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Oral cavity
Lips
 Tongue
 Floor of Mouth
 Buccal mucosa
 Palate
 Retromolar trigone
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Reactive lesions
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Inflammatory lesions
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Oral cancer
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Precancerous lesions (Leukoplakia &
erythroplakia)
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Benign Tumors of Oral Cavity
1-Irritation fibroma :
 Most common
 61 % of all the
reactive lesions
 Can occur
throughout the oral
cavity
 Most common along
the "bite line."
 Microscopically:
fibrous tissue covered
by squamous
mucosa.
Giant cell epulis
2-Pyogenic granulomas
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12 %
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Highly vascular lesions
similar to granulation tissue.
3-Peripheral giant cell
granuloma (giant cell
epulis)
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5%
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Aggregation of
multinucleated foreign
body-like giant cells
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Separated by
fibroangiomatous stroma.
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Epulis is a clinical
term applied to
swellings at the
gum margin.
Most of them are
granulomas
associated with
chronic gingivitis
A few are true
neoplasms
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Reactive lesions
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Inflammatory lesions
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Oral cancer
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Precancerous lesions (Leukoplakia &
erythroplakia)
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Benign Tumors of Oral Cavity
1.
2.
3.
Viral infection
Fungal infection
Bacterial infection
A - Vincent’s angina
B - Syphilis
C - Oral tuberculosis
4.
5.
Aphthous ulcers (aphthous stomatitis)
Dermatoses
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Inflammation of the mouth (Stomatitis)
Inflammation of the Lips (Cheilitis)
Inflammation of the soft tissues around teeth typically
resulting from inadequate oral hygiene (Gingivitis)
Inflammmation of the tongue (Glossitis).
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Glossitis more commonly applied to the "beefy-red" tongues of
certain deficiency states (e.g.; vitamin B12, and iron,
deficiencies).
Other causes of glossitis: hot and spicy foods, chronic irritation
by excessive smoking, ragged tooth or syphilitic inflammation
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Herpes simplex virus
(usually type 1) infection
causes "cold sores"
The virus infects the mouth in
children.
Most adults have had HSV1
infection, but it remains latent
and produces this small sore:
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During periods of stress
From local trauma
Environmental changes
Cold sores consist of
numerous vesicles and
shallow ulcerations.
Cold sore of lower lip (herpes
labialis)
Sore = abraded or painful area of the
body
 Treatment
 Antipyretics, analgesics, hydration
 Valacyclovir and famciclovir inhibit viral DNA
polymerase – help to suppress and control
symptoms, but does not cure (given for 1 week)
 If catch in the prodrome - 5% acyclovir cream for
1 week has shown to shorten course or
completely abort reactivation altogether
 KEY TO DIAGNOSIS – Clinical + Fluid analysis
(PCR) and/or serology (Elisa, Western Blot)
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Coxackie A virus causes
herpangia
Acute vesiculo-ulcertaive
mucosal lesion
Occurs in epidemics
Affects children
Begins in tonsils, soft palate
& uvula
Painful
Heal spontaneously within
few days
Herpangia
Koplik’s spots are a feature
of measles
Koplik’s spots
Herpangina
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Candida albicans is an oral commensal in 20-40% of
population.
Infection occurs in:
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Infants
Patients on broad spectrum antibiotics, steriod or cytotoxic therapy
Diabetes
Neutropenia
Immunodeficiency (AIDS)
Presents as superficial gray-white inflammatory
membranes comprising fungus in a
fibrinosuppurative exudate.
White exudate can be removed by scraping
Exudate bleeds on removal ?
Erythematous Candidiasis
 Treatment
 Mild, acute forms – topical Nystatin
 Mild, chronic – topical Nystatin +
Clotrimazole troches (troche=lozenge)
 Refractory or immunocomprimised
WITHOUT systemic involvement – add
oral Fluconazole
 Severe forms (systemic) – IV
Amphotericin B with or without
Fluconazole
 KEY TO DIAGNOSIS: Clinical + KOH
Prep; culture and serum (1,3)β-D-glucan
detection assay if unclear
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Caused by Borellia vincenti and
fusiform bacilli
Both are normal inhabitants of
oral cavity
Decreased resistance (inadequate
nutrition, immunofeciency) is a
predisposing factor to infection
Punched out erosions →
ulceration → spreads →
invovles all gingival margin,
which become covered by a
necrotic pseudomembrane
A-Ulcerated chancre
B-Ulcerated mucous
patches (snail track ulcers)
C - Tuberculosis
of
The Tongue
C-Gummatous ulcer
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Apthous ulcers are
extremely common
lesions (up to 20% of
population)
They are painful,
multiple, small, shallow,
recurrent ulcerations
Presented clinically as
white lesions (1<,1> CM)
Etiology is unknown
Aphtha = Whitish spot
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Most common cause of non-traumatic ulcerations of the oral cavity
Etiology unclear
10-20% of general population
Diagnosis of exclusion
Classifications
 Minor aphthous ulcer
- < 1cm in diameter
- Located on freely mobile oral mucosa
- Appears as a well-delineated white lesion with an erythematous halo
- Prodrome of burning or tingling in area prior to ulcer’s appearance
- Resolve in 7-10 days
- Never scars
 Major aphthous ulcer
- > 1cm in diameter
- Involves freely mobile mucosa, tongue, and palate
- Last much longer – 6 weeks or more
- Typically scar upon healing
 Herpetiform ulcers
- Small, 1-3mm in diameter ulcerations appearing in crops of
20-200 ulcers
- Typically located on mobile oral mucosa, tongue, and palate
- Last 1-2 weeks
- Called herpetiform because ulcerations resemble those of
HSV, but there is no vesicular phase
 Treatment
 Topical tetracycline solution for 5-7 days has shown good
results
 Topical steroids shown to shorten disease duration
 Sucralfate suspension shown to improve pain as well as
shorten disease duration
 Major aphthous ulcers or more severe forms of disease
require 2 week course of systemic steroids
 KEY TO DIAGNOSIS: Diagnosis of exclusion; clinical
appearance/course
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Lichen planus
White plaques
whitish linear lesions in lacy pattern
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Reactive lesions
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Inflammatory lesions
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Oral cancer
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Precancerous lesions (Leukoplakia &
erythroplakia)
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Benign Tumors of Oral Cavity
Squamous Cell Carcinoma
constitutes 95% of oral cancers
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Incidence:
Geographic variation:
Accounts for 2% of cancers in
UK
Commoner in S. East Asia
Ages & sex :
Old Men (50-60 years)
• Site :
1.Lip (lower lip)
2.Tongue (anterior ⅔)
3.Mouth floor
4.Tonsil and Fauces
Aetiology:
1-Tobacco and alcohol are the most common
associations:
Smokers can have 15-fold greater risk ( than nonsmokers ) of
malignancy.
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Chewing tobacco and betel nuts are important causes in India and
parts of Asia.
2- Leukoplakia and Erythroplakia
3- Human papilloma virus (HPV) (type16)
4- Genetic factors may also play a role

