ORAL MED - white patches Flashcards
what is the aetiology of white sponge nevus?
hereditary but may also be sporadic
very rare
what are signs and symptoms of white sponge naevus?
asymptomatic
may feel rough
what are the clinical features of white sponge naevus?
white/greyish white patches which merge with the surrounding normal mucosa
firmly adherent
no erythema or ulceration
surface is folded, soft and spongy
affects any area of oral mucosa, very variable
other than the oral cavity, where else does white sponge naevus affect?
oesophagus
nasal
genital
ano-rectal mucosa
skin, nails, hair
what investigations are performed for white sponge naevus?
diagnosis made clinically and with family history
genetic testing for mutation - keratin 4 +/or 13
what is the management of white sponge naevus?
explanation of condition - not potentially malignant
what is the aetiology of leukoedema?
secondary to low grade mucosal irritation, causing intracellular oedema in superficial layers of epithelium
what are signs and symptoms of leukoedema?
asymptomatic
what are clinical features of leukoedema?
buccal and labial mucosa filmy white/grey appearance
soft on palpation
what investigations are performed for leukoedema?
diagnosis made on clinical grounds
what is management of leukoedema?
explanation of condition
advice - potential source of irritation
what is the aetiology of epitheliolysis (oral mucosal peeling)?
secondary to mucosal irritation by toothpaste, mouthwashes
sodium lauryl sulphate in toothpaste
what are signs and symptoms of epitheliolysis?
asymptomatic
what are the clinical features of epitheliolysis?
strands of gelatinous milky white material
removable by wiping
no abnormality to underlying tissue
what investigations are performed for epitheliolysis?
diagnosis normally made on clinical grounds
what is the management of epitheliolysis?
explanation of condition
avoidance of sodium lauryl sulphate containing products, cease mouthwash use
what is the aetiology of traumatic keratosis?
secondary to physical (frictional), chemical, thermal irritation
what are the signs and symptoms of traumatic keratosis?
asymptomatic
affected areas may feel rough or ridged to the tongue
what are the clinical features of traumatic keratosis?
white plaque not removed by rubbing/ scraping
may have a shaggy surface, appear macerated or be associated with ridging
clinical appearance should match cause
what investigations should be performed for traumatic keratosis?
diagnosis made on clinical grounds
biopsy if cause not clear
what is the management of traumatic keratosis?
explanation of condition
management/ removal of cause
if lesion does not resolve - biopsy
what causes stomatitis nicotina?
smoking related
60% pipe smokers
30% cigarette smokers
is stomatitis nicotina malignant?
not potentially malignant
what are clinical features of stomatitis nicotina?
generalised white/ greyish white appearance on the hard palate extending onto soft palate
small red dots <1mm represent inflamed openings of minor salivary glands
what is the management of stomatitis nicotina?
smoking cessation
what is the aetiology of oral lichen planus/ lichenoid reaction?
unknown is 75% of cases
25% cases due to medication, dental materials
what conditions can mimic oral lichen planus?
lupus erythematosus
graft vs host disease
what are signs of oral lichen planus/ lichenoid reactions?
any site affected
tongue, cheek, and gingivae commonly affected
usually bilateral if lichen planus
palatal mucosa rarely affected but may be in lichenoid drug reactions
can get a combination resulting in a mixture of white and red and ulcerated lesions
what is the clinical criteria for oral lichen planus?
bullous
lesions are not localised exclusively to the sites of smokeless tobacco placement
lesions are not localised exclusively adjacent to and in contact with dental restorations
lesion onset does not correlate witht he start of a medication
lesion onset does not correlate with the se of cinnamon-containing products
describe the appearance of reticular lichen planus?
lace like pattern
bilateral
describe the appearance of papular lichen planus?
slightly raised small papules that can fuse together
what are the 2 presentations of gingival lichen planus?
desquamative gingivitis
reticular/ plaque - white striations in sulus extending on to gingivae
describe the appearance of atrophic lichen planus?
