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Common disorders of the oral cavity include inflammatory, infective, autoimmune, nutritional, traumatic and neoplastic conditions affecting the oral mucosa, gingiva, tongue, palate and lips.
Oral ulcers
Pain
Burning sensation
White patches
Red patches
Swelling
Dysphagia
Halitosis
Bleeding
Ulcer
Pain
Burning sensation
Swelling
Difficulty swallowing
Difficulty speaking
Duration
Recurrence
Progression
Fever
Weight loss
Trauma
Tobacco
Smoking
Alcohol
Betel nut chewing
Poor oral hygiene
Immunosuppression
NSAIDs
Chemotherapy
Antiepileptics
Steroids
Diabetes mellitus
HIV infection
Tuberculosis
Autoimmune disorders
Hematological disorders
Assess:
Site
Number
Shape
Size
Surface
Colour
Margins
Assess:
Tenderness
Induration
Consistency
Mobility
Evaluate:
Cervical lymphadenopathy
Neck masses
Stomatitis
Aphthous ulcers
Herpetic gingivostomatitis
Oral candidiasis
Vincent's angina
Tuberculosis
Syphilis
Pemphigus vulgaris
Mucous membrane pemphigoid
Behçet disease
Glossitis
Angular cheilitis
Leukoplakia
Erythroplakia
Oral submucous fibrosis
Stomatitis refers to inflammation of the oral mucosa.
Viral
Bacterial
Fungal
Burns
Mechanical injury
Food allergy
Drug allergy
Painful oral mucosa
Erythema
Edema
Ulcers
Dysphagia
Excess salivation
Chronic irritation
Nutritional deficiency
Autoimmune disease
Tobacco
Alcohol
Persistent soreness
Burning sensation
Recurrent ulceration
Mucosal atrophy
HSV
Candida
Streptococci
Iron deficiency
Vitamin B12 deficiency
Folate deficiency
Methotrexate
Chemotherapy
NSAIDs
Pemphigus vulgaris
Behçet disease
Lupus erythematosus
Diabetes mellitus
HIV infection
Leukemia
✅ Oral hygiene
✅ Adequate hydration
✅ Soft diet
Topical anesthetics
Antiseptic mouthwash
Antifungals
Antivirals
Antibiotics
Nutritional supplementation
Recurrent Aphthous Stomatitis (RAS) is a chronic recurrent disorder characterized by painful recurrent oral ulcers occurring in otherwise healthy individuals.
⭐ Most common ulcerative disease of oral cavity.
Associated factors:
Genetic predisposition
Stress
Trauma
Nutritional deficiency
Iron deficiency
Folate deficiency
Vitamin B12 deficiency
Hormonal factors
Food hypersensitivity
Immunological factors
⭐ Most common type
< 1 cm diameter
Single or multiple
Heals within 7–14 days
No scar formation
Buccal mucosa
Labial mucosa
Floor of mouth
1 cm diameter
Deep ulcers
Severe pain
Heal in weeks to months
Scar formation present
Multiple tiny ulcers
Numerous lesions
May coalesce
Very painful
⚠️ Not caused by herpes virus.
Round or oval
Yellow-grey floor
Erythematous halo
Painful
Associated symptoms:
Difficulty eating
Burning sensation
Herpetic ulcers
Traumatic ulcers
Tuberculous ulcers
Syphilitic ulcers
Oral cancer
Behçet disease
Triamcinolone oral paste
Benzydamine mouthwash
Chlorhexidine mouthwash
Oral corticosteroids
Colchicine
Dapsone
Thalidomide
🦠 Herpes Simplex Virus Type 1 (HSV-1)
Usually primary infection in children.
Fever
Malaise
Irritability
Diffuse gingivitis
Painful vesicles
Vesicles rupture forming ulcers
Gingiva
Tongue
Buccal mucosa
Palate
Usually clinical.
Tzanck smear
PCR
Viral culture
Hydration
Soft diet
Analgesics
💊 Acyclovir
⭐ Most effective if started within 72 hours.
Reactivation of latent HSV infection.
➡️ Commonly known as Cold Sore
Fever
Stress
Sunlight exposure
Immunosuppression
Burning sensation
Tingling
Vesicles on lip
Crusting
📍 Usually affects vermilion border.
Acyclovir cream
Acyclovir
Valacyclovir
Famciclovir
🦠 Candida albicans
Most common opportunistic fungal infection of oral cavity.
HIV infection
Diabetes mellitus
Denture use
Steroid therapy
Broad-spectrum antibiotics
Malnutrition
Xerostomia
White curd-like plaques
Easily scraped off
Leaves erythematous base
Painful red mucosa
Burning sensation
Often follows antibiotic use.
Persistent white plaques
Cannot be scraped off
⚠️ Premalignant potential.
(Denture Stomatitis)
Erythema beneath denture
Fissuring at mouth angles
Pain
Erythema
Clinical diagnosis
KOH mount
Gram stain
Culture
Nystatin suspension
Clotrimazole
Fluconazole
Itraconazole
✅ Correct predisposing factors.
