,slightly elevated with irregular outlinesurface being granular-speckled
14Submucous fibrosisSubepithelial inflammatory response to the irritants mainly due to betel nut chewingArecoline-active alkaloid found in betel nuts-stimulate fibroblasts to increase production of collagen by 150%White fibrotic bands extending from retromolar trigone to soft palate,buccal mucosa , tongue.It continues even after cessation of areca nut chewing
18Clinical featuresThe most common initial symptom-burning sensation of oral mucosa aggravated by spicy food followed by either hypersalivation or dryness of mouthIn advanced cases,the mucosa becomes tough and leathery, with numerous vertical fibrous band.
19Clinical stagingStage1-stomatitis..vesicles,mucosal ulcers, mucosal petechieStage2-fibrosis in ruptured vesicles and ulcers. a)early-blanching..b)late-vertical and circular palpable fibrous bands, trismus, blanched leathery floor of mouth, fibrotic and depigmented gingiva.Stage3-leukoplakia(>25%) and speech & hearing deficits.
20Treatment Prescription of chewable pellets of hydrocortisone Absteinence from alcohol,tea,coffeeSubmucosal inj of hydrocortisoneSubmucosal inj of human chorionic gonadotropinSurgical treatment-multiple release deep to mucosa,submucosa and fibrotic tissue & suturing the gap so created by mucosal flap obtained by tongue and Z-plasty.
21Cont…..In this procedure,multiple deep z shaped incisions are made into fibrotic tissue and sutured in straight fashionPentoxifylline-vasodilating properties and increased mucosal vascularity used as adjunct therapy.Stem cell therapy-intralesional inj of autologus bone marrow stem cell –angiogenesis of area and decreases fibrosis.
22Lichen planus Malignant potential is matter of dispute Prudent practice to biopsy the lesion at first visit to confirm diagnosis or monitor changes.Lesion appear white lace like pattern in buccal mucosa.