red and white lesions 1 Flashcards
what is leukoedema ?
variation of normal condition rather than true pathlogy
features of leukoedema ?
symmetrical distrubution on buccal mucosa, soft palate, and floor of the mouth.
faint white diffuse filmy apperance with numerous folds resulting in wrinkling
cannot be scrapped off
disappears upon stretching
what is white spongy nevus ?
rare autosomal dominant disorder that can be present at birth or mainifest at puberty .
involves bilateral symmetric white soft spongy thick plaque of buccal mucosa.
involves ventral aspect of tongue, floor of mouth, labial mucosa, soft palate, alveolar mucosa
no tendency towards malignancy
what is actinic keratosis ?(cheolitis)
pre-malignant epithelial lesion directly related to long term sun exposure.
on the lip, appears as white plaque <1cm . surface may be crusted and rough to the touch.
treatment is surgery
predisposing factors to atrophic candidiasis ?
inhalation of steroids, smoking, broad spectrum candidiasis
chronic plaque type candidiasis / nodular:
replaces older term candidal leukoplakia
characterized by white plaque which may be indistinguishable from oral leukoplakia
high malignant transformation
managment on candidiasis?
eradicate predisposing factors
topical antifungals :
-nystatin cream 100,000u dissolve 1 pastilee slowly after meals 4x a day for 7 days
clotrimazole cream - apply to affected area 2-3 times daily
amphotericin B oral suspension 100mg/ml placed in mouth after food 4x daily for 2 weeks
what is leukoplakia?
a white patch or plaque that cannot be characterized clinically or pathologically as any other disease and is not associated with any physical or chemical agent except use of tobacco.
discoloration is relatively homohgenous with the exception of numerous erythematous spots. produced by inflammation of ductal orificesof underlying minor slivary glands
what are the commonly affected areas on leukoplakia?
buccal mucosa , vermillion border of lower lip, gingiva
less common:palate , maxillary mucosa, retro molar are, floor of the mouth , tongue
what are the types of leukoplakia and their characteristics ?
homogenous leukoplakia:
-well defined white patch
-localized or extensive
-slightly elevated
-wrinkled, corrugated or fissuerd
-leathery or cracked mud feeling on palpation
nodular or speckled leukoplakia:
-non-homogenous
-mixed lesion with white nodules or pateches on erythematous back ground
-higher malignant transformation rate
verrucous leukoplakia:
-thick papillary projections
-heavily keratinized
-exophytic growth patterns
-60-80 years ols
proliferative verrucous leukoplakia :
-extensive papillary or verrucous plaques
-slow extensive involvement
-high potential for malignant transformation
how is leukoplakia diagnosed?
-clinical criteria: location and apperance
-exclusion of other white lesions
- vital tissue staining , exfoliative cytology-brush biposy, chemiluminescence
-biopsy and histopathology
hyperkeratinization with or without acanthosis
chronic inflammation in 80% of cases
what is erythroplakia and what are its clinical features ?
bright red velvety plaque or patch that cannot be diagnosed as any other lesion
-homogeneous erythroplakia
-interspersed with patches of leukoplakia
-asymptomatic
what is oral lichen planus:
activation of auto reactive T lymphocytes induces degeneration of basal cell layer of epithelium.
can affect any oral mucosal site but buccal mucosa is most common site (bilateral)
can be associated with pain or discomfort
co-factors of oral lichen planus :
Stress
diabetes
hepatitis C
trauma (aggravates the disease -koebners phenomenon- during mastication and tooth brushing
hypersensetivity to drugs and metals
clinical features of oral lichen planus :
reticular: keratotic white lace pattern- linear array of papules radiating from elevated point called wickhams striae, slightly elevated fine whitish lines
annular: white lace patterns arranged in ring forms
plaque like lichen planus :
homogenous well demarcated plaque similar to homogenous leukoplakia
erosive lichen planus is :
a complication of atrophic process when thin epithelium is abraded or ulcerated
clinically, fibrin coated ulcers are surrounded by an erythematous zone frequently displaying white striae
are any skin lesions present in Oral lichen planus patients?
skin lesions are associated with 15% of patients
diagnosis of oral lichen planus is based on ? and what are its histopathologic features ?
history , clinical examination and confirmed histopathology study
histopathologic features:
-areas of hyperparakeratosis or hyperorthokeratosis often with a thickening of the granular cell layer and a saw toothed apperance to the rete ridges
-liquefaction degeneration or necrosis of the basal cell layer which is often replaced by an eosinophillic band
-dense subepithelial band of lymphocytes
management of oral lichen planus :
for keratotic asymptomatic lesions no treatment is necessary
topical steroids
topical anesthetic
immunomodulators
topical antifungal?
what is lupus erythematous ?
autoimmune disease involving immune complexes.
affected by environmental factors such as sun exposure, drugs , chemical substances and hormones
drugs associated with lupus erythematous
hydralazine
methyldopa
chlorpromazine
isoniazid
quinidine
procainamide
what is the typical clnical lesion associated with lupus?
white straie with radiating orientation. sharply terminates toward center of lesion which has a more erythematous apperance.
mostly affects gingiva , buccal mucosa
oral lesions may be the first sign of the disease
what are the labratory findings associates with lupus ?
anti-nuclear antibodies
high titers of anti-DNA and anti smith antibodies
how do u manage oral lesions of Lupus?
intra-oral lesions : topical steroids
2-3x a day followed by tapering during the next 6-9 weeks
gingival cyst of newborn and adult present as:
multiple sessile dome shapeed lesions measuring about 2-3mm in diametes
they are chalk white and present predominantly on maxillary anterior alveolar ridge (remnants of dental lamina )
what can u do to resolve hairy tongue?
cessation of smoking or discontinuation of oxygenating mouth washses or antibiotics. improvement of oral hygiene and scrapping of the tongue.
1% solution of podophyllin resin
presentation of oral submucous fibrosis :
initially as burning sensation when consuming spicy food
often accompanies by formation of vesicles or ulcerations and by excessive salivation or xerostomia and altered taste sensation
stiffening of mucosa with dramatic reduction in mouth opening
apperance of oral submucous fibrosis
mucosa appears blanches and opaque with apperance of fibrotic bands that can easily be palpated
bands usually involve the buccal mucosa ,
management of oral submucous fibrosis
-submucosal injection of steroids and hyaluronidase
-oral iron preparations
0topical vitamin A and steroids
how are lichenoid reactions differentiated from lichen planus ?
association with administration of durg , contact with metals, use of food coloring or systenic disease
resolution when drug or other factor is eliminated or disease is treated
drug induced lichenoid reactions are UNILATERAL and present with an ulceratve reaction pattern
drugs and materials that could be resonsible for lichenoid reactions
Antimicrobials
* Antiparasitics
* Antihypertensives
* Antiarthritics
* Anxiolytics
* NSAIDs
* Oral hypoglycemic agents
* Uricosuric agents
* Penicillamine
* Iodides
* Quinidine sulfate
* Chemicals; dental restorative materials
What are the red and white lesions with defined potential for malignancy ?
-leukoplakia
-erythroplakia
-reverse OSMF, DLE
-Smokers palate
-lichen planus
-lichenoid reactions
-dyskeratosis congenita
