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aa BDS M6 - Oral medicine > White lesions > Flashcards

White lesions Flashcards

1
Q

What is this?

A

white sponge naevus

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2
Q

What is the aetiology of white sponge naevus?

A

inherited (autosomal dominant), may also be sporadic

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3
Q

What is the epidemiology of white sponge naevus?

A

rare - 1:200,000; birth/infancy/childhood/adolescence; F=M

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4
Q

What are the signs and symptoms of white sponge naevus?

A

asymptomatic; patient may feel roughness and/or notice white areas

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5
Q

What are the clinical features of white sponge naevus?

A
  • white/greyish white patches which merge with surrounding normal appearing mucosa
  • firmly adherent
  • no associated erythema or ulceration
  • surface is folded, soft and spongy
  • any area of the oral mucosa, variable extent
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6
Q

Is there others site involvement in white sponge naevus?

A
  • oesophageal, nasal, genital, ano-rectal mucosa
  • skin, nails, hair, teeth not affected
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7
Q

How is white sponge naevus investigated?

A
  • diagnosis normally made on clinical grounds =/- family history
  • biopsy if doubt
  • genetic testing for mutation - keratin 4 and/or 13
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8
Q

What id the management of white sponge naevus?

A

explanation of condition, not a potentially malignant disorder

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9
Q

What is this?

A

leukoedema

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10
Q

What s the aetiology of leukoedema?

A
  • ?secondary to low grade mucosal irritation, causing intracellular oedema
  • due to oedema in the epithelial layer of the mucosa
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11
Q

What is the epidemiology of leukoedema?

A

estimates vary from 24% to 90%, wide age range

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12
Q

What are the signs and symptoms of leukoedema?

A

asymptomatic

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13
Q

What are the clinical features of leukoedema?

A

buccal and labial mucosa filmy white/grey appearance, soft on palpation

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14
Q

How is leukoedema investigated?

A

diagnosis normally made on clinical grounds

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15
Q

What is the management for leukoedema?

A

explanation of condition, advice re. potential source of irritation

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16
Q

What is epitheliolysis?

A

oral mucosal peeling - shedding of the superficial layers of epithelium

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17
Q

What is the aetiology of epitheliolysis?

A

secondary to mucosal irritation by toothpaste, mouthwashes

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18
Q

What ingredient probably causes epitheliolysis?

A

probably caused by the irritation from SLS in toothpastes

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19
Q

What is the epidemiology of epitheliolysis?

A

prevalence uncertain, wide age range

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20
Q

What are the clinical features of epitheliolysis?

A

strands of gelatinous milky white material removable by wiping, no significant abnormality of underlying tissue

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21
Q

How is epitheliolysis investigated/diagnosed?

A

diagnosis normally made on clinical grounds

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22
Q

How id epitheliolysis managed?

A

explanation of condition, avoidance of SLS containing products, cease mouthwash use

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23
Q

What is this?

A

traumatic keratosis

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24
Q

What is the aetiology of traumatic keratosis?

A

secondary to physical (frictional), chemical, or thermal irritation
- usually friction when in the mouth, persistent low grade irritation/trauma to the mouth over a longer period of time

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25
Q

What is the epidemiology of traumatic keratosis?

A

prevalence uncertain, wide age range

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26
Q

What are the signs and symptoms of traumatic keratosis?

A

asymptomatic, affected area may feel rough or ridged to the patient’s tongue

27
Q

What are the clinical features of traumatic keratosis?

A

white plaque not removed by rubbing/scraping, may have a shaggy surface, appear macerated or be associated with ridging, clinical appearance should match cause

28
Q

How is traumatic keratosis investigated/diagnosed?

A

diagnosis can be made on clinical grounds, biopsy if cause not clear

29
Q

How is traumatic keratosis managed?

A

explanation of condition, management/removal of cause. if lesion does not resolved - biopsy

30
Q

What key questions should be asked when investigating oral trauma?

A
  • can you or the patient identify a source of trauma?
  • does the lesion have the right appearance?
  • can you remove the presumed source of trauma?
31
Q

What is this?

