Exam 2 - White Lesions

Question 1

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

Answer 1

1. Edema in the tissues
2. Necrosis - variable thickness; +/- removable
3. Superficial Coating
   (Bacteria/Candida) - removable
4. Keratin - either more or a change in type

Question 2

T/F Parakeratin has no nuclei in it.

Answer 2

False - Parakeratin has nuclei in it.

Question 3

T/F Orhtokeratin has no nuclei in it.

Answer 3

True

Question 4

In the mouth what is the keratinized tissue?

Answer 4

Palate and Gingiva

Question 5

What type of keratin is the palate and gingiva made up of?

Answer 5

Orthokeratin - NO Nuclei

Question 6

T/F When their is disease you may see orthokeratin become parakeratin.

Answer 6

True. Example immoveable mucosa (palate and gingiva) become parakeratinized.

Ex. orthokeratin appears on moveable mucosa.

Question 7

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

Answer 7

1. Edema in the tissues
2. Necrosis - variable thickness; +/- removable
3. Superficial Coating
   (Bacteria/Candida) - removable
4. Keratin - either more or a change in type

Question 8

White Lesions: Edema
1. ______ - Buccal Mucosae

Answer 8

Leukodema

Question 9

White Lesions: Extrinsic Coating —> +/- removable
1. Coated and hairy tongue
2. Plaque
3. Candida - burning irritating sensation can also be red

Question 10

White Lesion: Thermal or Chemical Injury —> Leads to cauterized or superficial sloughed epithelium +/- removable
1. Tooth paste, mouthwash

Answer 10

Dentifrice-Associated Slough

Question 11

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

Question 12

Name the lesion:
“White line”
Non-removable, white line along the occlusal plane (middle buccal mucosa)

Answer 12

Linea Alba

Question 13

T/F Linea alba is removable.

Answer 13

False

Question 14

What is linea alba caused by?

Answer 14

chronic, low-grade, frictional trauma from teeth

Question 15

How do you tx linea alba?

Answer 15

No tx- unless mouth guard/bite guard to protect tissue from teeth but no need to biopsy

Question 16

Leukoedema Demographics

Answer 16

African American and Smokers

Question 17

Name the Lesion:

Asymptomatic
Non-removable, opalescent/pale white appearance of the buccal mucosa that diminishes when stretched.
Often Bilateral

Answer 17

Leukoedema

Question 18

T/F Leukoedema is asymptomatic.

Answer 18

True

Question 19

How do you treat Leukoedema?

Answer 19

Recognize no tx

Question 20

Describe coated tongue.

Answer 20

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.

Question 21

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.

Answer 21

Hairy Tongue

Question 22

How do you tx a coated tongue?

Answer 22

Scrape tongue to get off some of the keratin

DO NOT PRESCRIBE ANTIFUNGALS

Question 23

T/F Hairy tongue is associated with smoking.

Answer 23

True

Question 24

How do you tx hairy tongue?

Answer 24

Brush tongue and stop smoking to reduce lesions

Question 25

Name the lesion: Necrosis of the very superficial parakeratin layer that sloughs .

Answer 25

Dentifrice-Associated Slough

Question 26

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

Answer 26

Dentifrice-Associated Slough

Question 27

How do you tx Dentifrice-Associated Slough?

Answer 27

Advise pt to get Bland toothpaste formula not

Question 28

T/F Dentifrice-Associated Slough is usually asymptomatic.

Answer 28

True

Question 29

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

Answer 29

Morsicatio (Cheek/tongue chewing)

Question 30

Describe the shape Morsicatio (Cheek/tongue chewing) often takes on buccal mucosa.

Answer 30

Kind of V shape broad anteriorly and narrows down towards the back

Question 31

How to tx Morsicatio (Cheek/tongue chewing)?

Answer 31

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

Question 32

How long does it take for tissues to turn over?

Answer 32

2-3 wks

Question 33

Name the lesion: Callus response from trauma of eating that is confined to the ridge.

Answer 33

Alveolar ridge keratosis Confined to ridge because the ridge is immovable where as alveolar mucosa is moveable so it just slides over.

Question 34

T/F Morsicatio is non-removable.

Answer 34

True but can possible peel/flake off

Question 35

T/F Vast majority of alveolar ridge keratosis have no dysplasia or precancerous change to them.

Answer 35

True - take caution if very red and unilateral/assymetry, erythema, spread off the ridge, or ulceration to warrant biopsy.

Question 36

Name the lesion: White keratotic change induced by heat of tobacco smoking (ex. Pipe smoking) or hot beverage

Answer 36

Nicotine Stomatitis

Question 37

T/F Nicotine stomatitis is heat induced.

Answer 37

True

Question 38

Describe Nicotine stomatitis look.

Answer 38

Posterior hard palate, soft palate Elevated papules with red center (orifices of minor salivary gland ducts) and white borders Not precancerous

Question 39

How to tx Nicotine stomatitis?

Answer 39

Habit cessation then get resolution 1-2 wks following

Question 40

T/F Nicotine stomatitis is precancerous.

Answer 40

FALSE NOT PRECANCEROUS

Question 41

Name the lesion: Epstein-Barr Virus (EBV) induced lesion often with superimposed candidiasis

Answer 41

Hairy Leukoplakia

Question 42

T/F Hairy Leukoplakia is NOT a precancerous lesion.

Answer 42

True

Question 43

Name the demographic Hairy Leukoplakia is commonly seen in.

Answer 43

Usually HIV infected or other immunocompromised - such as organ transplant suppressed immune system; RARE in a healthy pt

Question 44

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?

Answer 44

Hairy Leukoplakia

Question 45

How do you tx Hairy Leukoplakia?

Answer 45

Usually resolves with control of HIV infection or reduce immunosuppressive meds

Question 46

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

Answer 46

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

Question 47

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

Answer 47

Hairy Leukoplakia

Question 47

T/F Balloon cells in hairy leukoplakia contain EBV.

Answer 47

True