White Lesions Flashcards
Common oral mucosa condition of unknown cause
Leukoedema
Occurs more commonly in black than in whites - ethnic predisposition
Leukoedema
Characterized by a diffuse, gray-white, milky, opalescent appearance of the mucosa
Leukoedema
Surface frequently appears folded, resulting in wrinkles or whitish streaks
Leukoedema
Occurs bilaterally on the buccal mucosa and may extend forward onto the labial mucosa
Leukoedema
White appearance greatly diminishes or disappears when the cheeks is everted and stretched
Leukoedema
Treatment for leukoedema
None
An autosomal dominant inherited condition where there is a point mutation for genes coding for keratin 4 and / or 13
White sponge nevus
Cannon’s disease
White sponge nevus
Asymptomatic, folded, white lesions may affect several mucosal sites
White sponge nevus
Symmetrical, thickened, white, corrugated or velvety, diffuse plaques affect the buccal mucosa bilaterally
White sponge nevus
Usually appears at birth or in early childhood, typically before puberty
White sponge nevus
Treatment for white sponge nevus
None
A rare Autosomal dominant inherited condition primarily affect descendants of a triracial isolate or people who originally lived in north Carolina
Hereditary benign intraepithelial dyskeratosis
Usually develop during childhood, in most instances affecting the oral and conjunctival mucosa
Hereditary benign intraepithelial dyskeratosis
Oral lesions consists of soft, asymptmatic, white folds and plaques of spongy mucosa
Hereditary benign intraepithelial dyskeratosis
Areas involved buccal and labial mucosa and the labial commissures, as well as the floor of the mouth and lateral surfaces of the tongue, gingiva, and palate
Hereditary benign intraepithelial dyskeratosis
Most interesting feature of hereditary benign intraepithelial dyskeratosis
Ocular lesions
Appears as thick, opaque,gelatinous plaques affecting the bulbar conjunctiva adjacent to the cornea and sometimes involving the cornea itself
Hereditary benign intraepithelial dyskeratosis
May experience photophobia
HBID
Ocular lesion vary seasonally, with spontaneous shedding of conjunctival plaques
Hereditary benign intraepithelial dyskeratosis
Blindness may sometimes result from the induction of vascularity of the cornea secondary to the shedding process
HBID
Treatment for HBID
Oral lesion - none
Ocular lesion - refer to ophthalmologist ( plaques thatt obscure must be surgically excised )
Witkop’s disease, witkop-von sallmann syndrome
Hereditary benign intraepithelial dyskeratosis
Darier’s disease, darier-white disease
Follicular keratosis
Autosomal dominant disorder result in desmosomal defects and dysfunction by way of altered epithelial cell adhesion
Follicular keratosis
Gene Mutation of follicular keratosis
ATP2A2 on chromosome 12q23-24,
( a gene that encodes the sarcoplasmic/endoplasmic reticulum calcium-adenosine triphosphate (Ca21-ATPase) isoform2 )
Numerous erythematous, often pruritic, papules on the skin of the trunk and the scalp that develop during the first or second decade of life
Follicular keratosis
Accumulation of keratin, producing a rough texture, may be seen in association with the lesions, and a foul odor may be present as a result of bacterial degredation of the keratin
Follicular keratosis
Sensitivity in patients who have follicular keratosis will result in sweating because of increased heat, which can induce more?
Epithelial clefting
Palms and soles often exhibit pits and keartoses
Follicular keratosis
Nails show longitudinal lines, ridges, or painful splits
Follicular keratosis
Multiple, normal-colored or white, flat-topped papules that, if numerous enough to be confluent, result in a cobblestone mucosal appearance
Follicular keratosis
Treatment of follicular keratosis
Topical corticosteroids and vitamin A
In photosensitive patients - sunscreen, minimize exposure to hot environments
Chronic rubbing or friction against an oral mucosal surface
Focal (frictional) hyperkeratosis
Edentulous ridges and vestibules for denture wearers
Focal (frictional) hyperkeratosis
Common site of frictional hyperkeratosis
Buccal
Lips
Lateral tongue
Hyperkeratosis results in opacification of traumatized area
It is without dysplastic change
Focal (frictional) hyperkeratosis
Treatment of frictional hyperkeratosis
Control of habit results in clinical improvement
Direct contact of mucosa with smokless tobacco and contaminants
White lesion associated with smokeless tobacco
Most commonly seen in the mandibular vestibular mucosa surrounding tobacco
What is it called
Snuff dipper’s pouch
Asymptomatic white lesion in mucosa where tobacco is held
Damage seen in adjacent teeth and periodontum
WL associated with smokeless tobacco
Common tobacco related form of keratosis
Nicotine stomatitis
Opacification of the palate caused by heat and carcinogens
Nicotine stomatitis
Most severe changes seen in patients who “reverse smoke”
Nicotine stomatitis
Generalized white changes (hyperkeratosis) seen in hard palate
Nicotine stomatitis
Red dots in palate represents inflamed salivary duct orifices
Nicotine stomatitis
Treatment of nicotine stomatitis
Discontinue tobacco habit
Associated with local or systemic immunosuppression (AIDS, organ transplantation)
Hairy leukoplakia
Opportunistic infection f hairy leukoplakia
Epstein barr virus
Usually indicates significant underlying immunosuppression
Hairy leukoplakia
Hairy leukoplakia may be secondarily infected by ?