Acute Necrotizing Ulcerative Gingivitis (ANUG)
Also called:
Trench mouth
Vincent infection
🦠 Fusobacterium species
🦠 Borrelia vincentii (Spirochetes)
Poor oral hygiene
Smoking
Malnutrition
Stress
Immunosuppression
Severe gum pain
Halitosis
Fever
Necrotic gingiva
Bleeding gums
Grey pseudomembrane
Ulcerated interdental papillae
Debridement
Oral hygiene
Chlorhexidine
Hydrogen peroxide gargles
💊 Metronidazole
💊 Penicillin
🦠 Mycobacterium tuberculosis
More common in children
Associated with cervical lymphadenopathy
More common
Usually secondary to pulmonary TB
Chronic
Painful
Irregular margins
Undermined edges
Tongue
Palate
Gingiva
Oral cancer
Syphilis
Traumatic ulcer
Aphthous ulcer
Biopsy
Ziehl-Neelsen stain
GeneXpert
Chest X-ray
Sputum examination
💊 Isoniazid
💊 Rifampicin
💊 Pyrazinamide
💊 Ethambutol
🦠 Treponema pallidum
Features:
Painless ulcer
Indurated base
Regional lymphadenopathy
Lip
Tongue
Tonsil
Grey-white plaques
Highly infectious
Seen at oral commissures.
Granulomatous lesion
Destructive ulcer
May involve:
Tongue
Palate
⚠️ Can cause palatal perforation.
Primary lesion.
VDRL
RPR
TPHA
FTA-ABS
💊 Benzathine Penicillin G
Doxycycline
Tetracycline
⭐ Most common oral ulcer → Recurrent aphthous ulcer
⭐ Most common type of aphthous ulcer → Minor aphthous ulcer
⭐ Herpetiform ulcers are NOT caused by herpes virus
⭐ Herpetic gingivostomatitis → HSV-1
⭐ Recurrent herpes labialis = Cold sore
⭐ Oral thrush → Candida albicans
⭐ Scrapeable white plaques → Pseudomembranous candidiasis
⭐ Vincent's angina → Fusospirochetal infection
⭐ Trench mouth = ANUG
⭐ Chronic ulcer with undermined edge → Tuberculosis
⭐ Oral chancre = Primary syphilis
⭐ Mucous patches = Secondary syphilis
⭐ Gumma = Tertiary syphilis
⭐ Drug of choice for syphilis → Benzathine Penicillin G
Oral lesions are among the earliest and most common manifestations of HIV infection.
They may:
Be the first sign of HIV
Indicate disease progression
Suggest severe immunosuppression
Predict AIDS development
Oral candidiasis
Angular cheilitis
Oral hairy leukoplakia
Recurrent herpes simplex
Herpes zoster
HPV-associated lesions
Linear gingival erythema
Necrotizing ulcerative gingivitis
Necrotizing periodontitis
Kaposi sarcoma
Non-Hodgkin lymphoma
Aphthous ulcers
HIV-associated oral ulcers
Most common oral manifestation of HIV.
White curdy plaques
Easily scraped off
Burning sensation
Dysphagia if esophageal involvement
May indicate:
Falling CD4 count
Disease progression
Strongly associated with HIV infection.
Usually seen in:
Advanced HIV
AIDS patients
Associated with:
🦠 Human Herpes Virus-8 (HHV-8)
Purple
Red
Brown nodules or plaques
Common sites:
Hard palate
Gingiva
Tongue
AIDS-defining illness.
Characteristics:
Large
Deep
Painful
Persistent
May interfere with:
Eating
Speech
Swallowing
Oral hairy leukoplakia is a white corrugated lesion occurring predominantly in immunocompromised individuals.
Most commonly associated with HIV infection.
Caused by:
🦠 Epstein-Barr Virus (EBV)
EBV infects:
Oral epithelial cells
Occurs mainly when:
Cellular immunity is impaired
Most commonly:
📍 Lateral border of tongue
May involve:
Dorsum of tongue
Buccal mucosa
White plaques
Vertical folds
Corrugated surface
Hair-like projections
⚠️ Cannot be scraped off
(Unlike candidiasis)
Usually asymptomatic.
Sometimes:
Mild discomfort
Rough sensation
Suggests:
HIV infection
Immunosuppression
Falling CD4 count
May be one of the earliest indicators of AIDS.
Antiretroviral therapy (ART)
Acyclovir
Valacyclovir
Recurrence common.
Leukoplakia is a white patch or plaque that cannot be characterized clinically or histopathologically as any other disease.
⭐ Most important risk factor
Smoking
Tobacco chewing
Acts synergistically with tobacco.
Sharp teeth
Ill-fitting dentures
Vitamin A deficiency
HPV
Buccal mucosa
Commissures
Tongue
Floor of mouth
Features:
Uniform white plaque
Smooth surface
Lowest malignant potential.
Features:
Irregular surface
Nodular
Verrucous
Speckled appearance
Higher malignant potential.
Most aggressive form.
Highest malignant transformation rate.
May show:
↓
↓
↓
Overall risk:
⭐ Approximately 3–20%
Higher risk in:
Non-homogeneous lesions
Floor of mouth lesions
Tongue lesions
Female patients
Long-standing lesions
Stop tobacco
Stop alcohol
Antioxidants
Retinoids
Excision
Laser ablation
Cryotherapy
Lifelong surveillance required.
Most common premalignant lesion of oral cavity → Leukoplakia
Erythroplakia is a persistent red patch that cannot be clinically or histologically attributed to another disease.
