White Lesions Flashcards
It presents a white soft plaque that can be wiped off leaving a painful erythematous eroded, ulcerated surface.
Acute Pseudomembranous Candidiasis
This is a common opportunistic oral mycotic infection that develops in the presence of one of several predisposing conditions.
Candidiasis
Give atleast 5 predisposing factors in which Candida albicans can produce a disease state (candidiasis)
Immunodeficiency Diabetes mellitus Pregnancy Xerostomia Poor oral hygiene
It is the most common clinical type of candidiasis
Acute pseudomembranous candidiasis
What are the favored sites of acute pseudomembranous candidiasis
Buccal mucosa
Mucobuccal folds
Oropharynx
Lateral aspect of tongue
Acute erythematous candidiasis is also known as _____
Antibiotic stomatitis
Antibiotic glossitis
This type of candidiasis commonly occurs in geriatric patients who wears complete maxillary dentures
Chronic erythematous candidiasis
This type of candidiasis has bright red, somewhat velvety to pebbly surface, with relatively little keratinization
Chronic erythematous candidiasis
This case is usually seen in individuals with denture-related candidiasis
Angular cheilitis
True of False
Chronic Candidal Infections are capable of producing a hyperplastic tissue response.
True
Chronic hyperplastic Candidiasis
Type of hyperplastic candidiasis that involves the dorsum of the tongue
Median rhomboid glossitis
- Asymptomatic
- found anterior to circumvallate papillae
Chronic candidiasis may give rise to leukoplakia.
And this indicates that CC is a precancerous state
1st statement is true
2nd statement is false
If seen microscopically, fungal hyphae are seen penetrating the upper layers of epithelium at acute angles
Acute candidiasis
Type of candidiasis where epithelial hyperplasia can be seen during microscopic examination
Chronic candidiasis
Give atleast 3 differential diagnosis of Candidiasis
White: Slough associated with chemical burns Traumatic ulcerations Mucous patches of syphilis White keratotic lesions
Red:
Drug related reactions
DLE
Erosive lichen planus
Superficial burn in the oral mucosa that is caused by topical applications of chemicals
Mucosal burns
Mucosal Burns
Short term:
Long term exposure:
Short term: mild erythema
Long term exposure: white slough
The primary factor of this condition is chewing of areca (betel) nuts.
Submucous fibrosis
+ it is also caused by nutritional and vitamin deficiency
True or False
Oral submucous fibrosis is a premalignant disorder
True
What vitamin and mineral is deficient in persons with oral submucous fibrosis?
Vitami B complex
Iron
Presents a whitish yellow lesion which is chronic. It is usually located in the buccal mucosa and soft palate. It may cause difficulty in eating and trismus. Upon palpation, fibrous bands are easily palpable (stiff fibrous bands)
Oral submucous fibrosis
Histological examination reveals: atrophy of epithelium and subajacent fibrosis Epithelial dysplasia Poorly vascularized lamina propia Diffused to mild inflammatory infiltrate Type 1 collagen: submucosa Type 3 collagen: epithelium- CT
Oral submucous fibrosis
Treatment for Oral submucous fibrosis
Stop betel nut chewing
Local injection of chymotrypsin, hyaluronidase, and dexamethasone
Surgical excision of the fibrous bands
Submucosal placement of vascularized free flap grafts
Oral submucous fibrosis will progress to _____
Squamous cell carcinoma
These are ectopic sebaceous glands or sebaceous choristoma (normal tissue in abnormal location)
Fordyce’s granules
Where are the sites of predilection of fordyce’s granules?
Buccal mucosa
Vermillion of the upper lip
These are lymphoid tissues that appears yellow or yellow-white which produces small, dome-shaped elevations
Located in the posterolateral aspect of tongue.
Ectopic lymphoid tissue
Known as lingual tonsil
Waldeyer’s ring includes:
Pharyngeal tonsil,
two tubal tonsils,
two palatine tonsils and the
lingual tonsils
Nonodontogenic neonatal cyst that occurs along the palatal midline (fusion of palatine shelves)
Epstein’s pearls (palate)
Gingival cyst of newborn
Bohn’s nodules
What case in similar to gingival cyst of adult?
Lateral periodontal cyst
Gingival cyst of adult is formed by the remnants of the dental lamina (rests of serrez)
True
Occurs at 50-60 y/o
At premolar and bicuspid (mandibular region)
Treatment of gingival cyst of infants and adult
Infants: none ; spontaneously ruptures
Adult: surgical excision
Painful pus in the gingiva which is derived from an infection at the base of the occluded periodontal pocket or apex of nonvital tooth
Parulis (gum boil)
Yellow or yellow-white uninflammed submucosal mass of adipose tissue
Lipoma
What non epithelial white - yellow lesions does not required treatment?
Fordyce’s granule
Ectopic lymphoid tissue
Lipoma
A hereditary generalized mild opacification of the buccal mucosa - variation of normal. Asymptomatic and symmetrical. Disappears when stretched.
It appears as gray-white, diffuse, filmy, or milky surface alterations
Leukoedema
Differential Diagnosis for Leukoedema
White sponge nevus
HBID
Chronic cheek biting
Lichen planus
This is an autosomal dominant condition (mutation in genes coding for keratin 4 and/or 13). It is asymptomatic and occurs before puberty. It does not disappear when cheeks are stretched and are bilateral
White Sponge Nevus
Where do WSN usually occurs?
