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Oral Pathology 1/2/16 > Lec 2: White Lesions > Flashcards

Lec 2: White Lesions Flashcards

1
Q

White Surface Lesions 3 groups

A

Epithelial thickening
Surface debris
Subepithelial lesions

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2
Q

Epithelial thickening

A

Asymptomatic, rough, do not rub off

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3
Q

Surface debris

A

Symptomatic, rub off, underlying erythema

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4
Q

Subepithelial lesions

A

Asymptomatic, smooth to palpation, translucent

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5
Q

Keratinized tissue examples

A

Tongue
Hard Palate
Attached Gingiva
Outer lip (past Vermillion border)

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6
Q

Non-keratinized tissue

A 
Everywhere else that keratinized is not..
Buccal Mucosa
Labial Mucosa
Soft Palate
Floor of Mouth
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7
Q

White sponge nevus aka

A

Familial Epithelial Hyperplasia

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8
Q

White sponge nevus inheritance

A

autosomal dominant

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9
Q

Treatment for white sponge nevus?

A

None

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10
Q

Frictional keratosis

A

White lesion related to chronic rubbing or friction
Presumably a protective effect (~callous on skin)
Anywhere in oral cavity
Careful history taking and examination sufficient for diagnosis
Lesion should resolve or reduce after removal of causative agent
-Otherwise, no treatment necessary

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11
Q

Frictional keratosis usally seen in the

A

retromolar pad

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12
Q

Hairy tongue

A

Represents elongation of filiform papillae

Associated with lack of mechanical abrasion to tongue.

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13
Q

Hairy tongue treatment? prognosis?

A

brush or scrape the tongue

Prognosis: good

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14
Q

Hairy Leukoplakia

A

Epithelial thickening of the lateral surfaces of the tongue.

Present in immunocompromised patients, e.g. HIV/AIDS, transplant patients, et al.

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15
Q

Hairy Leukoplakia treatment? Prognosis?

A

Treatment: None other than to determine immune status of patient.
Prognosis: indicates poorly functioning immune system.

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16
Q

Oral Hairy Leukoplakia

A

Thickened parakeratin

Surface corrugations

Acanthotic epithelium

Superficial “baloon cells”

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17
Q

Leukoedema

A

Common, asymptomatic, variation of normal.

White, opalescent, filmy, folded surface, does not rub off, not rough

Distribution: bilateral buccal mucosa

More common in African Americans vs. more easily recognized in African Americans

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18
Q

Leukoedema-diagnose clinically?

A

white appearance decreases when tissue is stretched

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19
Q

Leukoedema-treatment?

A

no treatment

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20
Q

Erythema migrans aka? commonly seen on? appears? due to?

A

Aka geographic tongue, benign migratory glossitis

Commonly seen on anterior 2/3 of tongue and ventral and lateral surfaces.

Red patches with white border, well-demarcated

Due to atrophy of filiform papillae with elevated white border

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21
Q

Erythema migrans ass. with what sensation?

A

burning sensation

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22
Q

Erythema migrans treatment

A

Treatment is not needed. Topical steroids for symptomatic lesions.

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23
Q

Lichen planus common disease of over sensitivity reaction of?

A

T lymphocytes

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24
Q

Lichenoid Mucositis

A

Reaction to medication
Graft vs. Host Disease
Same clinical and microscopic appearance

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25
Q

Lichen planus mostly affects

A

Middle-aged

females (3:2)>males

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26
Q

Lichen planus 6 P’s of skin features sometimes present

A 
Planar
Purple
Pruritic 
Polygonal
Plaque
Papule
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27
Q

Lesions are _____; most typically _____ on the buccal mucosa

A

multifocal; bilaterally

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28
Q

Lichen planus 2 types of presentation? more common form?

A

Reticular Pattern***

Erosive Pattern

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29
Q

Reticular Pattern

A

Wickham’s stria: white lacy network pattern with underlying erythema
White plaques sometimes present
multifocal lesions

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30
Q

Erosive Pattern

A

Central area of ulceration that is painful
Areas of pseudomembrane centrally may be present
Wickham’s stria may be present
May present as desquamative gingivitis

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31
Q

Erosive lichen planus presents

A

Painful ulcers sometimes present

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32
Q

Lichen Planus-reticular pattern sign

A

Wickham’s straie

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33
Q

Litchen Planus-reticular pattern-mamagement/treatment?