Bright red patch
Velvety surface
Well-demarcated margins
Floor of mouth
Soft palate
Ventral tongue
Usually asymptomatic.
May cause:
Burning sensation
Mild pain
Majority show:
Severe dysplasia
Carcinoma in situ
Early invasive carcinoma
⚠️ Highest malignant potential among oral premalignant lesions.
Risk:
⭐ 50–90%
Required in every case.
Preferred treatment.
Long-term surveillance required.
Most dangerous premalignant lesion of oral cavity → Erythroplakia
A chronic progressive premalignant disorder characterized by fibrosis of oral mucosa leading to stiffness and restricted mouth opening.
⭐ Most important cause
Tobacco
Chillies
Nutritional deficiency
Iron deficiency
Genetic factors
Arecoline stimulates:
⬆ Collagen synthesis
⬇ Collagen degradation
↓
Progressive fibrosis
↓
Reduced mouth opening
↓
Premalignant change
Burning sensation
Blanched mucosa
Fibrous bands
Reduced mouth opening
Severe trismus
Restricted tongue movement
OSMF with dysplasia or carcinoma
Burning sensation
Intolerance to spicy food
Difficulty opening mouth
Pale blanched mucosa
Fibrous bands
Reduced cheek flexibility
Restricted tongue protrusion
🚫 Stop areca nut
🚫 Stop tobacco
Antioxidants
Iron supplements
Intralesional steroids
Hyaluronidase injections
Mouth-opening exercises
For severe trismus:
Fibrotomy
Coronoidectomy
Reconstruction
Most important cause of OSMF → Areca nut chewing
A chronic inflammatory mucocutaneous disorder affecting skin and oral mucosa.
Exact cause unknown.
Associated factors:
Autoimmune mechanisms
Stress
Hepatitis C infection
Drug reactions
⭐ Most common type
Most symptomatic type.
Rare.
Characteristic:
⭐ Wickham's striae
(Network of white lacy lines)
Common site:
Buccal mucosa
Features:
Painful erosions
Burning sensation
Ulceration
Burning sensation
Pain while eating
Oral discomfort
Hyperkeratosis
Saw-tooth rete ridges
Basal cell degeneration
Band-like lymphocytic infiltrate
Observation
Regular follow-up
⭐ First-line treatment
Examples:
Triamcinolone
Clobetasol
Systemic corticosteroids
Tacrolimus
Cyclosporine
Low but definite risk of malignant transformation.
Regular follow-up is essential.
⭐ Most common oral manifestation of HIV → Oral candidiasis
⭐ Oral hairy leukoplakia is caused by → Epstein-Barr Virus (EBV)
⭐ Oral hairy leukoplakia commonly affects → Lateral border of tongue
⭐ Oral hairy leukoplakia cannot be scraped off
⭐ AIDS-defining oral malignancy → Kaposi sarcoma
⭐ Most common premalignant lesion → Leukoplakia
⭐ Most dangerous premalignant lesion → Erythroplakia
⭐ Most important cause of leukoplakia → Tobacco
⭐ Highest malignant transformation rate → Proliferative verrucous leukoplakia
⭐ Most important cause of OSMF → Areca nut chewing
⭐ Classical feature of OSMF → Progressive trismus
⭐ Reticular lichen planus shows → Wickham's striae
⭐ Histology of lichen planus shows → Saw-tooth rete ridges
⭐ First-line treatment of symptomatic oral lichen planus → Topical corticosteroids
Smoker's palate (Nicotinic stomatitis) is a benign reactive lesion of the palate caused by chronic exposure to heat from smoking.
🚬 Cigarette smoking
🚬 Cigar smoking
🚬 Pipe smoking
🔥 Reverse smoking (common in some populations)
Produces maximum palatal heat damage.
Heat exposure causes:
→ Palatal epithelial hyperkeratosis
→ Inflammation of minor salivary gland ducts
→ Keratotic changes
📍 Hard palate
Diffuse grey-white palatal mucosa
Multiple elevated papules
Central red dots represent inflamed salivary gland openings
⭐ White palate with red punctate spots
Hyperkeratosis
Acanthosis
Squamous metaplasia of salivary ducts
🚫 Stop smoking
Most lesions regress within weeks to months.
Biopsy if suspicious
Rule out dysplasia
A chronic autoimmune blistering disorder characterized by intraepithelial bullae formation.
Autoantibodies against:
Desmoglein 1
Desmoglein 3
⭐ Often first manifestation
Fragile bullae
Painful erosions
Non-healing ulcers
Buccal mucosa
Palate
Tongue
⭐ Positive
Pressure on normal mucosa causes epithelial separation.
Suprabasal cleft
Acantholysis
Tzanck cells
Systemic corticosteroids
Azathioprine
Mycophenolate mofetil
Rituximab
Chronic autoimmune subepithelial blistering disorder.
Tense bullae
Gingival involvement common
Desquamative gingivitis
May be positive.
Subepithelial cleft
Topical steroids
Systemic corticosteroids
Immunosuppressants
Acute immune-mediated mucocutaneous disorder.
HSV infection
Drugs
Infections
⭐ Target lesions
Painful erosions
Hemorrhagic crusting of lips
Remove trigger
Supportive care
Corticosteroids in severe cases
Severe mucocutaneous hypersensitivity reaction.
