Leukoplakia and other White lesions

• Alveolar ridge keratosis
• White changes of the retromolar region or the alveolar mucosa where teeth have been extracted.
• Asymptomatic white, homogeneous discolouration of the mucosa
• Caused by direct irritation from foods against the edentulous ridge by opposing teeth
• Benign lesion. If believed to be alveolar ridge keratosis then no treatment other than follow up
• Aspirin burn
• Superficial burning of the oral mucosa due to the local application of aspirin or paracetamol.
• White, non wipeable discolouration of the mucobuccal fold, buccal mucosa or border of the tongue
• Cease drug, Should heal the lesion within a week or two
• Contact lesion
• Benign whitish, sometimes erythematous or mixed red and white lesion due to chronic, direct contact with a dental restoration (Usually amalgam)
• Diagnosis by removal or the amalgam restoration and replacement. Should result in resolution of the lesion within 2-3 months
• Usually buccal mucosa and borders of the tongue
• Frictional lesion (Frictional keratosis)
• Benign white lesions that is caused by mechanical irritation or friction
• Border of the tongue due to broken tooth or restoration or alveolar mucosa due to toothbrushing or mastication on the oral mucosa
• Homogeneous flat white lesion of the attached gingiva often present in all four quadrants
• Remove causative factor, regression within a few months. Complete disappearance is rare
• Leukedema
• Benign whitish lesion of the oral mucosa
• Tobacco is the main contributing factor
• Rare, mainly adults, often dark skinned
• Veil like, bilateral on buccal mucosa, asymptomatic
• Smoking cessation, may or may not regress
• Leukoplakia
• Clinival diagnosis, white lesions that can't be recognised as any other well defined lesion or condition
• Premalignant 2-3% annually, higher in females, non smoker, >200mm^2, FOM or tongue
• Smokers
• Pain or itching is ominous and may indicate the presence of SCC
• Homogeneous: Uniform flat, thin and white, usually asymptomatic
• Non Homogeneous: Nodular or flat with a mixed white and red discolouration, often burning sensation especially erythroleukoplakia
• Biopsy should be taken every time symptoms are present. In asymptomatic leukoplakias, cease etiologic factors e.g smoking. Wait 6-8 weeks. If unchanged, one or more biopsies should be taken. 
• Lichen planus
• May occur along with other mucosas e.g vaginal
• Reticular: White striae (Whickham's striae)
• Erythematous: Most likely to cause symptoms i.e pain and bleeding (in gingival involvement)
• Plaque type (Resembles leukoplakia)
• Ulcerative
• Bullous 
• Almost always bilateral, close to symmetrical distribution, Patient usually can't tolerate spicy foods
• Buccal mucosa, gingiva, dorsal tongue. FOM and palate is rare. Gingival involvement should consider vulvovaginal gingiva syndrome
• Characterised by remissions and exacerbations with intervals of several weeks or months of both signs and symptoms
• Many years to lifelong disease. No cure for OLP. Management with corticosteroids.
• Lichenoid lesions
• May be caused by direct anatomic contact with a large amalgam restoration or induced by certain drugs. Drug induced mucosal lesions are much rarer than cutaneous lesions.
• May occur in graft vs host disease
• sometimes difficult to distinguish from leukoplasia, Lupus erythematodes, linear IgA disease, MMP
• Lichen sclerosus
• Flat, pale or whitish changes of the skin and mucosa esp vulva
• Rare involvement of oral mucosa
• Upper or lower lip and rarely tongue or corners of the mouth
• No cure, may regress spontaneously
• Linea Alba
• Benign whitish line on the buccal mucosa at the line of occlusion
• Always bilateral, asymptomatic
• Lupus erythematodes, discoid type
• Scaly, erythematous patches of the skin, mucosa (mainly buccal mucosa and palate)
• May occur in children, more common in women
• Oral lesions may have a lichenoid appearance or present as tiny reddish nodules esp on palate. Often painful and bilateral 
• Topical corticosteroids
• Morsicatio
• Benign whitish-yellowish scaly lesion of the oral mucosa caused by habitual biting or chewing. Asymptomatic
• Common, adults
• Almost always bilateral, may occur on the buccal mucosa but also on the borders of the tongue and lips
• No treatment, cease habit, bruxism splint
• White sponge nevus
• Benign, heretitary
• Rare, manifests during childhood
• White, thickened buccal mucosa and border of tongue, usually bilateral.
• No treatment or followup