(deletions in chromosomes 18q, lap, 8p, and 3p are implicated).
5- Exposure to ultra-violet light (cancer of the lip).
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Gross:
 Ulcerated nodule with
raised everted edges
 Often on lower lip
Histologically:
 Well differentiated
squamous carcinomas
Spread:
 Growth is relatively
slow
 Submandibular nodes
 Deeper cervical lymph
nodes
More aggressive than tumors of the lips
 Grossly starts as a nodule → malignant ulcer
 Spread:
1-Local
 Local infiltration to floor of the mouth, facuces
and pharynx leads to fixation the tongue,
interfering with speech and swallowing.
 Local spreads into the medullary cavity of the
mandible.
2-lymphatic spread (occurs early) → deep
cervical lymph nodes.
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Perform incisional Bx in any oral lesion persist for more than 2wks
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Prognosis is best with lip lesions
Poorest with mouth floor and tongue base
lesions (20%-30% 5-year survival rate ).
Acute Leukemia: gum involvement
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Malignant melanoma
Lymphomas
Leukemic infiltration
Adenocarcinoma of
minor salivary glands
Sarcomas
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Reactive lesions

Inflammatory lesions

Oral cancer

Precancerous lesions (Leukoplakia &
erythroplakia)

Benign Tumors of Oral Cavity

Premalignant lesions
○ Leukoplakia
 Whitish plaque that cannot be scrapped off
 5-20% malignant potential
 Microscopic examination reveals hyperkeratosis and
atypia
 Lesions on lateral tongue, lower lip, and floor of mouth
more likely to progress to malignancy
○ Erythroplakia
 Red patch or macule with soft, velvety texture
 Much higher chance of harboring malignancy – 60-90% of
untreated cases
 Treatment is surgical excision or laser ablation
Causes include:
1- Chronic tobacco
use (pipe smoking).
2- Chronic irritation
(e.g.; dentures).
2- Alcohol abuse.
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An oral lesion seen in
HIV infected, AIDS
patients
Caused by EpsteinBarr virus (EBV)
infection, often with
superimposed
candida
Lesions are white
patches of fluffy
("hairy")
hyperkeratosis on
tongue lateral borders.
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Reactive lesions

Inflammatory lesions

Oral cancer

Precancerous lesions (Leukoplakia &
erythroplakia)

Benign Tumors of Oral Cavity
Cavernous hemangioma
1-Squamous cell
papilloma.****
2-Capillary hemangioma
3-Cavernous hemangioma
& lymphangioma →
macrochelia &
macroglossia
4-leiomyoma
5-Schwannoma
Bastaninejad, Shahin, MD