Dr. Rupak Sethuraman
SPECIFIC LEARNING OBJECTIVES
 To know what are red lesions and why they appear red
 To know the commonly occurring red lesions of the
oral mucosa.
 To know the clinical features, investigations and
management of these lesions.
FORMAT
 INTRODUCTION
 CLASSIFICATION
 COMMONLY OCCURRING RED LESIONS OF THE
ORAL MUCOSA
INTRODUCTION
 Red lesions are a large, heterogeneous group of
disorders of the oral mucosa.
 Traumatic
lesions,
infections,
developmental
anomalies, allergic reactions, immunologically
mediated diseases, premalignant lesions, malignant
neoplasms, and systemic diseases are included in this
group.
 The red color of the lesions may be due to:
 thin epithelium
 inflammation
 dilatation of blood vessels or increased numbers of
blood vessels and
 extravasation of blood into the oral soft tissues.
COMMON RED LESIONS OF THE
ORAL MUCOSA
 Erythroplakia
 Geographic tongue
 Linear gingival erythema
 Lupus erythematosus
 Contact allergic stomatitis
 Median rhomboid glossitis
 Denture stomatitis
 Erythematous candidiasis
ERYTHROPLAKIA
 Erythroplakia is defined
as a red lesion of the oral
mucosa that cannot be
characterized as any
other definable lesion .
 The lesion comprises an
eroded area
that is
frequently observed with
a distinct demarcation
against
the
normal
appearing mucosa.
ETIOLOGY AND CLINICAL
FEATURES
 Use of tobacco and alcohol are the most common risk
factors.
 Most commonly found on the floor of the mouth,
buccal vestibule, tongue and soft palate.
 Mostly
asymptomatic but some patients may
experience a burning sensation with food intake.
 40% of all erythroplakias transform into malignancy.
DIAGNOSIS
 The clinical diagnosis is based upon the appearance of
a red patch that cannot be explained by any other
definable cause such as trauma.
 If trauma is suspected, the cause such as a sharp tooth
cusp or restoration should be eliminated.
 If healing does not occur in two weeks, biopsy is
essential to rule out malignancy.
MANAGEMENT
 Various methods of management include:
1. Carotenoids such as beta carotene and lycopene due to
their antioxidant action.
2. Vitamins A, E and C
3. Topical Bleomycin
4. Photodynamic Therapy
Clinical evaluation every six months is recommended.
GEOGRAPHIC TONGUE
 Geographic tongue is a
lesion
affecting
the
dorsum and margin of
the tongue.
 The lesion is also known
as erythema migrans.
CLINICAL FEATURES
 Geographic tongue changes its position on the tongue
very frequently, leaving an erythematous area behind
which reflects atrophy of the filiform papillae.
 Healing of the depapillated and erythematous areas
starts after some time.
 Sometimes patients may have a burning sensation.
 When symptoms are present, topical analgesics may
be used to obtain relief.
 Other
drugs which have been tried include
antihistamines, anxiolytic drugs and steroids.
LINEAR GINGIVAL ERYTHEMA
(LGE)
 LGE is limited to the soft tissue of the periodontium,
appearing as a red line 2–3 mm in width adjacent to
the free gingival margin.
 Unlike conventional periodontal disease, though, LGE
is not significantly associated with increased levels of
dental plaque.
LUPUS ERYTHEMATOSUS
 Autoimmune disease
 Women affected more than men
 The typical oral manifestation comprises white striae
in a radiating pattern and these may sharply terminate
towards the centre of the lesions which has a more
reddish appearance.
 The most affected sites
are the gingiva, buccal
mucosa, tongue and
palate.
 The palate consists
mostly of red lesions.
MANAGEMENT
 When symptomatic intraoral lesions are present,




topical steroids should be considered .
To obtain relief of symptoms, potent topical steroids
such as
Clobetasol propionate gel 0.05%,
Betamethasone dipropionate 0.05%, or
Fluticazone propionate spray 50 mg aqueous solution
are usually required.
 The treatment may begin with applications two to
three times a day followed by a tapering during the
next 6 to 9 weeks.
 The overall objective is to use a minimum of steroids to
obtain relief.
 Any questions???
 Thank you