Candida albicans
Treatment for hairy leukoplakia
None
Antivital and antiretroviral regresses the lesion
Condition of filiform papillary overgrowth
Hairy tongue
Believed to be related to alterations in oral flora
Hairy tongue
Initiating factors of hairy tongue
Use of broad spectrum antibiotics
Systemic corticosteroids
Hydrogen peroxide
Intense smoking
Head and neck therapeutic radiation
Dense hair-like mat formed by hyperplastic papillae on the dorsal tongue surface
Can contribute to bad breath
Hairy tongue
Treatment of hairy tongue
Removal of causative agent and improved oral hygiene
Often result from ingestion of hot foods or liquids
Thermal burns
Treatment of thermmal burn
Resolve without treatment within 1-2 weeks
Common site of thermal burns
Anterior tongue, palate, posterior buccal mucosa
Caused by exposure t various types of chemical substances - topical anesthesia, aspirin, dentirifice, mouthwash, hydrogen peroxide
Chemical burns
Iatrogenic cause of chemical burn
Mishandling of dental instruments and materials
Overexposure of UV light
Represents a premalignant lesion
Actinic cheilitis and actinic keratosis
Atrophic, finely wrinkled and often swollen appearance of lip
Possible presence of white and/or pigmented foci
Actinic cheilitis
Poorly defined vermilion-skin junction
Possible chronic ulceration in more severely damaged lips
Actinic cheilitis
Treatment of actinic cheilits and actinic keratosis
Avoid direct sunlight
Use sunscreen
Biopsy of persistent ulcers and indurated lesions
Surgery needed in problematic cases
Condition typically involes the skin of sun exposed areas
Which
Shows irregular macules or plaques with rought, scaly surfaces
Actinic keratosis
“Sandpaper-like” texture is readily evident upon palpation
Actinic keratosis
White path or plaque that cannot be characterized clinically o pathological as any other disorder; it carries an increased risk of cancer development either in or close to the area or elsewhere in the oral cavity or the head and neck region
Idiopathic leukoplakia
Irreversile, non-scrapable and slightly raised white plaque that may have a wrinkled, leathery to “dry or cracked-mud” appearance
Idiopathic leukoplakia
Type of idiopathic leukoplakia
Regular, smooht whitish surface and well defined margins
Homogenous type
Type of IL
Conists of an erythematous part or a nodular, erosive, ulcerated or verrucous exophytic component
Non-homogenous IL
IL that is lesion is predominantly white
IL that is elevated, proliferative or corrugated surface
IL that is small polypoid enlargements or rounded mostly white excresences
- Speckled type
- Verrucous leukoplakia
- Granular or nodular type
A type of IL that is characterized by the development of multiple, slowly spreading, keratotic plaques, with rough surface projections
Proliferative verruous leukoplakia
Erythema migrans benign migratory glossitis
Geographic tongue
Incidental finding
Common inflammatory condition
Appears as red atrophic patches surrounded by hyperkeratotic margins
Geographic tongue
Where does geographic tongue usally located at
Dorsum and lateral surface of tongue
Pattern change with time (migratory glossitis)
Geographic tongue
Geographic tongue is often seen in company with?
Fissured tongue
Treatment of geographic otngue
None
When painful, baking soda rinses, antifungals, or topical corticosteroid
Chronic mucocutaneous disease of unknown cause
Lichen planus
Generally considered to be immunological mediated process taht microscopically resembles a hypersensitivity reaction
Lichen planus
White keratoic striae characteristic
Lichen planus
Types of lichen planus
Reticular form
Erosive form
Atrophic form
Plaque form
Papular form
A type of lichen planus that has a slight increase possible risk of carcinoma
Erosive form of lichen planus
Wickham’s striae is commonly seen in?
