Oral Path Exam 2 - Benign White Lesions

Question 1

Why does an oral lesion look white? (5)

Answer 1

Edema in tissue
Necrosis (variable thickness, +/- removable)
Superficial coatings (removable)
Keratin (more or change in type)
Thickening of epithelium

Question 2

Which cause of a white lesion?

Disappears w/ stretching

Answer 2

Edema

Question 3

Example of edema

Answer 3

Leukoedema (buccal mucosa)

Question 4

Which cause of a white lesion?

+/- removable

Answer 4

Extrinsic coatings (organisms)

Question 5

What are the following examples of?

Coated tongue
Hairy tongue
Plaque
Candida (burning/irritated sensation, can also be red)

Answer 5

Extrinsic coatings

Question 6

Which cause of a white lesion?

Leads to cauterized or superficial sloughed epithelium; +/- removable

Answer 6

Thermal or chemical injury

Question 7

Examples of thermal or chemical injury

Answer 7

Toothpaste
Mouthwash

Question 8

Which cause of a white lesion?

Non-removable

Answer 8

Keratin increased and/or epithelial lining

Question 9

What are the following examples of?

Frictional keratosis (linea alba, tongue/cheek chewing, alveolar ridge)
Nicotine stomatitis
Hairy leukoplakia (immunosuppression)
Smokeless tobacco keratosis
Leukoplakia

Answer 9

Keratin increased and/or epithelial lining

Question 10

Where is orthokeratinized tissue in the mouth normally?

Answer 10

Palate
Gingiva

Question 11

Why do we care about white lesions?

Answer 11

Some require no tx
Some are easily treated
Some have precancerous potential or indicate systemic disease

Question 12

What type of white lesion?

“White line”

Answer 12

Linea alba

Question 13

What type of white lesion?

Non-removable, white line along occlusal plane

Answer 13

Linea alba

Question 14

What type of white lesions?

Caused by chronic, low-grade, frictional trauma

Answer 14

Linea alba
Morsicatio (cheek/tongue chewing)

Question 15

What type of white lesions?

No tx needed, just recognize that it is there

Answer 15

Linea alba
Leukoedema

Question 16

What type of white lesions?

Asymptomatic

Answer 16

Linea alba
Leukoedema
Dentrifice-associated slough

Question 17

What type of white lesion?

Non-removable, opalescent/pale white appearance of buccal mucosa that diminishes when stretched

Answer 17

Leukoedema

Question 18

What type of white lesion?

More common in black adults and smokers

Answer 18

Leukoedema

Question 19

What are the 4 key questions for leukoedema?

Answer 19

Is it removable?
Does it disappear when stretched?
Is it on the other side?
Is it asymptomatic?

Question 20

What type of white lesion?

Very common on dorsal tongue, white in color

Answer 20

Coated tongue

Question 21

What type of white lesion?

Can be misdiagnosed as candidiasis

Answer 21

Coated tongue

Question 22

What type of white lesion?

May have malodor

Answer 22

Coated tongue

Question 23

What type of white lesion?

Tx: scrape tongue

Answer 23

Coated tongue

Question 24

What type of white lesion?

Elongated, discolored, filiform papillae

Answer 24

Hairy tongue

Question 25

What type of white lesion? Associated with smoking

Answer 25

Hairy tongue

Question 26

What type of white lesion? Discoloration (brown, black, green, yellow) due to bacteria, food, and tobacco

Answer 26

Hairy tongue

Question 27

What type of white lesion? Asymptomatic, or gagging if long; bad taste

Answer 27

Hairy tongue

Question 28

What type of white lesion? Tx: brush tongue and stop smoking to reduce lesions

Answer 28

Hairy tongue

Question 29

What type of white lesion? Common, often related to tartar control, whitening, sensitivity control, multi-care toothpaste, or overuse of mouthwash