A

White lesions are asymptomatic and are not treated

If burning occurs, treated with topical corticosteroids

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34
Q

Litchen Planus-erosive pattern-management/treatment?

A

Topical corticosteroids
Flare-ups require reapplication of drugs or prophylactic treatment
Severe cases require systemic corticoid therapy

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35
Q

The importance of a thorough history, careful physical examination and clinicopathological correlation is critical-true or false?

A

True

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36
Q

Lichenoid Mucositis reacts to what?

A

amalgam and cinnamon (in gum, seasoning)

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37
Q

Currently, is lichen planus considered a pre-malignant disease aka can it lead to oral cancer?

A

NO

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38
Q

Nicotinic stomatitis presents

A

on hard palate of people who smoke.

Seen mainly in pipe or cigar smokers

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39
Q

Treatment for nicotinic stomatitis

A

No treatment needed

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40
Q

Nicotinic stomatitis has almost no potential (on hard palate) for transformation to squamous cell carcinoma-true or false?

A

true

41
Q

Nicotinic stomatitis response to ____ rather than chemicals

A

heat

42
Q

Reverse smoker’s palate

A

Cigars/cigarettes smoked with lit inside mouth

Pronounced nicotinic stomatitis

43
Q

Reverse smoker’s palate has significant risk of

A

dysplasia or carcinoma

44
Q

Linea alba-caused by?

A

Pressure, frictional irritation or sucking trauma from the facial surfaces of the teeth.

Common alteration of buccal mucsoa

45
Q

Is linea alba usually bilateral and unilateral?

A

usually bilateral

46
Q

Linea alba-treatment?

A

No treatment necessary

47
Q

White linear thickening at the level of the occlusal plane is an example of?

A

Linea alba

48
Q

Morsicatio Buccarum is

A

chronic check chewing

49
Q

Chronic cheek chewing of labial mucosa =

A

morsicatio labiorum

50
Q

Chronic cheek chewing of tongue=

A

morsicatio linguarum

51
Q

Morsicatio Buccarum is usually unilateral or bilateral?

A

bilateral

52
Q

Morsicatio Buccarum treatment?

A

No treatment necessary.

Lateral acrylic shields connected by facial steel wire.

53
Q

Thickened, shredded, areas of white hyperkeratosis describes what?

A

Morsicatio Buccarum

54
Q

a white patch or plaque that cannot be characterized clinically or pathologically as any other disease describes

A

Leukoplakia

55
Q

Leukoplakia is a term that is strictly a _____ and does not imply a specific diagnosis

A

clinical term

56
Q

Lesions that must be excluded before the term “leukoplakia” can be used

A 
White sponge nevus
Frictional keratosis
Hairy tongue and hairy leukoplakia
Leukoedema
Geographic tongue (erythema migrans)
Lichen planus/Lichenoid mucositis
Tobacco pouch hyperkeratosis
Nicotine stomatitis
Morsicatio (chronic chewing on tissue)
57
Q

Clinical Significance of “Leukoplakia”-done by microscopic diagnosis of a biopsy. Microscopic diagnosis will be one of the following:

A

Hyperkeratosis
Epithelial dysplasia
Carcinoma-in-situ
Superficial squamous cell carcinoma

58
Q

Hyperkeratosis

A

a callous; not premalignant; does not need removal

59
Q

Epithelial Dysplasia is

A

Atypical cells confined to the cells of the epithelium

60
Q

Treatment if epithelial dysplasia is considered premalignant for mild, moderate, and severe?

A

Mild usually not removed
Moderate may be removed
Severe must be removed

61
Q

Enlarged nuclei/cells, Increased nuclear-to-cytoplasmic ratio, Hyperchromatic nuclei, Pleomorphic cells, Increased/abnormal mitotic activity are examples of

A

epithelial dysplasia

62
Q

Carcinoma in situ: cancer confined to the _____; will eventually _____; must be ______

A

epithelium, invade, removed

63
Q

Does superficial squamous cell carcinoma need o be removed?

