Summary
Definition
History and exam
Key diagnostic factors
- presence of risk factors
- homogeneous white plaques
- other causes for white lesions excluded
- non-homogeneous appearance
Other diagnostic factors
- male sex
- age >40 years
Risk factors
- tobacco use
- alcohol use
- betel use
- chronic candidiasis
- genetic predisposition
- immunosuppression
- Fanconi's anaemia
- sunlight exposure
- HPV infection
- Treponema pallidum infection (syphilis)
Diagnostic investigations
1st investigations to order
- incisional biopsy
Investigations to consider
- brush biopsy
- autoantibodies for ANA, double-stranded DNA, and Smith antigen
- Treponema pallidum serology
Emerging tests
- chemiluminescent spectroscopy
- molecular and chromosomal markers
Treatment algorithm
all patients
Contributors
Authors
James Sciubba, DMD, PhD
Consultant
Milton J. Dance Jr. Head and Neck Cancer Center
Greater Baltimore Medical Center
Baltimore
MD
Disclosures
JS declares that he has no competing interests.
Acknowledgements
We would like to gratefully acknowledge the late Dr Crispian Scully for his contribution to this topic.
Peer reviewers
Finn Praetorius, DDS
Oral Pathologist
Department of Oral Pathology
School of Dentistry
University of Copenhagen
Copenhagen
Denmark
Disclosures
FP declares that he has no competing interests.
Isaac Van der Waal, DDS, PhD
Professor and Head
Department of Oral and Maxillofacial Surgery/Oral Pathology
Vrije Universiteit Medical Center
Amsterdam
The Netherlands
Disclosures
IVdW declares that he has no competing interests.
Michaell Huber, DDS
Associate Professor
Head
Division of Oral Medicine
Department of Dental Diagnostic Science
Dental School
University of Texas Health Science Center
San Antonio
TX
Disclosures
MH declares that he has no competing interests.
Differentials
- Oral squamous cell carcinoma
- Chronic candidiasis
- Submucosal fibrosis
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