White Lesions Flashcards
Why does an oral lesion look white?
- Edema in the tissue
- Necrosis - variable thickness, +/- removable
- Superficial coatings - removable
- Keratin - more or change in type
- Thickening of the epithelium
Describe features of edema and the lesions it’s associated with
Disappears with stretching
-Leukoedema: buccal mucosae
Describe features of extrinsic coatings (organisms) and the lesions it’s associated with
+/- removable
-Coated and hairy tongue
-Plaque
-Candida: burning/irritated sensation- can also be red
Describe features of thermal or chemical injury and the lesions it’s associated with
Leads to cauterized or superficial sloughed epithelium: +/- removable
-Toothpaste, mouthwash
Describe features of increased Keratin and/or epithelial thickening and the lesions it’s associated with
Non-removable
-Frictional keratosis: linea alba, tongue/cheek chewing, alveolar ridge
-Smokeless tobacco keratosis
-Hairy Leukoplakia: immunosuppression
-Leukoplakia
Why do we care about white lesions?
-Some require no tx
-Others are easily treated
-Exclude precancerous change and systemic disease (HIV or inherited condition)
Linea Alba
-“white line”
-Non-removable, white line along the occlusal plane
-Caused by chronic, low-grade, frictional trauma
-Recognize - no tx
Leukoedema
-Asymptomatic
-Non-removable, opalescent/pale white appearance of the buccal mucosa that diminishes when stretched
-More common in black adults and smokers
-Recognize - no tx
What are the key questions for Leukoedema?
-Is it removable?
-Does it disappear when stretched?
-Is it on the other side?
-Is it asymptomatic?
Coated Tongue
-Very common white coating on the dorsal tongue
-May have malodor
-Can be misdiagnosed as candidiasis
-Tx: scrape tongue
Hairy Tongue
-Elongated, discolored, filiform papillae
-Associated with smoking
-Discoloration (brown, black, green, yellow) due to bacteria, food stains, tobacco
-Asymptomatic or gagging if long. Bad taste
-Tx: brush tongue and stop smoking to reduce lesions
Dentifrice-Associated Slough
-Common, often related to tartar-control, whitening, sensitivity-control, multi-care toothpaste or overuse of mouthwash
-Mild peeling, sloughing of superficial keratin layers, labial/buccal mucosa and floor of mouth, usually asymptomatic
-Bland toothpaste formula may be helpful
Morsicatio (cheek/tongue chewing)
-White, ragged, non-removable but possibly partially peeling surface texture
-Labial and anterior buccal mucosa and lateral tongue
-Caused by chronic, low-grade, frictional trauma
-Management:
1. Recognize - typically no tx, unless extensive which might require biopsy to exclude premalignant changes
2. Pt. education and possible occlusal guard
Alveolar Ridge Keratosis
-Look for asymmetry, spread off the ridge, erythema or ulceration to warrant biopsy
-Study with 477 cases: 97.9% lacked dysplasia. The 2.1% dysplastic cases contained 1+ of the following: verrucous appearance, tobacco or alcohol use, multiple white lesions and previous SCC
Nicotine Stomatitis
-White keratotic change induced by heat of tobacco smoking or hot beverages
-Posterior hard palate, soft palate
-Elevated papules with ed center (orifices of minor salivary gland cducts) and white borders
-Not precancerous; resolution in 1-2 weeks following habit cessation