A

Yes

64
Q

Clinically, leukoplakia means

A

white patch/area

65
Q

Why is leukoplakia considered a precancerous or premalignant lesion because

A

the frequency of transformation of all “leukoplakias” into malignancy (~4%) is greater than the risk associated with normal mucosa

66
Q

Most “leukoplakias” are ______ without dysplasia or cancer

A

hyperkeratosis

67
Q

White Surface Debris Lesions

A

Candidosis
Burning
Dentifrice-associated slough

68
Q

Candidosis is a

A

Common opportunistic oral mycotic infection

69
Q

Most common oral fungal infection in humans

A

Candidosis

70
Q

Agent for candidosis

A

Candida albicans

71
Q

British and older term for candidosis

A

British= candidosis

Older term=monoliasis

72
Q

Candidosis is a component of normal oral microflora in what percentage in patients? those older than 60 years old?

A

In 30-50% of patients

Up to 60% in patients older than 60

73
Q

Predisposing factors of candidosis?

A 
Immunodeficiency
Acquired immunosuppression
Endocrine disturbances
Diabetes mellitus
Corticosteroid therapy
Systemic antibiotic therapy
Xerostomia
Poor oral hygiene
74
Q

Pseudomembranous candidosis (thrush) symptoms?

A

White plaques that rub off leaving an erythematous base (can scrape them off)
Pain or burning sensation

75
Q

Thrush associated with?

A

xerostomia, antibiotics and/or decreased host resistance

76
Q

Thrush plaques made of?

A

yeast, hyphae, epithelial cells and debris

77
Q

Chronic Hyperplastic Candidiasis is seen as a?

A

white patch that CANNOT be removed.

Least common form and somewhat controversial

78
Q

Chronic Hyperplastic Candidiasis most common in

A

anterior buccal mucosa

79
Q

Erythematous Candidosis (Red Variations examples)

A

Acute Erythematous Candidosis
Chronic Erythematous Candidosis
Angular Cheilitis
Median Rhomboid Glossitis

80
Q

Candidosis can be confirmed with a

A

cytology smear

81
Q

Topical antifungal medications

A

Nystatin rinse or ointment
Clotrimazole rinse or troches
Ketoconazole cream

82
Q

Systemic antifungal medications

A

Ketoconazole (Nizoral) tablets

Fluconazole (Diflucan) tablets

83
Q

Candidosis can be confused with

A

dried saliva
food debris
superficial sloughing due to sodium lauryl sulfate

84
Q

Dentifrice-assocaited slough symptoms?

A

Painless, grayish-white gelatinous membranes on gingiva, vestibule, floor of mouth and lips

85
Q

Dentifrice-associatged slough most apparent when?

A

immediately upon arising in morning

86
Q

Dentifrice-associated slough associated with?

A

sodium lauryl sulfate (SLS) and pyrophosphates found in some dentifrices and mouthrinses

87
Q

Dentifrice-associated slough resolves by?

A

switching off toothpaste with SLS

88
Q

Chemical injury is

A

Chemicals/drugs come in prolonged contact with oral tissues that may cause pain in area of application

89
Q

Chemical injury examples

A

Children and psychiatric patients may hold medications in mouth

Topical products for mouth pain can compound problem

90
Q

Mucosa develops white, wrinkled appearance. Removal of necrotic epithelium reveals red, bleeding tissue is an example of

A

chemical injury

91
Q

Burn can be caused by?

A

heat, cold, or chemicals

92
Q

Burns appear as a

A

Area of yellow-white epithelial necrosis

93
Q

Subepithelial white spots (3)

A

Congenital cysts
Subepithelial fibrosis (scar)
Fordyce granules

94
Q

Congenital cysts (2)

A
  1. Palatal cysts of the newborn e.g, Bohn’s nodules, Epstein’s pearls
  2. Gingival cysts of the newborn
95
Q

Epstein’s pearls

A

palatal shelves fusing at midline entrap small islands of epithelium

96
Q

Bohn’s nodules

A

Epithelial remnants from minor salivary glands of palate entrapped below the surface

97
Q

Gingival cyst of the newborn

A

Entrapment of dental lamina
Appearance similar to palatal variant
Dental lamina cyst & congenital keratotic cysts
Resolve spontaneously: no treatment

98
Q

SUBEPITHELIAL FIBROSIS(SCAR)

A

Usually poorly defined
Patient usually has a history of injury or surgery
No treatment needed

99
Q

FORDYCE GRANULES represent and present

A

Represent ectopic sebaceous glands

Yellow, granular plaques and nodules present in clusters

Oral Pathology 1/2/16 (11 decks)

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