Buccal mucosa
Tongue
Vestibular mucosa
Esophagus
Vulva
Vagina
Microscopically, WSN epithelium is thickened with marked ____, ____, ___
Spongiosis, acanthosis, parakeratosis
Differential Diagnosis of WSN
HBID LICHEN PLANUS LICHENOID DRUG REACTION LE CHEEK CHEWING CANDIDIASIS
Hereditary Benign Intraepithelial Dyskeratosis (HBID) is AKA:
Witkop’s disease
It is an autosomal dominant disease (4q35) which occurs on first year of life. It includes conjunctiva. In oral lesion, it is a soft, asymptomatic, white folds and plaques of spongy mucosa (buccal, labial mucosa, and labial commissures, lateral surface of tongue(except dorsum), floor of mouth, gingiva, palate) . It does not disappear when stretched. May also result to photophobia and blindess
HBID
It is also known as Darier’s disease or Darier-white disease
Follicular Keratosis
All except 1 of the hereditary white lesion condition is not an autosomal dominant condition
Leukoedema
It is a desmosomal defect and dysfunction which alters epithelial cell adhesion (ATP 2A2). + abnormalities in calcium pump.
Follicular Keratosis
What hereditary condition in which vitamin A analogs or retinoid are used? Because others has no treatment
Follicular keratosis
It is a white lesion that is related to chronic rubbing or friction against an oral mucosal surface.
Focal ( frictional ) hyperkeratosis
Focal hyperkeratosis has no malignant potentials
True
It is caused by snuff dipping
White lesion associated with smokeless tobacco
White lesion that may cause changes in taste, accelerated periodontal disease, dental abrasion and it may also lead to malignancy
White lesions associated with smokeless tobacco
It is a carcinogen component of smokeless tobacco or snuff
Nitrosonornicotine
White lesions associated with smokeless tobacco are usually located at _____
Mucobuccal fold of the mandible in incisor or molar region/ mandibular vestibular mucosa surrounding tobacco (snuff dipper’s pouch)
This is a common tobacco-related form of keratosis. Associated with pipe and cigar especially those that are reverse smokers
Nicotine stomatitis
White changes and red dots that are usually found in the palate. It has increased risk of malignant transformation for reverse smokers
Nicotine stomatitis
The red dots in the palate of a patient with nicotine stomatitis represent ____
Inflamm of minor salivary glands
Histologic features of this case are :
epithelial hyperplasia and hyperkeratosis
Inflammatory change in minor salivary glands
Squamous metaplasia of excretory duct
Nicotine stomatitis
This white reactive lesion is almost exclusively seen in patient with HIV
Hairy leukoplakia
The most favored site of this lesion is in the lateral aspect of tongue and often bilateral
Hairy leukoplakia
+sometimes involves ventral surface
Give 3 differential diagnosis for hairy leukoplakia:
Idiopathic leukoplakia Frictional hyper keratosis ( tongue chewing ) Leukoplakia assoc with tobacco use Lichen planus LE Hyperplastic candidiasis
Treatment for hairy leukoplakia
None
But for cosmetic reasons: acyclovir, ganciclovir, famciclovir, tretinoin, and podophyllum may be given
It is a filiform papillary overgrowth on the dorsal surface of the tongue of variable color
Hairy tongue
T or F
Hairy tongue has a tendency to become malignant and has not treatment
False
It is a chemical burn or a reaction to a component of toothpaste
Dentifrice-associated slough
Microscopic examination of this lesion shows presence of elongated filiform papillae over the dorsum
Hairy tongue
Geographic tongue is also known as
Erythema migrans
Benign migratory glossitis
It has an unknown etiology but stress can be one of the factors as well as psoriasis.
Geographic tongue
T or F (2 statements)
Geographic tongue is more prevalent in smokers.
Patients with this case experience irritation or tenderness upon consumption of spicy foods and alcoholic beverages.
1st statement is false
2nd statement is true
It is characterized by presence of atrophic patches surrpunded by elevated keratotic margins
Geographic tongue
D/D of geographic tongue
Candidiasis
Leukoplakia
Lichen planus
LE
T or f
Geographic tongue is benign, asymptomatic, and self-limiting.
T
Treatment for symptomatic geographic tongue
Mouth rinse (sodium bicarbonate in water) Topical steroids ( those than contains antifungal agents) Reassure px that it is benign to reduce anxiety
What form of lichen planus is characterized by numerous interlacing white keratotic lines or striae ( Wickham’s striae). It is usually asymptomatic and commonly occurs in the buccal mucosa
Reticular form
Form of lichen planus that has an increased tendency to transform into carcinoma
Erosive form
Form pf lichen planus where it resembles leukoplakia clinically. Primary sites are dorsum of tongue and buccal mucosa
Plaque for,
Form of lichen planus where it commonly occurs on attached gingiva. Patient commonly complains burning, sensotivity, and generalized discomfort
Erythematous form (atrophic)
This form of lichen planus has ulceration in the central area.
Erosive for,
A rarely encountered form of lichen planus and is usually seen in buccal mucosa (posterior and inferiors areas)
Bullae variant
What form of lichen planus is painful?
Erosive form
Ocassionally erythematous
Autoimmune disease involving both humoral and cell mediated arms of immune system
Lupus erythematosus
What part of the oral cavity does DLE commonly occurs?
Buccal mucosa, gingiva, and vermilion
D/D of LE
Lichen Planus
D/D of erythematous gingival lupus erythematosus
Mucous membrane pemphigoid
Erythematous lichen planus
Erythematous candidiasis
Contact hypersensitivity
