Red & White Lesions- Dr. Flores

Question 1

Frictional Hyperkeratosis

Answer 1

• occurs in areas that are commonly traumatized
  
  • chronic rubbing or friction
  • lips
  • lateral tongue
  • buccal mucosa
• macrophages & epithelial cells produce IL-8
  
  • causes overexpression of keratinocyte chemokine (KC)

Question 2

What condition?

Answer 2

Frictional Keratosis

(hyperkeratosis without dysplasia)

Question 3

Management of a white lesion suspected to be from mechanical irritation

Answer 3

• remove source of irritation
  
  • will regress in absence of stimulus
• patient returns in 2-3 weeks
• If lesion has not regressed=biopsy

Question 4

What condition?

Answer 4

Frictional Hyperkeratosis

Question 5

Leukoplakia

Answer 5

• when you cannot
  
  • identify source of white lesion
  • diagnose as any other condition
• White lesion that does not rub off
• Clinical TERM only
  
  • no diagnostic meaning
    
    • never seen on biopsy report as diagnosis
• most common premalignant oral manifestation-85%

Question 6

Benign Alveolar Ridge Keratosis

Answer 6

• on edentulous alveolar ridge
  
  • Hyperkeratosis w/o dysplasia
    
    • similar to frictional hyperkeratosis
  • usually in patients who do not wear dentures
    
    • retromolar pod

Question 7

Hairy Tongue

Answer 7

• overgrowth of the dorsal tongue
  
  • filiform papillae
• Predisposing factors:
  
  • Broad spectrum antibiotics
  • oxygenating mouth rinses
  • smoking
  • radiation
  • stem cell transplant
• Management:
  
  • identify & eliminate predisposing factor
  • improve oral health
  • tongue scraper

Question 8

What condition?

Answer 8

Benign Alveolar Ridge Keratosis

Question 9

What condition?

Answer 9

Hairy Tongue

Question 10

What condition?

Answer 10

Hairy Tongue

Question 11

Smokeless Tobacco Keratosis

Answer 11

• Associated with
  
  • Squamous Cell Carcinoma
    
    • most common malignancy from smokeless tobacco
  • Verrucous carcinoma
    
    • snuff dipper’s canncer
    • uncommon
    • low-grade malignancy
• Clinical features
  
  • stretching reveals snuff pouch (tobacco pouch)
  • soft fissured gray-white lesion that blends in with surrounding mucosa
  • induration (hardened), pain, and ulceration are NOT associated

Question 12

What condition?

Answer 12

Smokeless Tobaccoo Keratosis

Question 13

What condition?

Answer 13

Smokess Tobacco Keratosis

Question 14

What condition?

Answer 14

Smokeless Tobacco Keratosis

Question 15

Oral Submucous Fibrosis

Answer 15

• Pale, Marble-like stiff mucous in betel quid users
• precancerous condition
• Chief complain
  
  • trismus and generalized oral burning sensation
  • intolerance to spicy foods
• Betel Chewers Mucosa
  
  • not precancerous
  • Brown-red mucosa
• Betal quid lichenoid lesions
  
  • tooth staining
  • attrition
  • perio

Question 16

What condition?

Answer 16

Oral Submucous Fibrosis

Question 17

Nicotinic Stomatitis

Answer 17

• aka Smoker’s Palate
• associated with tobacco smoking
  
  • develops in response to the heat
• Dry mud apperance
  
  • Palatal mucosa is grey w/numerous pappules w/red center
• Reverse smoker’s palate
  
  • should resolve w/stopping in 1 month

Question 18

What condition?

Answer 18

Nicotinic Stomatitis (Aka Smoker’s Palate)

Question 19

What condition?

Answer 19

Nicotinic Stomatits (smoker’s palate)

Question 20

What condition?

Answer 20

Nicotinic Stomatitis (smoker’s palate)

Question 21

Actinic Cheilitis

Answer 21

• Actinic Cheilosis
  
  • farmer’s lip
  • sailor’s lip
• common premalignant alteration of LOWR LIP Vermilion
• results from long-term UV exposure
• Clinical:
  
  • rare in younger than 45 y.o.
  • Males 10:1
  • slow developing lesion
  • overtime Scaly lesion develops sometimes w/ulceration
    
    • suggests SCC

Question 22

What condition?

Answer 22

Actinic Cheilitis

Question 23

What condition?

Answer 23

Actinic Cheilitis

Question 24

White Sponge Nevus

Answer 24

• aka Cannon Disease
• mutation- Keratin 4 & 13
• white plaque on buccal mucosa, nasal, and anal mucosa
• Unique:
  
  • eosinophilic condensation in perinuclear region of cells in superficial layers of epithelium

Question 25

What condition?

Answer 25

White sponge nevus

Question 26

What condition?

Answer 26

White Sponge Nevus

Question 27

Hereditary Benign intraepithelial Dyskeratosis

Answer 27

* Primarily affects decendents of triracial people originally from NORTH CAROLINA * Duplication in chromosome 4q35 * developed during childhood * Oral lesions: * thick, corrugated white plaques in buccal & labial mucosa * Occular lesions * gelatinous plaques of bulbar conjuctiva * adjacent to cornea

Question 28

What condition?

Answer 28

Hereditary Benign Intrapeithelial Dyskeratosis

Question 29

Oral Hairy Leukoplakia

Answer 29

* Related to Epstein-Barr Virus infection (EBV) * common oral manifestation of imunosuppression due to HIV * Etiology: * HIV infections * Hematologic neoplasms * post-transplant proliferative disorders * Prolonged used of corticosteroids

Question 30

Candidiasis

Answer 30

* Caused by Candida Albicans * apart of normal oral flora in 30-50% * Dimorphism * Yeast form * Hyphal form-invasion of host tissue * 3 factors of infection: * immune status * oral mucosal enviroment * C. Albicans strain

Question 31

Pseudomembranous Candidiasis

Answer 31

* aka Thrush * exposed to broad-spectrum antibiotics or immunocompromised * affects infants * Clinical presentation: * buccal mucosa, palate, dorsal tongue * white plaques that resemble cottage cheese * scrape off to remove * Symptoms: * burning sensation or unpleasant taste

Question 32

What condition?

Answer 32

Pseudomembranous Candidiasis (Thrush)

Question 33

How do you manage a dental lesion that is able to be scraped off?

Answer 33

* Antifungals

Question 34

Hyperplastic Candidiasis

Answer 34

* aka Candidal Leukoplakia * idiopathic * _immunosuppression_ * locations: * tongue * anterior buccal mucosa

Question 35

Erythroleukoplakia

Answer 35

* red & white patches

Question 36

What condition?

Answer 36

Erythroleukoplakia