Commonly drug induced:
Sulfonamides
Anticonvulsants
NSAIDs
Fever
Extensive mucosal ulceration
Oral erosions
Ocular involvement
Skin detachment
🚨 Medical emergency
Hospitalization
Fluid replacement
Wound care
Withdrawal of offending drug
Multisystem inflammatory vasculitic disorder.
⭐ Recurrent oral ulcers
⭐ Genital ulcers
⭐ Uveitis
Multiple aphthous-like ulcers
Recurrent painful lesions
Corticosteroids
Colchicine
Immunosuppressive therapy
Atrophic glossitis
Angular cheilitis
Burning tongue
(Vitamin B12 Deficiency)
Beefy red tongue
Glossitis
Burning sensation
Glossitis
Angular cheilitis
Mucositis
Oral candidiasis
Xerostomia
Periodontitis
Delayed wound healing
Gingival enlargement
Bleeding gums
Petechiae
Ulcers
Secondary infections
Glossitis
Mucositis
Angular cheilitis
Recurrent ulcers
Sharp teeth
Dentures
Accidental biting
Solitary painful ulcer
Irregular margins
History of trauma
Remove source of trauma
Topical anesthetics
Oral hygiene
Aspirin burn
Phenol
Silver nitrate
White necrotic mucosa
Pain
Ulceration
Remove causative agent
Symptomatic treatment
🔥 Hot food
🔥 Hot beverages
Erythema
Ulceration
Pain
Analgesics
Soft diet
Healing usually spontaneous
(Benign Migratory Glossitis)
Irregular depapillated areas
White serpiginous borders
Lesions change location
⭐ Map-like tongue
Multiple grooves
Deep fissures
Usually asymptomatic
Associated with:
Down syndrome
Melkersson–Rosenthal syndrome
Associated with:
🦠 Candida infection
Rhomboid red patch
Midline dorsum
Anterior to circumvallate papillae
Elongated filiform papillae
Brown or black discoloration
Associated with:
Smoking
Antibiotics
Poor oral hygiene
Smooth tongue
Loss of papillae
Burning sensation
Common Causes:
Iron deficiency
Vitamin B12 deficiency
Folate deficiency
(Tongue Tie)
Short lingual frenulum
Restricted tongue movement
Feeding difficulties
Speech problems
Frenotomy
Frenuloplasty
Mucus-filled cyst caused by rupture of minor salivary gland duct.
📍 Lower lip
Bluish swelling
Soft
Fluctuant
Surgical excision
Mucocele occurring in floor of mouth.
Bluish translucent swelling
Unilateral
Painless
Excision of ranula with sublingual gland
Ranula extending through mylohyoid muscle into neck.
Neck swelling
Floor of mouth swelling
Excision of sublingual gland
Developmental cyst containing skin appendages.
Midline floor of mouth swelling
Doughy consistency
Dysphagia
Speech difficulty
Surgical excision
Cyst lined by squamous epithelium without skin appendages.
Similar to dermoid cyst
Softer consistency
Surgical excision
Associated with:
Ill-fitting dentures
Candida infection
Erythematous mucosa beneath denture
Usually painless
Improve denture hygiene
Antifungals
Denture adjustment
Reactive fibrous hyperplasia due to chronic denture irritation.
Fold of tissue along denture flange
Surgical excision
Denture correction
Associated with:
🦠 HPV 6 and HPV 11
Pedunculated lesion
Cauliflower appearance
Excision
Reactive lesion due to chronic trauma.
Firm nodular swelling
Buccal mucosa common
Excision
Red-blue vascular lesion
Blanches on pressure
Observation
Sclerotherapy
Laser
Surgery
Pebbly surface
Tongue commonly involved
Surgical excision
Reactive vascular proliferation.
Red friable lesion
Bleeds easily
Common in:
Pregnancy
Gingiva
Excision
Eliminate irritants
Conditions associated with increased risk of oral squamous cell carcinoma.
Most common PMD.
Highest malignant potential.
Strongly associated with areca nut chewing.
Particularly erosive type.
Caused by chronic sunlight exposure.
Commonly affects:
📍 Lower lip
Persistent non-scrapable white plaque with dysplastic potential.
⭐ Smoker's palate = Nicotinic stomatitis
⭐ White palate with red dots = Smoker's palate
⭐ Pemphigus vulgaris shows positive Nikolsky sign
⭐ Pemphigoid shows subepithelial cleft
⭐ Pemphigus vulgaris shows suprabasal cleft with acantholysis
⭐ Classical triad of Behçet disease = Oral ulcers + Genital ulcers + Uveitis
⭐ Geographic tongue = Benign migratory glossitis
⭐ Median rhomboid glossitis is associated with Candida
⭐ Most common site of mucocele = Lower lip
⭐ Ranula occurs in floor of mouth
⭐ Plunging ranula extends into neck through mylohyoid
⭐ Dermoid cyst produces doughy midline floor-of-mouth swelling
⭐ HPV 6 and 11 are associated with squamous papilloma
⭐ Pyogenic granuloma bleeds easily
⭐ Most common potentially malignant disorder = Leukoplakia
⭐ Highest malignant potential = Erythroplakia
⭐ Actinic cheilitis commonly affects the lower lip
⭐ Chronic hyperplastic candidiasis is a WHO-recognized potentially malignant disorder.
Oral Squamous Cell Carcinoma (OSCC) is a malignant tumour arising from the stratified squamous epithelium of the oral cavity.
