Lec 2: White Lesions Flashcards
White Surface Lesions 3 groups
Epithelial thickening
Surface debris
Subepithelial lesions
Epithelial thickening
Asymptomatic, rough, do not rub off
Surface debris
Symptomatic, rub off, underlying erythema
Subepithelial lesions
Asymptomatic, smooth to palpation, translucent
Keratinized tissue examples
Tongue
Hard Palate
Attached Gingiva
Outer lip (past Vermillion border)
Non-keratinized tissue
Everywhere else that keratinized is not.. Buccal Mucosa Labial Mucosa Soft Palate Floor of Mouth
White sponge nevus aka
Familial Epithelial Hyperplasia
White sponge nevus inheritance
autosomal dominant
Treatment for white sponge nevus?
None
Frictional keratosis
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
Frictional keratosis usally seen in the
retromolar pad
Hairy tongue
Represents elongation of filiform papillae
Associated with lack of mechanical abrasion to tongue.
Hairy tongue treatment? prognosis?
brush or scrape the tongue
Prognosis: good
Hairy Leukoplakia
Epithelial thickening of the lateral surfaces of the tongue.
Present in immunocompromised patients, e.g. HIV/AIDS, transplant patients, et al.
Hairy Leukoplakia treatment? Prognosis?
Treatment: None other than to determine immune status of patient.
Prognosis: indicates poorly functioning immune system.
Oral Hairy Leukoplakia
Thickened parakeratin
Surface corrugations
Acanthotic epithelium
Superficial “baloon cells”
Leukoedema
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
Leukoedema-diagnose clinically?
white appearance decreases when tissue is stretched
Leukoedema-treatment?
no treatment
Erythema migrans aka? commonly seen on? appears? due to?
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
Erythema migrans ass. with what sensation?
burning sensation
Erythema migrans treatment
Treatment is not needed. Topical steroids for symptomatic lesions.
Lichen planus common disease of over sensitivity reaction of?
T lymphocytes
Lichenoid Mucositis
Reaction to medication
Graft vs. Host Disease
Same clinical and microscopic appearance
Lichen planus mostly affects
Middle-aged
females (3:2)>males
Lichen planus 6 P’s of skin features sometimes present
Planar Purple Pruritic Polygonal Plaque Papule
Lesions are _____; most typically _____ on the buccal mucosa
multifocal; bilaterally
Lichen planus 2 types of presentation? more common form?
Reticular Pattern***
Erosive Pattern
Reticular Pattern
Wickham’s stria: white lacy network pattern with underlying erythema
White plaques sometimes present
multifocal lesions
Erosive Pattern
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
Erosive lichen planus presents
Painful ulcers sometimes present
Lichen Planus-reticular pattern sign
Wickham’s straie
Litchen Planus-reticular pattern-mamagement/treatment?
White lesions are asymptomatic and are not treated
If burning occurs, treated with topical corticosteroids
Litchen Planus-erosive pattern-management/treatment?
Topical corticosteroids
Flare-ups require reapplication of drugs or prophylactic treatment
Severe cases require systemic corticoid therapy
The importance of a thorough history, careful physical examination and clinicopathological correlation is critical-true or false?
True
Lichenoid Mucositis reacts to what?
amalgam and cinnamon (in gum, seasoning)
Currently, is lichen planus considered a pre-malignant disease aka can it lead to oral cancer?
NO
Nicotinic stomatitis presents
on hard palate of people who smoke.
Seen mainly in pipe or cigar smokers
Treatment for nicotinic stomatitis
No treatment needed
Nicotinic stomatitis has almost no potential (on hard palate) for transformation to squamous cell carcinoma-true or false?
true
Nicotinic stomatitis response to ____ rather than chemicals
heat
Reverse smoker’s palate
Cigars/cigarettes smoked with lit inside mouth
Pronounced nicotinic stomatitis
Reverse smoker’s palate has significant risk of
dysplasia or carcinoma
Linea alba-caused by?
Pressure, frictional irritation or sucking trauma from the facial surfaces of the teeth.
Common alteration of buccal mucsoa
Is linea alba usually bilateral and unilateral?
usually bilateral
Linea alba-treatment?
No treatment necessary
White linear thickening at the level of the occlusal plane is an example of?
Linea alba
Morsicatio Buccarum is
chronic check chewing
Chronic cheek chewing of labial mucosa =
morsicatio labiorum
Chronic cheek chewing of tongue=
morsicatio linguarum
Morsicatio Buccarum is usually unilateral or bilateral?
bilateral
Morsicatio Buccarum treatment?
No treatment necessary.
Lateral acrylic shields connected by facial steel wire.
Thickened, shredded, areas of white hyperkeratosis describes what?
