According to the World Health Organization (WHO), these are morphologically altered tissues where cancer is more likely to occur than in their normal counterparts.
For general dental practitioners, the ability to identify these disorders is critical. Early diagnosis not only facilitates timely treatment but significantly improves the patient's prognosis.
Below, we review the 11 key lesions currently recognized by the WHO as potentially malignant.
1. Leukoplakia
Defined as a white plaque of questionable risk once other specific conditions have been ruled out. It cannot be scraped off and is not clinically or pathologically characterized as any other disease. While it can appear anywhere, it is most frequently found on the buccal mucosa, labial commissures, tongue, and gums.
2. Erythroplakia
This presents as a fiery red patch that cannot be characterized clinically or pathologically as any other definable disease. It often appears as a velvety, asymptomatic red plaque with well-defined borders. Common sites include the floor of the mouth, tongue, soft palate, and tonsillar pillars.
3. Erythroleukoplakia
Considered a non-homogeneous leukoplakia, this lesion exhibits a mixed red and white appearance. It may present as a flat surface with red areas and can be associated with a burning sensation or pain.
4. Oral Lichen Planus
A chronic autoimmune inflammatory disease affecting 0.1% to 2.2% of the population, mostly women aged 30 to 50. It commonly affects the posterior buccal mucosa and vestibule but can also appear on the gingiva and tongue.
5. Actinic Cheilitis
An inflammation of the lips caused by prolonged exposure to ultraviolet (UV) radiation. It predominantly affects the lower lip in fair-skinned men who spend significant time outdoors.
6. Oral Submucous Fibrosis
A chronic, progressive scarring disease associated with the chewing of betel nut, tobacco, and spicy foods. It leads to fibrosis and stiffness in the mucosa, commonly affecting the buccal mucosa, lips, and soft palate.
7. Nicotine Stomatitis (Reverse Smoking)
Associated with the habit of "reverse smoking" (placing the lit end of a cigarette inside the mouth). It manifests as a diffuse whitening of the hard palate, often with a rough, fissured surface and red dots representing inflamed salivary duct openings.
8. Chronic Hyperplastic Candidiasis
Also known as candidal leukoplakia, this fungal infection presents as rough, opaque white plaques or papules on an erythematous background. It is most often found on the buccal mucosa near the commissures.
9. Discoid Lupus Erythematosus
While oral lesions are less common than cutaneous ones, they can appear as annular leukoplakic areas, erythematous erosions, or ulcerations, often accompanied by pain or a burning sensation.
10. Syphilitic Glossitis
Oral manifestations of syphilis can occur at any stage. The classic primary lesion is a painless ulcer with elevated borders (chancre) at the site of inoculation, such as the lips or tongue.
11. Dyskeratosis Congenita
A rare hereditary disorder characterized by reticulated skin hyperpigmentation, nail dystrophy, and oral leukoplakia. Patients may also suffer from premature tooth loss and bone marrow failure.
Conclusion
The early identification of these 11 disorders is a cornerstone of preventive dentistry.
Regular screenings and patient education are essential to prevent malignant transformation.
If you suspect any of these lesions, a biopsy and referral to a specialist are strongly recommended.
