Exam 2 - White Lesions Flashcards
Why does an oral lesion look white?
1. ______ in the tissues
2. Necrosis - variable thickness; +/- removable
3. _______ __________ (Bacteria/Candida) - removable
4. Keratin - either more or a change in type
- Edema in the tissues
- Necrosis - variable thickness; +/- removable
- Superficial Coating
(Bacteria/Candida) - removable - Keratin - either more or a change in type
T/F Parakeratin has no nuclei in it.
False - Parakeratin has nuclei in it.
T/F Orhtokeratin has no nuclei in it.
True
In the mouth what is the keratinized tissue?
Palate and Gingiva
What type of keratin is the palate and gingiva made up of?
Orthokeratin - NO Nuclei
T/F When their is disease you may see orthokeratin become parakeratin.
True. Example immoveable mucosa (palate and gingiva) become parakeratinized.
Ex. orthokeratin appears on moveable mucosa.
Why does an oral lesion look white?
1. ______ in the tissues
2. _______ - variable thickness; +/- removable
3. Superficial Coating (Bacteria/Candida) - removable
4. _______- - either more or a change in type
- Edema in the tissues
- Necrosis - variable thickness; +/- removable
- Superficial Coating
(Bacteria/Candida) - removable - Keratin - either more or a change in type
White Lesions: Edema
1. ______ - Buccal Mucosae
Leukodema
White Lesions: Extrinsic Coating —> +/- removable
1. Coated and hairy tongue
2. Plaque
3. Candida - burning irritating sensation can also be red
White Lesion: Thermal or Chemical Injury —> Leads to cauterized or superficial sloughed epithelium +/- removable
1. Tooth paste, mouthwash
Dentifrice-Associated Slough
Keratin increased and/or epithelial thickening —> NON-removable
1. Frictional keratosis-linea alba, tongue/cheek chewing, alveolar ridge
2. Nicotine stomatitis
3. Hairy leukoplakia- immunosuppression
4. Smokeless tobacco keratosis
5. Leukoplakia
Name the lesion:
“White line”
Non-removable, white line along the occlusal plane (middle buccal mucosa)
Linea Alba
T/F Linea alba is removable.
False
What is linea alba caused by?
chronic, low-grade, frictional trauma from teeth
How do you tx linea alba?
No tx- unless mouth guard/bite guard to protect tissue from teeth but no need to biopsy
Leukoedema Demographics
African American and Smokers
Name the Lesion:
Asymptomatic
Non-removable, opalescent/pale white appearance of the buccal mucosa that diminishes when stretched.
Often Bilateral
Leukoedema
T/F Leukoedema is asymptomatic.
True
How do you treat Leukoedema?
Recognize no tx
Describe coated tongue.
Thickened layer of keratin.
Thought to be from when changes in diet, but not usually something to worry about.
Very common white coating on the dorsal tongue.
May have malodor.
Can be misdiagnosed as candidiasis.
Not elevated.
Name the Lesion:
Elongated, discolored, filiform, papillae.
Discoloration (brown, black, green, yellow) due to bacteria, food stains, tobacco.
Asymptomatic or gagging if long. Bad taste.
Elevated.
Hairy Tongue
How do you tx a coated tongue?
Scrape tongue to get off some of the keratin
DO NOT PRESCRIBE ANTIFUNGALS
T/F Hairy tongue is associated with smoking.
True
How do you tx hairy tongue?
Brush tongue and stop smoking to reduce lesions
Name the lesion:
Necrosis of the very superficial parakeratin layer that sloughs .
Dentifrice-Associated Slough
Name the lesion: Common, often related to tartar control, whitening, sensitivity-control, multi-care toothpaste or overuse of mouthwash
Mild peeling, sloughing of superficial keratin layers, labial/buccal mucosa and floor of mouth, usually asymptomatic
Dentifrice-Associated Slough
How do you tx Dentifrice-Associated Slough?
Advise pt to get Bland toothpaste formula not
T/F Dentifrice-Associated Slough is usually asymptomatic.
True
Name the lesion
Caused by chronic low grade frictional trauma
Bilateral, White, ragged, non-removable but possibly partially peeling surface texture
Labial and anterior buccal mucosa and lateral tongue
Morsicatio (Cheek/tongue chewing)
Describe the shape Morsicatio (Cheek/tongue chewing) often takes on buccal mucosa.
Kind of V shape broad anteriorly and narrows down towards the back
How to tx Morsicatio (Cheek/tongue chewing)?
Recognize - Need to eliminate source of trauma typically no tx, unless extensive which might require biopsy to exclude premalignant changes
Pt education and possible occlusal guard
How long does it take for tissues to turn over?
2-3 wks
Name the lesion: Callus response from trauma of eating that is confined to the ridge.
Alveolar ridge keratosis
Confined to ridge because the ridge is immovable where as alveolar mucosa is moveable so it just slides over.
T/F Morsicatio is non-removable.
True but can possible peel/flake off
T/F Vast majority of alveolar ridge keratosis have no dysplasia or precancerous change to them.
True - take caution if very red and unilateral/assymetry, erythema, spread off the ridge, or ulceration to warrant biopsy.
Name the lesion: White keratotic change induced by heat of tobacco smoking (ex. Pipe smoking) or hot beverage
Nicotine Stomatitis
T/F Nicotine stomatitis is heat induced.
True
Describe Nicotine stomatitis look.
Posterior hard palate, soft palate
Elevated papules with red center (orifices of minor salivary gland ducts) and white borders
Not precancerous
How to tx Nicotine stomatitis?
Habit cessation then get resolution 1-2 wks following
T/F Nicotine stomatitis is precancerous.
FALSE NOT PRECANCEROUS
Name the lesion: Epstein-Barr Virus (EBV) induced lesion often with superimposed candidiasis
Hairy Leukoplakia
T/F Hairy Leukoplakia is NOT a precancerous lesion.
True
Name the demographic Hairy Leukoplakia is commonly seen in.
Usually HIV infected or other immunocompromised - such as organ transplant suppressed immune system; RARE in a healthy pt
What white benign lesion has this description Non-removable white plaque/s of the lateral tongue
Faint vertical strands to thick furrowing with shaggy keratotic surface?
Hairy Leukoplakia
How do you tx Hairy Leukoplakia?
Usually resolves with control of HIV infection or reduce immunosuppressive meds
Histology of Hairy Leukoplakia:
Thick, irregular _________ filled with pseudohyphae (elongated) and ______ form
Hyperplastic (thicker) epithelium with “______ ________” that show EBV by situ hybridization
_______ infection common
No dysplasia
Minimal inflammation
Thick, irregular parakeratin filled with pseudohyphae (elongated) and yeast form
Hyperplastic (thicker) epithelium
with “balloon cells” that show EBV
by situ hybridization,
Candida infection common
No dysplasia
Minimal inflammation
Name the lesion based on this histology:
Hyperplastic (thicker) epithelium
with “balloon cells” that show EBV
by situ hybridization
Parakeratin filled with pseudohyphae (elongated) and yeast form
No dysplasia and minimal inflammation
Hairy Leukoplakia
T/F Balloon cells in hairy leukoplakia contain EBV.
True