⭐ Accounts for >90% of all oral malignancies.
One of the most common head and neck cancers
High prevalence in South and Southeast Asia
⭐ Among the commonest cancers in males
Major reason:
Tobacco chewing
Areca nut consumption
Forms:
Smoking
Tobacco chewing
Gutkha
Khaini
Pan masala
Strongly associated with:
OSMF
Oral cancer
Acts synergistically with tobacco.
Combined risk increases markedly.
High-risk types:
HPV 16
HPV 18
More important in oropharyngeal cancer but implicated in some oral cancers.
Poor oral hygiene
Chronic trauma
Nutritional deficiencies
Immunosuppression
Previous oral cancer
Leukoplakia
Erythroplakia
OSMF
Lichen planus
Actinic cheilitis
Chronic hyperplastic candidiasis
Non-healing ulcer
Oral pain
Burning sensation
Bleeding
Dysphagia
Odynophagia
Speech difficulty
Weight loss
Most common presentation.
Features:
Everted margins
Indurated base
Contact bleeding
Fungating mass
Irregular surface
Hard indurated swelling
Restricted mobility
May present with:
Cervical lymphadenopathy
Fixed nodal mass
⭐ Most common site in India
⭐ Most common site in Western countries
High-risk site for occult metastasis.
| Stage | Tumour Size |
|---|---|
| T1 | ≤ 2 cm |
| T2 | > 2 cm and ≤ 4 cm |
| T3 | > 4 cm |
| T4a | Invades adjacent structures |
| T4b | Advanced local disease |
| Stage | Description |
|---|---|
| N0 | No node |
| N1 | Single ipsilateral node ≤3 cm |
| N2 | Multiple/large nodes |
| N3 | Node >6 cm or extensive disease |
| Stage | Description |
|---|---|
| M0 | Absent |
| M1 | Present |
Complete oral examination
Neck examination
Preferred for:
Bone involvement
Neck nodes
Better for:
Soft tissue spread
Tongue cancers
Useful for:
Advanced disease
Recurrence
Metastasis
Useful for mandibular invasion.
⭐ Investigation of choice
Used for:
Large lesions
Suspected malignancy
For:
Small lesions
Useful for:
Cervical lymph nodes
Invasive nests of malignant squamous cells
Keratin pearl formation
Intercellular bridges
Cellular atypia
Increased mitosis
Many keratin pearls.
Intermediate features.
Minimal keratinization.
Worst prognosis.
Management is stage dependent.
Wide local excision
Primary closure
Composite resection
Segmental mandibulectomy
Neck dissection
Reconstruction
Aim:
⭐ ≥5 mm clear margin
Used for:
Early lesions
Adjuvant treatment
Inoperable disease
Common Drugs:
Cisplatin
Carboplatin
5-Fluorouracil
Docetaxel
Targets:
⭐ EGFR
Used in:
Recurrent disease
Metastatic disease
Early stage
Small tumour
No nodal disease
Well differentiated tumour
Large tumour
Positive neck nodes
Extracapsular spread
Positive margins
Perineural invasion
Lymphovascular invasion
Poor differentiation
Neck node status is the single most important prognostic factor in oral cancer.
Presence of nodal metastasis:
⭐ Reduces survival by approximately 50%.
Most common route of dissemination.
→ Submental
→ Submandibular
→ Submandibular
→ Deep cervical nodes
→ Submental/Submandibular
First lymph node receiving drainage from primary tumour.
Useful in:
Early oral cancer
Clinically N0 neck
Metastasis bypassing expected nodal stations.
Example:
Level I bypassed and disease appears in Level III.
Tongue carcinoma
| Level | Location |
|---|---|
| I | Submental/Submandibular |
| II | Upper jugular |
| III | Mid jugular |
| IV | Lower jugular |
| V | Posterior triangle |
| VI | Central compartment |
Commonly:
Supraomohyoid neck dissection
Selective neck dissection
or
Radiotherapy
Chemoradiotherapy
Think:
Aphthous ulcer
Herpes
Trauma
ANUG
Think:
Cancer
Tuberculosis
Syphilis
Autoimmune disease
Trauma
Cancer
TB
Syphilis
Aphthous ulcers
Herpes
Behçet disease
Aphthous ulcer
Herpes
Trauma
Syphilis
Early carcinoma
Induration present:
⚠️ Suspect malignancy
HSV
TB
Syphilis
Aphthous ulcer
Pemphigus
Behçet disease
SCC
Mechanical injury
CBC
Blood sugar
Iron studies
Vitamin B12
Biopsy
Serology
TB workup
Most common.
Tobacco use
Duration
Symptoms
Assess:
Site
Size
Surface
Scrapeability
⭐ Gold standard
Required for:
Persistent lesions
Suspicious lesions
KOH mount
Cytology
Histopathology
Denture stomatitis
Glossitis
Erythematous candidiasis
⭐ Erythroplakia
Erosive lichen planus
Pemphigus vulgaris
Hemangioma
| Red Lesion | Key Feature |
|---|---|
| Erythroplakia | Velvety red patch |
| Candidiasis | Burning sensation |
| Hemangioma | Blanches on pressure |
| Glossitis | Smooth red tongue |
| Pemphigus | Bullae and erosions |
Tobacco use
Trauma
Denture use
Symptoms
Assess:
Size
Site
Surface
Bleeding tendency
⭐ Mandatory for erythroplakia
CBC
Iron studies
Vitamin B12
KOH mount
Culture
⭐ Oral SCC accounts for >90% of oral cancers.
