More diseaess-Kerr, Dry mouth Flashcards
What is this clinical presentation?
Homogeneous leukoplakia
○ Thickened leathery, White plaque
○ Well-demarcated, Deepened fissures
○ Non-wipeable white patch
What is this clinical presentation?
Homogeneous leukoplakia.
○ Non-wipeable white patch
What is this clinical presentation?
homogenous leukoplakia
Just
white color
What is this clinical presentation?
Non-homogenous leukoplakia
Nodular leukoplakia ~ Largely white
Verrucous leukoplakia ~ Largely white
Erythroleukoplakia ~ Red and white
Speckled and verrucous leukoplakia have a greater risk for malignant
transformation than the homogeneous form
What is this clinical presentation?
Speckled leukoplakia.
Non-homogenous leukoplakia
Leukoplakia
Etiology
Etiology
The exact etiology remains unknown. Tobacco, alcohol,
chronic local friction, and Candida albicans are important predisposing
factors. Human papilloma virus (HPV) may also be involved in the
pathogenesis of oral leukoplakia.
Leukoplakia
Treatment
- Biopsy to rule out malignancy
- Elimination or discontinuation of predisposing factors,
- systemic retinoid compounds.
- Smoking cessation (leukoplakias often disappear or become smaller within first year of smoking cessation)
- Complete removal with surgical excision, electrocautery, cryosurgery, or laser ablation
What is this clinical presentation?
Hairy Leukoplakia
corrugated white lesion on the lateral tongue.
• It only occurs on the lateral tongue
What is this clinical presentation?
Hairy Leukoplakia
Hairy Leukoplakia
Etiology
Epstein–Barr virus seems to play an important role in the
pathogenesis.
Hairy Leukoplakia
Treatment
- Not required
- however, in some cases aciclovir or valaciclovir
- can be used with success.
- Topical retinoids or podophyllum resin for temporary remission
What is this clinical presentation?
Proliferative Verrucous Leukoplakia
Patient with proliferative verrucous leukoplakia but manifesting more as
an erythroplakia in multiple sites than a leukoplakia
Proliferative verrucous leukoplakia has very high risk (49.5% in malignant transformation)
almost 10% risk for malignant transformation every year
What is this clinical presentation?
Proliferative Verrucous Leukoplakia
Location
○ Gingiva (Frequent)
○ Buccal Mucosa
○ Palatal Mucosa
What is this clinical presentation?
Proliferative Verrucous Leukoplakia
Multifocal
Proliferative Verrucous Leukoplakia
Treatment
complete removal: excision, electrocautery, cryosurgery, or laber ablation
Lesions rarely regress despite therapy
What is this clinical presentation?
Oral lichen planus
White lacy appearance, with
a network reticular appearance (Wickham’s striae)
sometimes punctate or plaque‐like lesions predominate
o Wickham’s striae→ very characteris► white wispy changes
What is this clinical presentation?
Oral lichen planus
on the buccal mucosa (most common site
reticular form.
What is this clinical presentation?
Oral lichen planus
slightly more red as you move to the left of the picture
● The white lines have small sunburst effect at the periphery
○ Very very characteristic of lichen planus
○ Will never see this in a leukoplakia
What is this clinical presentation?
Oral lichen planus
Lichen planus of the dorsum of the tongue
this is a hypertrophic form.
Oral lichen planus
Etiology
Although the cause is not well known, T cell-mediated autoimmune
phenomena are involved in the pathogenesis of lichen planus.
Oral lichen planus
Treatment:
- Incisional biopsy on non-keratinized, non-ulcerated mucosa
○ Asymptomatic → no tx
○ Symptomatic → 0.5mg/ml Dexamethasone Elixir.
What is this clinical presentation?
Lichenoid Reactions
Contact Lesions
a sensitivity in contact with a dental amalgam
▪ When you replace these amalgams, the lichenoid reaction will typically
disappear
What is this clinical presentation?
Oral Lichenoid
Contact lesion
chenoid reaction to dental amalgam and cold: white and erythematous
lesions on the buccal mucosa.
What is this clinical presentation?
pts takes Thiazide Diuretic
Oral Lichenoid Drug
Reaction
What is this clinical presentation?
pts takes allopurinol
Oral Lichenoid Drug
Reaction
Oral Lichenoid
Contact Lesions
Etiology
Hypersensitivity
to
- dental restorative materials, amalgam or other metal, composite resins
- Foods, oral products
- Especially cinnamon
- dental plaque accumulation are the most common
Oral Lichenoid Drug
Reaction
Etiology
- Lichenoid reactions may develop after exposure to a medication for periods of > 1 year
- May develop very slowly after the problem is initiated so it can be very challenging to connect the dots
Many different medications that can lead to lichenoid reactions
- Beta blockers, ACE inhibitors, Rituxumab etc…
- A number of new targeted agents “mabs” and “nibs” can cause lichenoid reactions
- In cancer centers, this has become quite a problem because they are taking disease‐modifying drugs
Oral lichenoid reaction
Treatment
Insicional biopsy Mandated to distinguish from OLP
○ Biopsy white areas on non-keratinized mucosa NOT ulcerated OR red areas
Treatment Replacement of the restorative material, polishing and
smoothing, and good oral hygiene are recommended.
Topical steroid
treatment for a short time is also helpful.
