red and white patches Flashcards
What contributes to the colour of the oral mucosa?
Epithelial thickness
Keratinisation
Inflammation
Melanin
Candida
Exogenous factors eg - strawberry lolly would make it red
Give some reasons for white patches
Abnormal or increased keratin
Increased epithelial thickness
Candida infection
Name 4 risk factors for oral candida infection
Any from:
- immunocompromised
- dentures
- smoking
- inhaler use
- dry mouth
- antibiotics
How is oral candidiasis managed?
Antifungal therapy - fluconazole, miconazole, nystatin
Local measures - rinse after inhalers, use a spacer, denture hygiene, smoking cessation
What common drugs interact with -azoles?
Warfarin
Statins
What are the different types of oral candidiasis?
Pseudomembranous
Erythematous
Hyperplastic
Angular cheilitis
Describe pseudomembranous candidosis
White, curd like patches
Can be wiped away, leaving red/bleeding underneath
Seen in immunocompromised, inhalers and infants
Describe erythematous candidosis
Red, atrophic areas
Burning sensation
Bleeding areas
Seen in immunocompromised, denture wearers and people with xerostomia
Describe hyperplastic candidosis
Chronic, persistent white patches
Cannot be wiped away
Found in immunocompromised and those with poor fitting dentures
Describe angular cheilitis
Found on the corners of the mouth
Erythema and fissuring
Due to poor fitting dentures, immunocompromised and nutritional deficiencies
What is traumatic keratosis and how is it treated?
Increased keratin deposition at the site of trauma as a protective mechanism
Give smoking cessation and take a photograph
How can oral lichen planus and oral lichenoid reactions be classified?
Reticular
Atrophic
Papular
Erosive
Plaque like
Bullous
What is lichen planus?
A chronic inflammatory condition where T cells cause destruction of basal keratinocytes
A white patch
Most patients are asymptomatic but some have burning/stinging sensation to hot/spicy foods and fizzy drinks
1% malignant potential over 10 years
What are the causes of oral lichenoid reactions?
Drugs:
- antihypertensives
- NSAIDS
- lithium
Materials:
- metals
- amalgam
How are OLP/OLR managed?
Symptomatic relief
1. Mouthwash - hot, salty water
2. LA - benzydamine mouthwash
3. Avoid triggers eg - spicy foods, fizzy drinks
4. Steroid mouthwash - betamethasone
5. Change restorations
6. Onwards referral - biopsy for histopathology
What is hairy leukoplakia?
A non-removable white patch found mostly on the lateral borders of the tongue
Acanthotic and parakeratinised tissue
Triggered in EBV
Found in patients with HIV due to being immunocompromised
What is leukoplakia and how is it managed?
A clinical diagnosis of exclusion
No obvious cause for white patch but potential to become malignant
Needs biopsy for histopathological examination
Give 4 examples of red patches?
Erythematous candidiasis
Granulomatosis with polyangiitis
Erythroplakia
Orofacial granulomatosis
Describe granulomatosis with polyangiitis and how it is managed
Systemic vasculitis
Patient may have fever and weight loss
Potentially fatal
Managed with immunosuppressants
What is erythroplakia?
Clinical diagnosis of exclusion
Velvety, fiery, red patch
Most will have dysplasia or malignancy
Very high malignant transformation
Urgent referral indicated
What is OFG and oral Crohn’s and how is it managed?
Non-necrotising granuloma formation
Consider GI investigation
Manage with topical steroids, avoidance diets and biologics for Crohn’s disease
What are speckled white and red patches and how is it managed?
Erythroleukoplakia
High risk, refer to secondary care urgently
Biopsy needed
What 8 things should be assessed in a white patch?
Location
Colour
Homo/heterogeneity
Induration (soft or hard)
Raised or flat
Texture
Is it wipeable
Symmetry
Which oral tissues are keratinised?
Gingiva
Hard palate
Dorsum of tongue
Which oral tissues are non-keratinised?
Buccal and labial mucosa
Soft palate
Floor of mouth
Inner lining of lips
Which systemic conditions are often mistaken for lichen planus?
Lupus
Graft versus host disease