tongue can lose all papilla
list the types of oral lichen planus
reticular
papular
gingival
plaque
atrophic
bullous
erosive, atrophic, and reticular - combinations can occur
erosive, atrophic, plaque
describe the appearance of erosive (ulcerative), atrophic and reticular lichen planus
ulceration surrounded by atrophy surrounded by striations
list the range of symptoms that can occur for oral lichen planus/ lichenoid reaction
asymptomatic
affected area may feel rough
soreness only on eating - spicy, salty, acidic, rough, hot foods and tooth brushing
soreness presented at all times exacerbated by factors
symptoms tend to wax and wane in severity
stress may be an exacerbating factor
what other sites can be affected by lichen planus/ lichenoid reaction?
skin
scalp
nails
genital - vulvovaginal gingival lichen planus
what investigations are performed for oral lichen planus/ lichenoid reaction?
diagnosis made on clinical grounds if presentation is classical
biopsy
swab if suspect super-added candia
blood test if associated disease suspected
what is the initial non-pharmacological management in primary care for oral lichen planus?
explanation of diagnosis
ask if other site involvement and refer is necessary
advise potentially malignant
counsel - smoking cessation and alcohol
baseline photographs
consider referral to secondary care if concerns regard:
- possible malignancy
- diagnosis
- ability to manage in primary care
what presentation of oral lichen planus is more likely to be malignant?
tongue involvement
atrophic and erosive pattern
what medications are common culprits of lichenoid reactions?
antihypertensives - ACE inhibitors, beta blockers, CCBs, thiazide diuretics, loop diuretics
methyldopa
oral hypoglycaemics- tolbutamide, chlorpropamide
NSAIDS - ibuprofen, naproxen, phenylbutazone
what restorative materials usually cause lichenoid reactions?
amalgam
what test can be performed for lichenoid reactions?
patch testing
what are the risk factors for malignant transformation in lichen planus/ lichenoid reactions?
tongue lesions, smoking, alcohol consumption, atrophic-erosive lesions, hepatitis C infection42 and female sex.
what mechanism underlies lichenoid reactions to restorative materials?
amalgam dental fillings and their interactions with the electrolytes in saliva
what is graft vs host disease and why does it cause lichen planus?
Graft-versus-host disease (GVHD) occurs due to the presence of immunocompetent T lymphocytes in the graft attacking the immunodeficient recipient tissue due to histocompatibility differences within 100 days, causing tissue damage
what other diseases are associated with lichen planus
hep C
lupus erythematous
how does hairy leukoplakia present?
firmly adherent corrugated surface
lateral border of tongue
often super added candida
uni or bilateral
what diseases is hairy leukoplakia associated with?
EBV (human herpes virus 4)
HIV
immunosuppressed pts
pts using inhaled corticosteroids
what tests should be performed for hairy leukoplakia?
biopsy
HIV test
what is the term for thrush?
acute pseudomembranous candidosis
what does thrush present as?
white patches removed by scaping leaving an erythematous/ bleeding base
what are underlying and/or systemic predisposing factors of thrush?
dry mouth
steroid inhaler
anaemia
nutritional deficiency
diabetes
immunosuppressed
extremes of age
what investigations are performed for thrush?
oral rinse - colony forming units (CFU) per ml of rinse (gold standard)
saliva sample - CFU per ml of saliva
imprint culture - CFU per mm2 mucosa
swab - light or profuse growth
sensitivity to antifungals can be carried out
when a pt presents with candidosis what do investigations look for?
underlying cuases;
- FBC
- serum B12, folate, ferritin
- HbA1c
- TSH
how does chronic hyperplastic candidosis present?
firmly adherent white plaques
may be inter-mingles erythema and nodularity
commisure/ anterior region of buccal mucosa
bilateral
may also affect tongue
what is a significant aetiological factor of chronic hyperplastic candidosis?
cigarette smoking
is chronic hyperplastic candidosis malignant?
no longer classified as potentially malignant
