White Lesions Flashcards by BUENO, Theresa Grace

It presents a white soft plaque that can be wiped off leaving a painful erythematous eroded, ulcerated surface.

Acute Pseudomembranous Candidiasis

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This is a common opportunistic oral mycotic infection that develops in the presence of one of several predisposing conditions.

Candidiasis

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Give atleast 5 predisposing factors in which Candida albicans can produce a disease state (candidiasis)

Immunodeficiency 
Diabetes mellitus
Pregnancy
Xerostomia
Poor oral hygiene

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It is the most common clinical type of candidiasis

Acute pseudomembranous candidiasis

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What are the favored sites of acute pseudomembranous candidiasis

Buccal mucosa
Mucobuccal folds
Oropharynx
Lateral aspect of tongue

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Acute erythematous candidiasis is also known as _____

Antibiotic stomatitis

Antibiotic glossitis

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This type of candidiasis commonly occurs in geriatric patients who wears complete maxillary dentures

Chronic erythematous candidiasis

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This type of candidiasis has bright red, somewhat velvety to pebbly surface, with relatively little keratinization

Chronic erythematous candidiasis

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This case is usually seen in individuals with denture-related candidiasis

Angular cheilitis

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True of False

Chronic Candidal Infections are capable of producing a hyperplastic tissue response.

True

Chronic hyperplastic Candidiasis

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Type of hyperplastic candidiasis that involves the dorsum of the tongue

Median rhomboid glossitis

Asymptomatic
found anterior to circumvallate papillae

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Chronic candidiasis may give rise to leukoplakia.

And this indicates that CC is a precancerous state

1st statement is true

2nd statement is false

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If seen microscopically, fungal hyphae are seen penetrating the upper layers of epithelium at acute angles

Acute candidiasis

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Type of candidiasis where epithelial hyperplasia can be seen during microscopic examination

Chronic candidiasis

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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

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Superficial burn in the oral mucosa that is caused by topical applications of chemicals

Mucosal burns

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Mucosal Burns

Short term:
Long term exposure:

Short term: mild erythema

Long term exposure: white slough

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The primary factor of this condition is chewing of areca (betel) nuts.

Submucous fibrosis

+ it is also caused by nutritional and vitamin deficiency

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True or False

Oral submucous fibrosis is a premalignant disorder

True

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What vitamin and mineral is deficient in persons with oral submucous fibrosis?

Vitami B complex

Iron

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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

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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

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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

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Oral submucous fibrosis will progress to _____

Squamous cell carcinoma

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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.

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