What is this clinical presentation?
Nicotinic Stomatitis
also known as
Smoker’s keratosis
smoker’s palate
- the palatal mucosa becomes diffusely gray or white; numerous slightly elevated papules are noted, usually with punctate red centers
What is this clinical presentation?
Nicotinic Stomatitis
These papules represent inflamed minor salivary glands and their ductal orifices.
What is this clinical presentation
Nicotine Stomatitis.
Nicotine Stomatitis
Treatment
Smoking Cessation.
- Nicotine stomatitis is completely reversible, even when it has been present for many decades.
- The palate usually returns to normal within 1 to 2 weeks of smoking cessation.
Nicotine Stomatitis.
Etiology
The elevated temperature, rather than the tobacco chemicals,
is responsible for this lesion.
What is this clinical presentation?
Pseudomembranous candidiasis
on the palate.
usually caused by Candida albicans
Predisposing factors are local
(poor oral hygiene, xerostomia, mucosal
damage, dentures, antibiotic mouthwashes)
What is this clinical presentation?
Geographic tongue/
areata migrans
Multiple, well-demarcated zones of erythema (due to filiform atrophy) surrounded by slightly elevated, yellow-white, serpentine/ scalloped border
annular
- serpiginous
- atrophic
- Fissured
What is this clinical presentation?
Geographic tongue/
areata migrans
What is this clinical presentation?
Geographic tongue/
areata migrans
What is this clinical presentation?
Geographic tongue/
areata migrans
What is this clinical presentation?
Geographic tongue, localized lesion.
Geographic tongue/
areata migrans
Treatment
- Generally no treatment is indicated
- Reassuring the patient that the condition is completely benign is often all that is necessary.
- In case of tenderness or a burning sensation that is so severe –topical corticosteroids, such as fluocinonide or betamethasone gel, may provide relief
Geographic tongue/
areata migrans
Etiology
The exact etiology remains unknown. It may be genetic.
What is this clinical presentation?
Fordyce’s granules
on the buccal mucosa.
a normal anatomical variation.
ectopic sebaceous glands of the oral
mucosa.
What is this clinical presentation?
Leukoedema of the buccal mucosa.
Laskaris,
Leukoedema
Etiology
Treatment
Etiology
It is due to increased thickness of the epitheliumand intracellular
edema of the prickle-cell layer.
Treatment
No treatment required
What is this clinical presentation?
White Sponge Nevus
Diffuse, thickened white plaques
of the buccal mucosa
What is this clinical presentation?
White Sponge Nevus
(Canon disease)
White Sponge Nevus
Etiology
Autosomal dominant skin disorder
Etiology:
● This condition is due to a defect in the normal keratinization of the oral mucosa in the 30-member family of keratin filaments, the pair of keratins known as keratin 4 and keratin 13 is specifically expressed in the spinous cell layer of mucosal epithelium.
What is this clinical presentation?
Verrucous Carcinoma
Early verrucous carcinoma of the buccal mucosa.
What is this clinical presentation?
Verrucous Carcinoma
Large, exophytic, papillary
mass of the maxillary alveolar ridge.
What is this clinical presentation?
Verrucous Carcinoma
Large, exophytic, papillary
mass of the maxillary alveolar ridge.
What is this clinical presentation?
Verrucous Carcinoma
Extensive papillary, white
lesion of the maxillary vestibule
Verrucous Carcinoma
Etiology
a low-grade variant of squamouscell
carcinoma.
Etiology
Leading theories include
- human papillomavirus (HPV) infection
- chemical carcinogenesis induced by smoking and chewing tobacco
- alcohol consumption
- betel nut chewing (oral lesions),
- chronic inflammation
Verrucous Carcinoma
Treatment
○ Surgical Excision
○ Radiotherapy
Traumatic Erythema /Traumatic Hematoma
on the lower lip.
What is this clinical presentation?
Geographic tongue: well-demarcated red patch on the tongue.
What is this clinical presentation?
Median rhomboid glossitis.
a Chronic hyperplastic, erythematous candidiasis
Median Rhomboid Glossitis
Treatment
No treatment is required.
Median Rhomboid Glossitis
Etiology
Atrophy of central filiform papillae
Presumably developmental. Candida albicans may also be
involved.
but smokers, people with xerostomia , who use inhalation steroids
and denture wearers are at increased risk
what is this clinical presentation?
Denture stomatitis.
Erythroplakia
Malignant transformation
Erythroplakia is a high risk for malignant transformation. So, if you
encounter an erythroplakia, it’s probably already a cancer or it’s fast‐tracking
towards a cancer
What is this clinical presentation?
Erythroplakia
of the buccal mucosa
Well-demarcated erythematous patch or plaque with soft velvety texture
What is this clinical presentation?
Erythroplakia of the buccal mucosa.
What is this clinical presentation?
Erythroplakia
of the lateral margin of the tongue.
Well-demarcated erythematous patch or plaque with soft velvety texture
What is this clinical presentation?
Erythroplakia
Firey red Well-demarcated patch or plaque with soft velvety texture
transformed into SCC
Erythroplakia
Treatment
○ Biopsy required for diagnosis
○ If a source of irritation can be identified and removed, biopsy may be delayed for 2 weeks to allow lesion to heal
○ Complete excision