⭐ Most common oral cancer site in India → Buccal mucosa
⭐ Most common oral cancer site worldwide → Lateral border of tongue
⭐ Most important risk factor for oral cancer → Tobacco
⭐ Most important prognostic factor in oral cancer → Neck node status
⭐ Investigation of choice for oral cancer → Incisional biopsy
⭐ Histological hallmark of SCC → Keratin pearls
⭐ Sentinel lymph node = first draining node from tumour.
⭐ Skip metastasis is common in tongue carcinoma.
⭐ Chronic ulcer >3 weeks must be considered malignant until proven otherwise.
⭐ Indurated ulcer = carcinoma unless proved otherwise.
⭐ Gold standard investigation for persistent white lesions → Biopsy
⭐ Erythroplakia has the highest malignant potential among red lesions.
⭐ Mandatory biopsy lesion → Erythroplakia
⭐ Positive neck nodes reduce survival by nearly 50%.
⭐ Clear surgical margin in oral SCC → ≥ 5 mm.
| Feature | Minor Aphthous Ulcer | Major Aphthous Ulcer | Herpetiform Ulcer |
|---|---|---|---|
| Other Name | Mikulicz Ulcer | Sutton Disease | Herpetiform Aphthae |
| Size | <1 cm | >1 cm | 1–3 mm |
| Number | Single/Few | Usually Single | Numerous |
| Pain | Moderate | Severe | Severe |
| Healing Time | 7–14 days | Weeks to months | 1–2 weeks |
| Scar Formation | No | Yes | Rare |
| Common Site | Buccal mucosa | Soft palate, fauces | Any oral mucosa |
Most common type → Minor aphthous ulcer
Most severe type → Major aphthous ulcer
Herpetiform ulcers are not caused by HSV
| Lesion | Scrapeable | Malignant Potential |
|---|---|---|
| Oral Candidiasis | Yes | No |
| Leukoplakia | No | Yes |
| Oral Hairy Leukoplakia | No | No |
| Lichen Planus | No | Low |
| Chronic Hyperplastic Candidiasis | No | Yes |
| White Sponge Nevus | No | No |
| Nicotinic Stomatitis | No | Minimal |
Most common premalignant white lesion → Leukoplakia
| Lesion | Clinical Appearance | Malignant Potential |
|---|---|---|
| Erythroplakia | Velvety red patch | Very High |
| Erythematous Candidiasis | Diffuse red area | Low |
| Glossitis | Smooth red tongue | No |
| Denture Stomatitis | Red mucosa under denture | No |
| Erosive Lichen Planus | Red erosive areas | Moderate |
| Hemangioma | Red-blue vascular lesion | No |
Most dangerous red lesion → Erythroplakia
| Type | Clinical Features |
|---|---|
| Acute Pseudomembranous | White curdy plaques, scrapeable |
| Acute Erythematous | Red painful mucosa |
| Chronic Hyperplastic | Non-scrapeable white plaques |
| Chronic Atrophic | Denture stomatitis |
| Angular Cheilitis | Fissuring at mouth angles |
Most common oral fungal infection → Oral candidiasis
| Feature | Pemphigus Vulgaris | Pemphigoid | Erythema Multiforme | SJS |
|---|---|---|---|---|
| Level of Split | Intraepithelial | Subepithelial | Epithelial necrosis | Extensive necrosis |
| Nikolsky Sign | Positive | May be Positive | Negative | Variable |
| Oral Involvement | Common | Common | Common | Severe |
| Skin Lesions | Present | Present | Target lesions | Extensive |
| Severity | Severe | Moderate | Acute | Life-threatening |
Pemphigus → Suprabasal cleft
Pemphigoid → Subepithelial cleft
SJS → Medical emergency
| Lesion | Significance |
|---|---|
| Oral Candidiasis | Most common lesion |
| Oral Hairy Leukoplakia | EBV-related, advanced HIV |
| Kaposi Sarcoma | AIDS-defining illness |
| Recurrent HSV | Immunosuppression |
| Aphthous Ulcers | Severe HIV disease |
| Necrotizing Gingivitis | Advanced immunodeficiency |
Most common oral manifestation of HIV → Oral candidiasis
| Disease | Oral Manifestation |
|---|---|
| Iron Deficiency Anemia | Atrophic glossitis, angular cheilitis |
| Pernicious Anemia | Beefy red tongue |
| Vitamin B Deficiency | Glossitis, cheilitis |
| Diabetes Mellitus | Candidiasis, xerostomia |
| Leukemia | Gingival enlargement, bleeding |
| Malnutrition | Recurrent ulcers |
| Disorder | Major Risk Factor | Malignant Potential |
|---|---|---|
| Leukoplakia | Tobacco | Moderate |
| Erythroplakia | Tobacco | Very High |
| OSMF | Areca Nut | High |
| Lichen Planus | Autoimmune | Low–Moderate |
| Actinic Cheilitis | Sunlight | Moderate |
| Chronic Hyperplastic Candidiasis | Candida | Moderate |
Most common PMD → Leukoplakia
Highest malignant potential → Erythroplakia
| Lesion | Characteristic Feature |
|---|---|
| Geographic Tongue | Migrating depapillated patches |
