1、Red and White Lesions of Oral MucosaOral Licken Planus(OLP)Common diseases,prevalence rate only next to RAU, about0.51.Mostly appears in young adults, female more than male; skin and mucosa can onset at the same time or separatelylong term erosion tend to canceration, WHO classify it into precancero

2、us condition. Oral lichen planusdefinitionPsychological factorsEndocrine factors Immune factors：Immune reactivity disease mediated by Tcells.Infection factorsMicrocirculation disturbanceGenetic factorOral lichen planuspathogenyBasic lesion：white or graywhite linear figure formed by little papulesBil

3、aterally symmetrical , can occur at any parts of oral mucosa, mostly in buccal mucosaSubjective symptom：local sensitive and burning pain, be aware of rough mucosa. Oral lichen planusmanifestationOral lesion：clinical classification according to forms：reticulated，plaque， papule，atrophy，vesicle accordi

4、ng to conditions ：Hyperaemia erosion type、nonerosion typeSkin lesion aubergine or kermesinus polygon flat papule； Wickham lines：Small white spots or the reticular white stripes can be seen in papule. clearly seen under magnifying glass when applying the paraffin wax in the surface of papule.Oral lic

5、hen planusmanifestationEpithelium parakeratosisLiquefaction degeneration of basal cells Infiltration of lymphocyte cells adjacent to basement membrane is the typical feature. Oral lichen planuspathologyClinical features：mostly seen in middle-aged women, symmetrical lesion,the typical lesion formed b

6、y white papule can present hyperaemia, erosion or even ulcerationTissue biopsy if necessary.Oral lichen planusdiagnosispsychotherapy and systemic therapylocal therapysystemic therapy： immunosuppressor and immunomodulatorOral lichen planustreatmentLeukokeratosis Definition White benign hyper-keratini

7、zed lesions of the oral mucosa with apparent causes.leukokeratosisPathogenesis Caused by long term mechanical and chemical stimulation.clinical features: white poorly defined plaque or patch *Nicotinic stomatitisOccurred in the hard palate mucosa and gums, diffuse in distribution, with scattered red

8、 dot, gray or light white lesions are caused due to long-term smoking The patient may have dry, rough and other self-conscious symptoms.nicotinic stomatitis Appears as a flat, single white patch with exact stimulating factor. white lesion fade away when 1-2weeks after removing the stimulation.leukok

9、eratosisdiagnosis1eukoedema: mostly in the vicinity of the mucous membrane of the buccal mucosa, which is white or opalescent, and the soft, non-tenderness of the partial The patient has no self-conscious symptoms. This disease is benign damage, cause unknown, may be associated with smoking, chewing

10、 betel nut.2. linea alba buccalis: teeth bite line corresponding to the mucous membrane, for continuous white or grey lines, in conformity with the teeth shape Many are caused by the constant stimulation of the teeth during chewing Differential diagnosis has no self-conscious symptoms.Differential d

11、iagnosisOral Leukoplakiaoral leukoplakia-definitionA predominantly white patch or plaque of the oral mucosa that can not be characterized clinically or pathologically as any other definable lesion.WHO classified it into precancerous lesion.Chemical and mechanical stimulation Monilial infection :oral

12、 candidal leukoplakiaSystemic factorsoral leukoplakia-etiologyClinically, the diagnosis process of leukoplakia can be divided into 2 phases-temporary diagnosis and definite diagnoses. Temporary diagnosis can be made when the white lesion can not be diagnosed as other possible diseases. Such temporar

13、y diagnosis possibly includes some of the cases of white keratosis described before. If the local possible causative factors are removed for 1-3 months and the lesion is still there, the definite diagnosis can be made. However, its till a clinical diagnosis without any histological meaning. To furth

14、er assure the diagnosis, tissue biopsy is needed to make the histological diagnosis.diagnosistemporarydefiniteHistological diagnosisClinical Typeoral leukoplakia-clinical featuresHomogeneous Non-homogeneous GranularCrimpe paperPatch Ulcerous VerrucousEpithelial hyperplasia ,with orthokeratosis or pa

15、rakeratosisEpithelia dysplasia Pathology description：match the diagnosis of oral leukoplakia, with(without)mild, moderate or severe epithelial dysplasia.oral leukoplakia-pathologyexfoliative cytologic examination is the the detection of early cancerous exfoliated cells which were obtained by scrapin

16、g the lesion and papanicolaou staining. It features with 1-5 times enlarged cell nucleus, hyperchromatic nucleus,anomalouscells, formation of vesicle in cytoplasm and unclear nuclear membrane etc.exfoliative cytologic examinationtoluidine blue staining : smear the toluidine blue on the dry lesion su

17、rface, and then wash with 1% acetic acid after 0.5 minutes. The stained dark blue lesion is the suspicious malignant lesion and can be selected as the spot for tissue biopsy.toluidine blue stainingDiagnosis clinical features, pathological examination, exfoliocytology examination and toluidine blue s

