Done by: Dr. Amel Ismael 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 systemic diseases The red color of the lesions may be due to Thin epithelium, inflammation
Dilatation of blood vessels and increased numbers of blood vessels, and extravasation of blood into the oral soft tissues, Increased amount of melanin pigmentation
A hematoma (Bruise) is accumulation of blood cells and fluid(outside of blood vessels.). It is usually caused by trauma an injury to the wall of a blood vessel, prompting blood to seep out of the blood vessel into the surrounding tissues Petechia, which is a small type of hematoma measure less than 3 mm, (<3 mm) Purpura is a Medium type of hematoma measure 3-10 mm, Ecchymosis, which is a large type of hematoma (>1 cm) and echomyosis greater than 1 cm. Hematomas may appear raised, while patches of ecchymosis are flat TRAUMATIC ERYTHEMA OR HEMATOMA Traumatic erythema occurs when a traumatic effect results in hemorrhage within the oral tissue present either as an ecchymosis or as a hematoma. Clinically, it appears as an irregular, usually flat, area with a bright or deep red color. The lips, tongue, and buccal mucosa are the most common areas affected. Treatment: No treatment is required.s. ERYTHROPLAKIA . Definition: is a premalignant lesion occurring on the oral mucosa. It is defined as a red, nonspecific patch or plaque that cannot be classified clinically and pathologically under any other disease Etiology: Unknown Clinical features: It appears as a usually asymptomatic, fiery red, well demarcated plaque, with a smooth and velvety surface. The red lesions may be associated with white spots or small plaques. The floor of the mouth, retromolar area, soft palate, and tongue are the most common sites of involvement Erythroplakia occurs more frequently between the ages of 50 and 70 years. Over 91% of erythroplakias histologically demonstrate severe dysplasia, carcinoma in situ, or early invasive squamous-cell carcinoma at the time of diagnosis Differential diagnosis: Erythematous candidiasis, lichen planus, discoid lupus erythematous, early squamous-cell carcinoma, local irritation Treatment: Surgical excision Radiation Mucosites Definition and etiology: Oral radiation mucositis is a side effect of radiation treatment of head and neck tumors. Clinical features: The oral lesions are classified as early and late. 1. Early reactions may begin at the end of the first week of radiotherapy, and consist of erythema and edema of the oral mucosa. 2. Soon after, ulcers or erosion may develop. covered by awhitish- yellow exudate 3. Xerostomia, loss of taste, burning and pain during mastication. swallowing, and speech are common The diagnosis is made clinically. Differential diagnosis: Mucositis due to chemotherapy, erythema multiforme, herpetic stomatitis, lichen planus. Treatment Supportive Cessation of the radiation treatment, B-complex vitamins, and sometimes low doses of steroids are indicated GEOGRAPHIC TONGUE
Geographic tongue or erythema migraines presents as multiple, well-demarcated
patches of erythema surrounded by a thin, raised, whitish border. D.D. :Erythematous candidiasis, lichen planus, DLE, early S.C.C. local irritation. The diagnosis is made clinically.(Location and appearance). . Differential diagnosis: Candidiasis, lichen planus, psoriasis, Reiter syndrome, syphilitic mucous patches. Treatment: Reassurance of the patient, avoidance soreness and spicy food Thermal Trauma Thermal burn to the oral mucosa are fairly common, usually due to contact with very hot foods, liquids, or hot metal objects Clinical features: Clinically, the condition appears as a red, painful erythema that may undergo desquamation, leaving erosions. The lesions heal spontaneously in about a week. The diagnosis is made exclusively on clinical arounds D.D : Chemical burn, herpes simplex, aphthous ulcers, drug reactions. Treatment: No treatment is required(spontaneous healing) DENTURE STOMATITIS
Denture stomatitis or denture sore mouth is frequent condition in patient who wear denture continuously for extended time Clinical features: The condition is characterized by diffuse erythema, edema, and sometimes petechiae and white spots that represent accumulations of candidal hyphae,papillary hyperplasia,erythema almost always located in the denture bearing area of the maxilla Differential diagnosis: Allergic contact stomatitis due to acrylic Linear Gingival Erythema Definition: It is a relatively uncommon gingival disorder usually following HIV infection. Etiology: The exact etiology remains unclear. However, a close association of the disorder with Candida infection is common. Clinical features: Characteristically, linear gingival erythema appears as a fiery red band (2-4 mm wide) along the margin of the gingiva and a punctate or diffuse erythema of the attached gingival. Gingival bleeding is rare. The lesion does not respond to plaque control measures or root planning and scaling. The diagnosis is mainly based on the history, the clinical features, and laboratory tests for HIV infection. Differential diagnosis: Plaque-related gingivitis, herpetic gingivitis desquamative gingivitis, granulomatous gingivitis, plasma-cell gingivitis, leukemia. Treatment: High level of oral hygiene and plaque control. Systemic antifungals such as itraconazole or fluconazole are usually usefu Contact Allergic Stomatitis Definition it is a rare acute or chronic allergic reaction. Etiology Denture base materials, restorative materials, mouthwashes, dentifrices, chewing gums, foods, and other substances may be responsible. Clinical features: Clinically, in the acute form, the affected mucosa presents with diffuse erythema and edema, and occasionally small vesicles and erosions. A burning sensation is a common symptom. In the chronic form, hyperkeratotic white lesions may be seen in addition to erythema. Differential diagnosis: Denture stomatitis, erythematous candidiasis, erythroplakia, leukoplakia, drug reactions. Treatment: Removal of suspected allergens, topical or systemic steroids, antihistamines EROSIVE LICHEN PLANUS Erosive lichen planus is a destructive Autoimmune disorder causes painful and persistent ulcers. These heal with scarring. It mainly affects adults, particularly women, and is rare in .children SQUAMOUS CELL CARCINOMA Early stage persistent red or white patches, non-healing ulcer, progressive swelling o, unusual surface changes, sudden tooth mobility bleeding Late stage symptoms can include an indurated area, .parasthesia, pain Lupus Erythmatous is a chronic immunologically mediated disease discoid (DLE). .and systemic (SLE)disease D.D. :Lichen planus, geographic glossitis, speckled ..leukoplakia, erythroplakia, cicatricial pemphigoid, syphilis THROMBOCYTOPENIA PURPURA hematological disorder characterized by a decrease in platelets in the peripheral blood. Etiology: Presumably a nonspecific viral infection, myelotoxic agents (destructive to bone marrow) Clinical features: The oral manifestations consist of red lesions in the form of petechiae, ecchymoses, or even hematomas, usually located on the palate and buccal mucosa. Spontaneous gingival bleeding is a constant early finding. Purpuric skin rash, epistaxis, and bleeding from the gastrointestinal and urinary tract are common. Differential diagnosis: Aplastic anemia, leukemias, agranulocytosis, macroglobulinemia, drug reactions. Treatment. Steroids, platelet transfusions, cessation of drug treatment if it is drug- related ANEMIA Pernicious anemia(vitamin B12 deficiency), and iron deficiency anemia usually affect the oral mucosa. The oral manifestations are early and common, and are characterized by an atrophic, smooth and red tongue. A burning sensation, taste loss, angular cheilitis, and rarely erosions may be present. The differential diagnosis includes atrophic lichen planus and malnutrition disorders. The diagnosis is based on hematological laboratory tests