| Fissured Tongue | Deep grooves |
| Hairy Tongue | Elongated filiform papillae |
| Median Rhomboid Glossitis | Midline red patch |
| Glossitis | Smooth red tongue |
| Ankyloglossia | Short lingual frenulum |
| Tumour | Clinical Features |
|---|---|
| Squamous Papilloma | Cauliflower growth |
| Fibroma | Firm nodular swelling |
| Hemangioma | Red-blue compressible lesion |
| Lymphangioma | Pebbly surface lesion |
| Pyogenic Granuloma | Red lesion that bleeds easily |
| Risk Factor | Importance |
|---|---|
| Tobacco | Most important |
| Areca Nut | Strong association |
| Alcohol | Synergistic with tobacco |
| HPV | Selected cases |
| Poor Oral Hygiene | Contributory |
| Chronic Trauma | Possible role |
Most important risk factor for oral SCC → Tobacco
| Subsite |
|---|
| Lip |
| Buccal Mucosa |
| Gingiva |
| Alveolus |
| Retromolar Trigone |
| Hard Palate |
| Oral Tongue |
| Floor of Mouth |
| Stage | Size |
|---|---|
| T1 | ≤2 cm |
| T2 | >2–4 cm |
| T3 | >4 cm |
| T4a | Moderately advanced disease |
| T4b | Very advanced disease |
| Stage | Description |
|---|---|
| N0 | No node |
| N1 | Single ipsilateral node ≤3 cm |
| N2 | Multiple nodes |
| N3 | Large/extensive nodes |
| Stage | Description |
|---|---|
| M0 | No metastasis |
| M1 | Distant metastasis |
| Level | Location |
|---|---|
| I | Submental/Submandibular |
| II | Upper Jugular |
| III | Mid Jugular |
| IV | Lower Jugular |
| V | Posterior Triangle |
| VI | Central Compartment |
Most important node in oral cancer → Level II (Jugulodigastric node)
| Primary Site | First Echelon Node |
|---|---|
| Lower Lip | Submental |
| Upper Lip | Submandibular |
| Buccal Mucosa | Submandibular |
| Tongue | Deep Cervical |
| Floor of Mouth | Submental/Submandibular |
| Soft Palate | Jugulodigastric |
| Factor |
|---|
| Early Stage |
| Small Tumour |
| Well Differentiated |
| Negative Nodes |
| Clear Margins |
| Factor |
|---|
| Positive Neck Nodes |
| Extracapsular Spread |
| Positive Margins |
| Perineural Invasion |
| Lymphovascular Invasion |
| Poor Differentiation |
Most important prognostic factor → Cervical lymph node status
| Drug | Common Use |
|---|---|
| Nystatin | Oral candidiasis |
| Clotrimazole | Oral candidiasis |
| Fluconazole | Moderate-Severe candidiasis |
| Itraconazole | Resistant disease |
| Amphotericin B | Severe systemic infection |
| Drug | Common Indication |
|---|---|
| Acyclovir | HSV infection |
| Valacyclovir | Recurrent herpes |
| Famciclovir | Recurrent herpes |
| Ganciclovir | CMV infection |
| Drug | Role |
|---|---|
| Triamcinolone Oral Paste | First-line topical therapy |
| Benzydamine Mouthwash | Symptomatic relief |
| Chlorhexidine Mouthwash | Secondary infection prevention |
| Colchicine | Severe recurrent disease |
| Dapsone | Refractory ulcers |
| Thalidomide | Severe resistant ulcers |
| Disorder | Management |
|---|---|
| Leukoplakia | Tobacco cessation + biopsy ± excision |
| Erythroplakia | Mandatory biopsy + excision |
| OSMF | Habit cessation + steroids + physiotherapy |
| Lichen Planus | Topical steroids |
| Actinic Cheilitis | Sun protection ± excision |
| Chronic Hyperplastic Candidiasis | Antifungals + biopsy |
⭐ Most common oral ulcer → Aphthous ulcer
⭐ Most common oral fungal infection → Candidiasis
⭐ Most common oral manifestation of HIV → Oral candidiasis
⭐ Oral hairy leukoplakia → EBV
⭐ Most common premalignant lesion → Leukoplakia
⭐ Most dangerous premalignant lesion → Erythroplakia
⭐ Most important cause of OSMF → Areca nut
⭐ Most common site of mucocele → Lower lip
⭐ Most common oral cancer in India → Buccal mucosa SCC
⭐ Histological hallmark of SCC → Keratin pearl
⭐ Most important prognostic factor in oral cancer → Neck node status
⭐ Most important node in oral cancer → Jugulodigastric node (Level II)
⭐ Drug of choice for oral candidiasis → Nystatin (topical)
⭐ Drug of choice for herpes labialis → Acyclovir
⭐ First-line drug for oral lichen planus → Topical corticosteroids
⭐ Mandatory biopsy lesion → Erythroplakia
Figures
Aphthous ulcer types (Minor, Major, Herpetiform)
Herpetic ulcer
Traumatic ulcer
Figures
Oral ulcer diagnostic algorithm
White lesion diagnostic algorithm
Red lesion diagnostic algorithm
Figures
Oral candidiasis
Angular cheilitis
Median rhomboid glossitis
Figures
Herpetic gingivostomatitis
Herpes labialis
ANUG
Figures
Leukoplakia