18、taining. Early prevention and treatment to prevent cancerMethods：Early education；remove stimulations；Vitamin A acid drugs；periodic check，resect the lesion with canceration tendency. *Resect the whole lesion for biopsy with ulceration forms,verrucous forms and granular forms.oral leukoplakiaGender no

19、nsmoking women，especailly young women，with large possibility.Location U-shaped zone in the floor of oral tongue abdomen、triangular mouth corner in the buccal mucosa、soft palate complexityType ulceration forms,verrucous forms and granular forms and types with oral candidal infection.Pathology with ep

20、ithelial dysplasia，the severe one tend to have malignant transformationSymptoms pain under stimulation or spontaneous pain Time long time lesionArea more than 200m2oral leukoplakia-canceration tendency Oral ErythroplakiaA velvet sample, poorly defined, red patch of the oral mucosa that can not be ch

21、aracterized clinically or pathologically as any other definable lesion.Belong to precancerosisOral Erythroplakiadefinition紅白斑type homogeneous interspersed granular（carcinoma in situ or early invasive carcinoma）diagnosis biopayOral ErythroplakiaDiscoid Lupus Erythematosus(DLE) CDLE is a kind of self-

22、immunological disease that frequently involves the skin and/or oral mucosa 0.40.5，female is double of male，usual between 2040 years old。Precancerous conditionPersistent erythema, the center of the lesion sunked into discoid shapeMainly involve face skin and oral mucosa，skin lesion with adhesion scal

23、es, mucosa lesion with radial arranged tiny striae around the lesion. DLEdefinition Autoimmunity diseaseInvolves inheritance、infection、physical factorsThe relationship between SLE and DLE in contraversial two different disease or two different manifistation od one disease in common: belongs to spect

24、rum of disease,the one end is DLE，limiting in skin and mucosa;another end is SLE with spreaded lupus nephritisDLEetiologyLocalized type mucosa damage hollowly discoid lupus, with tiny striae around *vermilion of labium is predilection site skin damage erythema、scales、angiotelectasis(毛細血管擴張)、horn plu

25、g(毛囊角質栓)、hyperpigmentation or depigmentation systemic symptoms ：exclude SLEGeneralized type DLEclinical featuresEpithelial hyperkeratosis or parakeratosis The basal cell layer is significantly liquefied, and the gap between the epithelium and the natural layer can form fissures and vesicles, and the

26、 basement membrane is not clear. The intrinsic layer capillary dilation, the blood vessels can see glass thrombus.The blood vessels are surrounded by dense lymphocytes (mainly T cells) and a small number of plasma cells, which are infiltrated by blood vessels.Direct immunofluorescence test, there is

27、 a continuous, uneven thickness of green fluorescence band, granule or block in the epithelial basement membrane zone, known as lupus band , it is the immunoglobulin (IgG, IgM) and C3 deposits. There is significance in the diagnosis, treatment and prognosis of the disease. The skin lesions of DLE an

28、d SLE are about 90% of the incidence of lupus.DLEpathologydiagnosisLesion charaters+laboratory examinationDLEdiagnosisOral Submucous Fibrosis, OSF A chronic progressive oral mucosa disease with tendency to cancerationpathological changes including epithelial tissue atrophy collagenous fiber accumula

29、tion or degeneration in lamina propria or submucosa Show as thirst, burning pain, pain stimulated by food progressive restriction of mouth opening, dysphagia.OSFdefinitionBetel nut chewing ：necessary factors Nutritional factors Immune factors Genetic factorsOSFetiologysubjective symptom：oral mucosa

30、burning pain，thirsty、hypogeusia、lips numb、ulceration, gradually feel stiff of mucosa, progressive restriction of mouth opening and dysphagia.Lesion：color change(pale or graywhite lesion in mucosa)，vesicle、ulcer，then appear yellow white、opacity、reluster fibrosis stripes。OSFclinical featuresOPMD（oral

31、premalignant disease）？Differential DiagnosisOLKOLPLeukokeratosisNO Areca Nut,Smoking,drinking,spicy food adrenocortical hormone： OSF early stage dexamethasone+ yaluronidase 1time/week8week；oral prednisone：15mg/d，23weekSubmcous IFN- injection ： antifibrosisSalvia miltiorrhiza Bunge submcous injection

32、High pressure oxygen SurgeryTreatmentWhite sponge nevus ( familial white folded dysplasia ) is an autosomal dominant condition of the oral mucosaIt is caused by a mutations in certain genes coding for keratin, which causes a defect in the normal process of keratinization of the mucosa. This results

33、in lesions which are thick, white and velvety on the inside of the cheeks within the mouth. Usually, these lesions are present from birth or develop during childhood. The condition is entirely harmless, and no treatment is requiredWhite sponge nevus It presents itself in the mouth, most frequently as a thick, bilateral, symmetrical white plaques with a spongy, corrugated or velvety texture.Most usually, the lesions a