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Diseases of oral mucosa

Brief comments for some oral mucosal diseases:
Oral Cancer | Oral Leukoplakia | Smoker's Palate | Oral Candidosis | Smoker's Melanosis

We thank Dr Tony Axéll for allowing us to present pictures of oral mucosal diseases.


Oral cancer (squamous cell carcinoma):

More than 90% of oral malignancies are squamous cell carcinomas - cancer arising from the squamous epithelium lining the oral cavity. Oral cancer is the commonest type in the Southeast Asian region due to both chewing and smoking tobacco habits practised. All forms of tobacco including chewing tobacco are important causative agents of mouth cancer. Alcohol consumption, Human papilloma virus and chronic irritation can also contribute to this disease.

Clinical Appearance:
Oral cancer appears most commonly in the lateral boarder of the tongue and floor of the mouth. In Southeast Asia buccal (cheek) mucosa is the commonest site. It may present as a non-healing ulcer, irregular mass, red patch (erythroplakia) or a white patch (leukoplakia).



 Oral Leukoplakia:

The significant fact about oral leukoplakia is that a small percentage of these lesions show premalignant or malignant epithelial changes and a small percentage eventually could become malignant. Tobacco in any form (smoking, chewing) is thought to be associated with the development of some of these lesions. Factors like alcohol, trauma, Candida albicans infection and nutritional deficiencies may also contribute to the development of leukoplakia.

Clinical Appearance:
Usually affects middle-aged or older adults. Appears as a white patch that can not be rubbed off, typically in the cheek, sides of the tongue and floor of the mouth. Malignant transformation varies in different populations, nearly 5% are malignant at first biopsy and 5% develop into malignancies at a later stage.




Smoker's palate:

Relatively common tobacco related white lesion seen in the palate of a pipe, cigar or a cigarette smoker. Unless the habit is particularly intense or the patient is a reverse smoker (burning end directed inside the mouth), risk for malignancy is quite low. The combination of tobacco smoke and heat combustion is believed to be important for this tissue change.

Clinical Appearance:
White opaque appearance of the palatal mucosa, sometimes showing red dots.



Oral Candidosis:
Oral candidosis is an opportunistic infection by the fungus Candida albicans. There are several clinical forms of candidosis - acute, chronic and mucocutaneous. Here we will describe the chronic hyperplastic candidosis. Candida albicans is a resident fungus of the normal oral flora. It can infect when predisposing factors such as antibiotic therapy, corticosteroid therapy, xerostomia (dry mouth), diabetes mellitus, HIV/AIDS, chemo/radiation therapy, poor oral hygiene and immunosuppression are present.
Clinical Appearance:
Chronic hyperplastic candidosis appears as a white plaque, usually near the angle of the mouth and cheek mucosa.
Smoker's melanosis:

Cigarette smoking in particular may lead to melanin pigmentation of the gums and other mucosal sites in the oral cavity. The process is reversible and improves when the patient quits smoking. It is a harmless condition but needs to be separated from other more serious pigmental disorders.


Clinical Appearance:

source: Regesi JA, Sciubba JJ and Pogrel MA.
                Atlas of Oral and Maxillofacial Pathology, W.B Sanders Company, 2000. 
Last updated by Thu Hang Vu