Erythroplakia
OSMF
Figures
OSMF pathogenesis
Fibrosis progression
Trismus development
Figures
Lichen planus
Wickham striae
Reticular pattern
Figures
Geographic tongue
Fissured tongue
Hairy tongue
Figures
Mucocele
Ranula
Plunging ranula
Figures
Pemphigus vulgaris
Pemphigoid
Erythema multiforme
Figures
Oral SCC progression
TNM staging
Routes of spread
Figures
Oral cavity subsites
Cervical node levels
Neck metastasis pathways
Aphthous ulcer classification
Oral ulcer diagnostic algorithm
Leukoplakia vs erythroplakia
OSMF pathogenesis and fibrosis progression
Wickham striae in lichen planus
Ranula vs plunging ranula
Pemphigus vulgaris vs pemphigoid
Oral SCC progression and TNM staging
Cervical lymph node levels
Routes of lymphatic spread from oral cavity cancers
Slides
Candida pseudohyphae
Candida budding yeast
PAS stain candidiasis
Slides
HSV multinucleated giant cells
Tzanck smear
Oral hairy leukoplakia
Slides
Fusospirochetal organisms (ANUG)
Tuberculous granuloma
Syphilitic gumma
Slides
Hyperkeratosis
Mild dysplasia
Moderate dysplasia
Slides
Severe dysplasia
Carcinoma in situ
OSMF collagen deposition
Slides
Lichen planus saw-tooth rete pegs
Band-like lymphocytic infiltrate
Basal cell degeneration
Slides
Pemphigus suprabasal cleft
Tzanck cells
Pemphigoid subepithelial split
Slides
Well differentiated SCC
Keratin pearl
Moderately differentiated SCC
Slides
Poorly differentiated SCC
Perineural invasion
Lymphovascular invasion
Slides
Oral melanoma histology
Melanin-containing malignant cells
Invasive mucosal melanoma
Candida pseudohyphae
PAS-positive Candida organisms
HSV multinucleated giant cells
Tzanck smear
Oral hairy leukoplakia
Hyperkeratosis
Mild → Moderate → Severe dysplasia
Carcinoma in situ
OSMF collagen deposition
Lichen planus saw-tooth rete pegs
Pemphigus suprabasal cleft
Acantholytic (Tzanck) cells
Pemphigoid subepithelial split
Well differentiated SCC with keratin pearls
Moderately differentiated SCC
Poorly differentiated SCC
Perineural invasion
Lymphovascular invasion
Oral melanoma histology
Candida → Pseudohyphae + budding yeast, PAS positive.
HSV → Multinucleated giant cells on Tzanck smear.
Pemphigus vulgaris → Suprabasal cleft with acantholysis.
Pemphigoid → Subepithelial split.
Lichen planus → Saw-tooth rete pegs.
OSMF → Dense collagen deposition in subepithelial connective tissue.
Well differentiated SCC → Keratin pearl formation.
Aggressive SCC → Perineural and lymphovascular invasion.
Oral melanoma → Malignant melanocytes containing melanin pigment.
Clinical Photographs
Aphthous ulcer
Major aphthous ulcer
Herpetiform ulcer
Clinical Photographs
Oral candidiasis
Angular cheilitis
Median rhomboid glossitis
Clinical Photographs
Herpetic gingivostomatitis
Herpes labialis
ANUG
Clinical Photographs
Oral tuberculosis
Oral syphilis
Oral hairy leukoplakia
Clinical Photographs
Leukoplakia
Erythroplakia
OSMF
Clinical Photographs
Reticular lichen planus
Erosive lichen planus
Wickham striae
Clinical Photographs
Geographic tongue
Hairy tongue
Fissured tongue
Clinical Photographs
Pemphigus vulgaris
Mucous membrane pemphigoid
Behçet ulcer
Clinical Photographs
Mucocele
Ranula
Plunging ranula
Clinical Photographs
Oral papilloma
Oral fibroma
Oral hemangioma
Clinical Photographs
Early oral SCC
Advanced oral SCC
Cervical nodal metastasis
Aphthous ulcer
Major aphthous ulcer
Herpetiform ulcer
Oral candidiasis
Herpetic gingivostomatitis
Herpes labialis
Oral hairy leukoplakia
Leukoplakia
Erythroplakia
OSMF
Reticular lichen planus
Wickham striae
Erosive lichen planus
Geographic tongue
Hairy tongue
Fissured tongue
Pemphigus vulgaris
Mucous membrane pemphigoid
Behçet ulcer
Mucocele
Ranula
Plunging ranula
Oral papilloma
Oral hemangioma
Early oral SCC
Advanced oral SCC
Cervical nodal metastasis
Leukoplakia → White patch not scrapable and not attributable to another disease.
Erythroplakia → Velvety red lesion with highest malignant potential.
OSMF → Blanched mucosa with fibrous bands and trismus.
Reticular lichen planus → Lace-like Wickham striae.
Pemphigus vulgaris → Painful erosions with positive Nikolsky sign.
Ranula → Bluish translucent swelling in floor of mouth.
Early SCC → Non-healing ulcer or indurated lesion.
Advanced SCC → Ulceroproliferative growth with cervical lymphadenopathy.
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