A Guide to Clinical Differential Diagnosis of Oral Mucosal Lesions
Surface Debris White Lesions

Course Author(s): Michael W. Finkelstein, DDS, MS

Surface Debris White Lesions

Surface debris white lesions are associated with necrosis of the overlying epithelium. The necrotic epithelium can be removed with a gauze leaving an erythematous or ulcerated base. Surface debris lesions are usually painful.

A burn of oral mucosa can be caused by heat or chemicals. It presents as a painful ulcer covered by a white to yellow surface. Often the patient can provide a history of burn to confirm the diagnosis. A burn will resolve spontaneously.

Fibrin clot* refers to coagulated protein present on the surface of an ulcer. A fibrin clot appears clinically as a tan or yellow surface lesion usually surrounded by an erythematous halo associated with the ulcer. It can be rubbed off. There may be a history of injury or a mucosal disease associated with ulcers. Management should be aimed at treating the cause of the ulcer, as the fibrin clot resolves with the ulcer.
Fibrin clot

Fibrin clot

Candidosis (candidiasis)* is a common cause of oral discomfort. Predisposing factors include immunosuppression, antibiotic therapy, xerostomia and use of dentures. Oral lesions may appear as white plaques, which rub off leaving an erythematous base. Diffuse painful erythematous mucosa is another common presentation. Nail and/or vaginal lesions may also be present. A wide variety of topical and systemic antifungal agents are used for management.
Candidosis (candidiasis)

Candidosis (candidiasis)

To view the Decision Tree for Oral Mucosal Lesions, click on one of the options shown.