Morsicatio Buccarum
a white patch or plaque that cannot be characterized clinically or pathologically as any other disease describes
Leukoplakia
Leukoplakia is a term that is strictly a _____ and does not imply a specific diagnosis
clinical term
Lesions that must be excluded before the term “leukoplakia” can be used
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)
Clinical Significance of “Leukoplakia”-done by microscopic diagnosis of a biopsy. Microscopic diagnosis will be one of the following:
Hyperkeratosis
Epithelial dysplasia
Carcinoma-in-situ
Superficial squamous cell carcinoma
Hyperkeratosis
a callous; not premalignant; does not need removal
Epithelial Dysplasia is
Atypical cells confined to the cells of the epithelium
Treatment if epithelial dysplasia is considered premalignant for mild, moderate, and severe?
Mild usually not removed
Moderate may be removed
Severe must be removed
Enlarged nuclei/cells, Increased nuclear-to-cytoplasmic ratio, Hyperchromatic nuclei, Pleomorphic cells, Increased/abnormal mitotic activity are examples of
epithelial dysplasia
Carcinoma in situ: cancer confined to the _____; will eventually _____; must be ______
epithelium, invade, removed
Does superficial squamous cell carcinoma need o be removed?
Yes
Clinically, leukoplakia means
white patch/area
Why is leukoplakia considered a precancerous or premalignant lesion because
the frequency of transformation of all “leukoplakias” into malignancy (~4%) is greater than the risk associated with normal mucosa
Most “leukoplakias” are ______ without dysplasia or cancer
hyperkeratosis
White Surface Debris Lesions
Candidosis
Burning
Dentifrice-associated slough
Candidosis is a
Common opportunistic oral mycotic infection
Most common oral fungal infection in humans
Candidosis
Agent for candidosis
Candida albicans
British and older term for candidosis
British= candidosis
Older term=monoliasis
Candidosis is a component of normal oral microflora in what percentage in patients? those older than 60 years old?
In 30-50% of patients
Up to 60% in patients older than 60
Predisposing factors of candidosis?
Immunodeficiency Acquired immunosuppression Endocrine disturbances Diabetes mellitus Corticosteroid therapy Systemic antibiotic therapy Xerostomia Poor oral hygiene
Pseudomembranous candidosis (thrush) symptoms?
White plaques that rub off leaving an erythematous base (can scrape them off)
Pain or burning sensation
Thrush associated with?
xerostomia, antibiotics and/or decreased host resistance
Thrush plaques made of?
yeast, hyphae, epithelial cells and debris
Chronic Hyperplastic Candidiasis is seen as a?
white patch that CANNOT be removed.
Least common form and somewhat controversial
Chronic Hyperplastic Candidiasis most common in
anterior buccal mucosa
Erythematous Candidosis (Red Variations examples)
Acute Erythematous Candidosis
Chronic Erythematous Candidosis
Angular Cheilitis
Median Rhomboid Glossitis
Candidosis can be confirmed with a
cytology smear
Topical antifungal medications
Nystatin rinse or ointment
Clotrimazole rinse or troches
Ketoconazole cream
Systemic antifungal medications
Ketoconazole (Nizoral) tablets
Fluconazole (Diflucan) tablets
Candidosis can be confused with
dried saliva
food debris
superficial sloughing due to sodium lauryl sulfate
Dentifrice-assocaited slough symptoms?
Painless, grayish-white gelatinous membranes on gingiva, vestibule, floor of mouth and lips
Dentifrice-associatged slough most apparent when?
immediately upon arising in morning
Dentifrice-associated slough associated with?
sodium lauryl sulfate (SLS) and pyrophosphates found in some dentifrices and mouthrinses
Dentifrice-associated slough resolves by?
switching off toothpaste with SLS
Chemical injury is
Chemicals/drugs come in prolonged contact with oral tissues that may cause pain in area of application
Chemical injury examples
Children and psychiatric patients may hold medications in mouth
Topical products for mouth pain can compound problem
Mucosa develops white, wrinkled appearance. Removal of necrotic epithelium reveals red, bleeding tissue is an example of
chemical injury
Burn can be caused by?
heat, cold, or chemicals
Burns appear as a
Area of yellow-white epithelial necrosis
Subepithelial white spots (3)
Congenital cysts
Subepithelial fibrosis (scar)
Fordyce granules
Congenital cysts (2)
- Palatal cysts of the newborn e.g, Bohn’s nodules, Epstein’s pearls
- Gingival cysts of the newborn
Epstein’s pearls
palatal shelves fusing at midline entrap small islands of epithelium
Bohn’s nodules
Epithelial remnants from minor salivary glands of palate entrapped below the surface
Gingival cyst of the newborn
Entrapment of dental lamina
Appearance similar to palatal variant
Dental lamina cyst & congenital keratotic cysts
Resolve spontaneously: no treatment
SUBEPITHELIAL FIBROSIS(SCAR)
Usually poorly defined
Patient usually has a history of injury or surgery
No treatment needed
FORDYCE GRANULES represent and present
Represent ectopic sebaceous glands
Yellow, granular plaques and nodules present in clusters