Answer 29

Dentrifice-associated slough

Question 30

What type of white lesion? Mild peeling, sloughing or superficial keratin layers, labial/buccal mucosa and floor of mouth

Answer 30

Dentrifice-associated slough

Question 31

What type of white lesion? Tx: bland toothpaste

Answer 31

Dentrifice-associated slough

Question 32

What type of white lesion? Non-removable, white, ragged, but possibly partially peeling surface texture

Answer 32

Morsicatio (cheek/tongue chewing)

Question 33

What type of white lesion? Found on labial and anterior buccal mucosa and lateral tongue

Answer 33

Morsicatio (cheek/tongue chewing)

Question 34

What type of white lesion? Typically no tx needed, just recognize that it is there -> unless extensive, which might require biopsy to exclude premalignant changes

Answer 34

Morsicatio (cheek/tongue chewing)

Question 35

What type of white lesion? Tx could include pt education and occlusal guard

Answer 35

Morsicatio (cheek/tongue chewing)

Question 36

What type of white lesion? Asymmetric, spread off the alveolar ridge

Answer 36

Alveolar ridge keratosis

Question 37

What type of white lesion? Basically a callous response to eating when a tooth is missing. Food compacts on the ridge, and you get a pressure response

Answer 37

Alveolar ridge keratosis

Question 38

T/F: Most cases of alveolar ridge keratosis lack dysplasia

Answer 38

True

Question 39

What type of white lesion? The pts who did have dysplasia had 1+ of the following: Verrucous appearance Tobacco use Alcohol use Multiple white lesions Previous squamous cell carcinoma

Answer 39

Alveolar ridge keratosis

Question 40

What type of white lesion? Erythema or ulceration warrants biopsy

Answer 40

Alveolar ridge keratosis

Question 41

What type of white lesion? White keratotic change induced by heat of tobacco smoking or hot beverages

Answer 41

Nicotine stomatitis

Question 42

What type of white lesion? Found on the posterior hard palate and soft palate

Answer 42

Nicotine stomatitis

Question 43

What type of white lesion? Elevated papules with red center (orifices of minor salivary gland ducts) and white borders

Answer 43

Nicotine stomatitis

Question 44

What type of white lesion? Not precancerous; resolution in 1-2 weeks after habit cessation

Answer 44

Nicotine stomatitis

Question 45

What type of white lesion? Epstein-Barr Virus (EBV) induced lesion, often with superimposed candidiasis

Answer 45

Hairy leukoplakia

Question 46

What type of white lesion? Usually HIV-infected or other immune compromised; rare in healthy pts

Answer 46

Hairy leukoplakia

Question 47

What type of white lesion? Non-removable white plaques of lateral tongue

Answer 47

Hairy leukoplakia

Question 48

What type of white lesion? Faint vertical strands to thick furrowing w/ shaggy keratotic surface

Answer 48

Hairy leukoplakia

Question 49

What type of white lesion? Tx: usually resolves with control of HIV infection

Answer 49

Hairy leukoplakia

Question 50

What type of white lesion? Thick, irregular parakeratin

Answer 50

Hairy leukoplakia

Question 51

What type of white lesion? Candida infection is common

Answer 51

Hairy leukoplakia

Question 52

What type of white lesion? Hyperplastic (thicker) epithelium w/ balloon cells that show EBV by in situ hybridization

Answer 52

Hairy leukoplakia

Question 53

What type of white lesion? No dysplasia Minimal inflammation

Answer 53

Hairy leukoplakia

Question 54

Which white lesions are removable?

Answer 54

Coated tongue Hairy tongue Dentrifice-associated slough

Question 55

Which white lesions are non-removable?

Answer 55

Linea alba Leukoedema Morsicatio (cheek/tongue chewing) Hairy leukoplakia

Question 56

How long does it take tissues in the mouth to turnover?

Answer 56

2-3 weeks

Question 57

Which benign white lesion should you always biopsy to confirm it is not precancerous?

Answer 57

Hairy leukoplakia