Lichen planus - reticular form
Tends to resemble leukoplakia clinically
Lichen planus - plaque form
Appears as red patches with very fine wite striae
May complain of burning, sensitivity and generalized discomfort
Lichen planus - atrophic form
Central area of lesin is ulcerated
Shows keratotic striae peripheral to the site of erosion, along with erythema
Lichen planus - erosive form
Autoimmune disease involving both humoral and cell-mediated arms of the immune system
Lupus erythematosus
A type of LE that commonly appear on the skin, commonly on the face and scalp
Oral and vermillion lesions are seen - usually in the company of cutaneous lesions
Lesion appears as DISC-SHAPED erythematus plaques with hyperpigmented margins on the skin
Discoid lupus erythematosus
As the lesion expands peripherally, the center heals, and formation of scar and loss of pigment
Discoid lupus erythematosus
Skin results in an erythematous rash, classically seen over molar processes and the bridge of the nose
Butterfly rash
Systemic lupus erythematosus
Treatment for lupus erythematosus
DLE - topical corticosteroids
SLE - systemic steroids
Antimalarials and NSAID may help control this disease
Common opportunistic oral mycotic infection
Candidiasis
Most common oral fungal infection in humans
Candidiasis
Candidiasis is caused by ___
Candida albicans
Most common clinical type of candidiasis
Acute psedomembranous form (aka thrush)
Soft plaques that sometimes grow centrifugally and merge.
Plaque is composed of fungal organisms, keratotic debris, inflammatory cells, desquamated epithelial cells, bacteria, and fibrin
Favored site include the buccal mucosa and mucobuccal folds, oropharynx, and lateral aspect of tongue
Creamy0white plaques removable; burning sensation foul taste
Acute pseudomembranous form ( thrush )
Commonly seen in geriatric individuals who wear complete maxillary dentures
Bright red, velvety to pebble surface, with little keratinization
Rd, asymptomatic
Chronic erythematous candidiasis
Denture stomatitis
This condition is prevalent in individuals who have deep folds at the commissures as a result of mandibular overclosure
Red, fissured lesions, irritated, raw feeling
Angle of mouth
Angular cheilitis
Red macules, burning sensation
Dorsum of tongue, posterior hard palate
Erythematous oral candidiasis
Red atrophic mucosal areas; asymptomatic
Midline posterior dorsal tongue
Has an oval or rhomboid outline with a paramediandistribution
Central papillary atrophy ( median rhomboid glossitis )
Treatment of oral candidiasis
topical and systemic
Topical - nystatin
Systemic - fluconazole, ketoconazole ( cant be use to patients with xerostomia kay naay sugar)
Chronic, precancerous and often debilitating condition
Oral submucous fibrosis
General nutritional or vitamin deficiencies and hypersensitivity to various dietary constituents
Oral submucous fibrosis
Chief complain of oral submucous fibrosis
Trismus - inability to open the mouth
Stomatopyrosis - intolerance to spicy food
Vesicles, petechiae, melanosis, xerostomia and stomatopyrosis is the first sign and symptom?
Oral submucous fibrosis
Sebaceous glands that occur on the oral mucosa
Appear as multiple yellow or yellow-white papules
Common in buccal mucosa and the lateral portion of the vermillion of the upper lip
Fordyce’s granules
Arise from dental lamina remnants (rests of serres)
Gingival cyst
Soft tissue counterpart of lateral periodontal cyst
Gingival cyst
Gingival cyst of newborn
1
2
Epstein’s pearls - midline of the palate
Bohn nodule - laterally on the hard and soft palate
Gingival cyst treatment
Newborn
Adult
Newborn - none
Adult - surgical excision
Mass of subacutely inflamed granulation tissue at the sinus tract
“Gum boil”
Parulis
Mass of granulation tissue at the gingiva/alveolar mucosa at the opening of a sinus tract
Parulis
Cause of parulis
Odontogenic or periodontal infection
Benign tumor of fat
Lipoma
Cells of lipoma
Adipose cells
Most common true neoplasm o mesenchymal origin
Common location are buccal mucosa, tongue and floor of the mouth
Lipoma
Usually soft, smooth-surfaced nodular masses that can be sessile or pedunculated
Asymptomatic
Lipoma
Treatment of lipoma
Conservative Local excision
