White lesions

Question 1

What are the possible causes of white lesions

Answer 1

• hereditary
• smoking/frictional
• lichen planus
• lupus erythematosus
• GVHD
• candidal leukoplakia
• carcinoma

Question 2

What is an example of hereditary oral white lesions

Answer 2

white sponge nevus

Question 3

What is smoking/frictional keratosis

Answer 3

irritation to the mucosa
irritation causes thickening of keratin layer
this obstructs the visibility to connective tissue so whiter skin/mucosa

Question 4

What is the structure of the skin

Answer 4

epidermis
dermis
hypodermis

Question 5

What are the layers of epithelium in the skin

Answer 5

stratum corneum
stratum lucidum (thick skin)
stratum granulosum
stratum spinosum
stratum germinativum

Question 6

What are the types of oral mucosa

Answer 6

• masticatory
• lining
• gustatory

Question 7

Describe the features of masticatory mucosa

Answer 7

• subjected to friction and compression
• (para)keratinized
• thick lamina propria

Question 8

Where is masticatory mucosa present

Answer 8

areas of high friction
gingiva & hard palate

Question 9

What is lining mucosa

Answer 9

mobile and distensible
non-keratinized
loose lamina propria and wide sub mucosa
more rapid turnover

Question 10

Where is lining mucosa present

Answer 10

lip, cheeck, floor of mouth, soft palate, ventral surface of tongue

Question 10

Where is lining mucosa present

Answer 10

lip, cheeck, floor of mouth, soft palate, ventral surface of tongue

Question 11

What is gustatory epithelium

Answer 11

similar to masticatory
keratinized (mostly)
present only on dorsum of tongue
characterized by papillae, some containing taste buds

Question 12

Is the vermillion border of the lip keratinized or unkeratinized

Answer 12

keratinized

Question 13

Is junctional epithelium keratinized or unkeratinized

Answer 13

unkeratinized

Question 14

Is sulcular epithelium keratinized or unkeratinized

Answer 14

unkeratinized

Question 15

What is the structure of the oral mucosa

Answer 15

epithelium
lamina propria
submucosa
bone

Question 16

What are the layers of epithelium in the oral epithelium

Answer 16

stratum corneum
stratum grnaulosum
stratum spinosum
stratum germinativum

Question 17

What are the papillae of the tongue

Answer 17

fungiform
filiform
vallate

Question 18

What is parakeratosis

Answer 18

incomplete maturation of epidermal keratinocytes resulting in abnormal retention of nuclei in the stratum corneum

Question 19

What is orthokeratosis

Answer 19

thickening of keratin layer with preserved keratinocyte maturation

Question 20

What is acanthosis

Answer 20

elongation of rete ridges due to thickening of the spinous layer +/- enlargement of rete pegs

Question 21

What are the two reasons behind why white lesions appear white

Answer 21

• thickening of mucosa/keratin
• reduced blood supply in tissues

Question 22

What is leukoplakia

Answer 22

white patch
cannot be wiped off
no other cause attributed

Question 23

What can be used to describe the leukoplakia

Answer 23

is it homogenous or non-homogenous

Question 24

How may homogenous leukoplakia appear

Answer 24

most common uniformly white plaques common in cheek **low malignant potential**

Question 25

How may non-homogenous leukoplakia appear

Answer 25

* nodular, speckles, verrucous * often seen in eroded areas * **high risk of malignant transformation**

Question 26

What % of leukoplakias become malignant

Answer 26

2-5%

Question 27

What sites are high risk for malignant tranformation of leukoplakias

Answer 27

soft palate complex ventrolateral tongue floor of mouth

Question 28

What is keratosis

Answer 28

Increased keratin producing clinical white lesion

Question 29

How does keratosis appear histologically

Answer 29

benign hyperplasia often w/ ortho/para keratosis

Question 30

What are the main two types/causes of keratosis

Answer 30

frictional e.g linea alba tobacco - smoker's keratosis

Question 31

Is keratosis at high risk of malignant transformation

Answer 31

Not really Smoking is a risk factor for OC however

Question 32

What are the main types of candida infection

Answer 32

* pseudomembranous (acute/chronic) * erythematous (acute/chronic) * chronic hyperplastic * angular cheilitis

Question 33

What is acute pseudomembranous candidosis known as

Answer 33

thrush

Question 34

What are predisposing factors to acute pseudomembranous candidosis

Answer 34

* antibiotic use * corticosteroid use * hyposalivation * systemic disease e.g terminally ill px

Question 35

What is the most common organism in acute pseudomembranous candidosis

Answer 35

c. albicans

Question 36

How does acute pseudomembranous candidosis appear clinically

Answer 36

* white plaques which can be wiped off w/ gauze to reveal a raw erythematous and sometimes bleeding base

Question 37

What is chronic hyperplastic candidosis also known as

Answer 37

candidal leukoplakia

Question 38

How does chronic hyperplastic candidosis appear clinically

Answer 38

Persistant white/ speckled red and white lesion

Question 39

What is chronic hyperplastic candidosis characterized by histologically

Answer 39

* parakeratosis * chronic intraepithelial inflammation * fungal hyphae invading superficial layers of epithelium

Question 40

Which type of candida infection has high risk of malignant transformation

Answer 40

* chronic hyperplastic candidosis

Question 41

What is the malignant transformation of candidal leukoplakia

Answer 41

9-40%

Question 42

What is the main species present in chronic hyperplastic candidosis

Answer 42

candida albicans

Question 43

What is the management of chronic hyperplastic candidosis

Answer 43

* control risk factors e.g tobacco/alcohol use * manage iron/folate deficiency * use of antifungals * excision if dysplasia more than mild * regular follow up

Question 44

What is the prescription for candida infection (thrush, candidal leukoplakia, erythematous candidosis)

Answer 44

7 day regimen of: * fluconazole 50mg 7 capsules OR * miconazole gel 20mg/g, pea size amount after food 4 times daily

Question 45

What is the maximum administration of fluconazole for oral candida

Answer 45

14 days

Question 46

Which patients is fluconazole/miconazole contra-indicated in

Answer 46

* warfarin/statin patients

Question 47

If fluconazole/miconazole is contraindicated, what should oral candida patients be prescribed

Answer 47

* nystatin * 100,000 units/ml * 1 ml after food 4 times daily for 7 days

Question 48

How should patients use nystatin

Answer 48

* rinse suspension around mouth * retain near lesion for 5 mins * swallow

Question 49

What is oral herpes usually caused by

Answer 49

HSV1

Question 50

How does oral herpes tend to present

Answer 50

* herpetic stomatitis * fever/malaise * oral vesicles breaking down to leave ulcers * gingival oedema * enlarged cervical lymph nodes

Question 51

When should you refer a white lesion

Answer 51

* be more wary of red and white lesions * if the lesion is becoming more thick and raised, refer * refer if lesion is without cause, especially if in the following areas * 1. lateral tongue * 2. anterior FOM * 3. soft palate