A

stomatitis nicotina (nicotinic stomatitis)

32
Q

What is stomatitis nicotina a specific type of?

A

specific type of traumatic keratosis

33
Q

What is the aetiology of stomatitis nicotina?

A

smoking related

34
Q

What is the epidemiology of stomatitis nicotina?

A

M>F, 60% pipe smokers, 30% cigarette smokers

35
Q

Is stomatitis nicotina a potentially malignant mucosal disorder?

A

no

36
Q

What are the clinical features of stomatitis nicotina?

A

generalised white/greyish white apparence of the hard palate extending onto the soft palate

soft red dots </= 1mm represent the inflamed openings of minor salivary glands

37
Q

How is stomatitis nicotina investigated/diagnosed?

A

diagnosis made on clinical grounds

38
Q

How is stomatitis nicotina managed?

A

smoking cessation

39
Q

What is the aetiology of of oral lichen planus/lichenoid reactions?

A

unknown in approx. 75% of cases; approx. 25% of cases reaction to medication, dental materials. N.B. other conditions can mimic oral lichen planus e.g. lupus erythematosus, graft versus host disease

40
Q

What is the epidemiology of oral lichen planus/lichenoid reactions?

A

probably affects between 1-2% of population, 1.55% Europe, F>M; wide age range, majority >40yo, can occur in childhood

41
Q

What are the signs of oral lichen planus/lichenoid reactions?

A
  • any site
  • tongue, cheeks and gingivae most commonly affected
  • usually bilateral if lichen planus
  • palatal mucosa rarely affected but may be in lichenoid drug reactions
  • different types, may be a combination fo these present resulting in a mixture of white +/- red +/- ulcerated lesion
42
Q

What are te clinical criteria for orla lichen planus (not lichenoid reactions)?

A
  • multi focal symmetric distribution
  • white and red lesions exhibiting one or more of the following forms:
    • reticular/papular
    • atrophic (erythematous)
    • erosive (ulcerative)
    • plaque
    • bullous
  • lesions are not localised exclusively to the sites of smokeless tobacco placement
  • lesions are not localised exclusively adjacent to and in contact with dental restorations
  • lesion onset does not correlate with the start of a medication
  • lesion onset does not correlate with the use of cinnamon-containing products
43
Q

What is this?

A

reticular lichen planus

44
Q

What is this?

A

papular lichen planus
- slightly raised small papules, may be fused together

45
Q

What is this?

A

gingival lichen planus - desquamative gingivitis

46
Q

What is this?

A

gingival lichen planus - reticular/plaque

47
Q

What is this?

A

plaque lichen planus

48
Q

What is this?

A

atrophic lichen planus

49
Q

What is the classic appearance if the dorsum of tongue is affected by atrophic lichen planus?

A

loss of papillae

50
Q

What is this?

A

bullous lichen planus

51
Q

What is the rarest variant of lichen planus?

A

bullous lichen planus
- blister will rupture leaving behind an ulcer

52
Q

What presentations of lichen planus can be seen here?

A

erosive (ulcerative), atrophic and reticular

53
Q

What is this?

A

erosive lichen planes

54
Q

What is this?

A

erosive lichen planus, multiple sites

55
Q

What are the range of symptoms of oral lichen planus/lichenoid reaction?

A
  • asymptomatic
  • affected area may feel rough
  • soreness only eating e.g. spicy, salty, acidic, rough, hot foods and tooth brushing
  • soreness present at all times exacerbated by above factors
  • symptoms tend to wax and wane in severity
  • stress may be an exacerbating factor
56
Q

What other sites may be involved in oral lichen planus/lichenoid reaction?

A
  • skin
  • scalp
  • nails
  • genital - may be particularly problematic in females - vulvovaginal gingival lichen planus

less commonly:
- oesophagus
- larynx
- anus
- bladder
- eyelids
- lacrimal glands

57
Q

What investigations are done for oral lichen planus/lichenoid reaction?

A
  • diagnosis can be made on clinical grounds if presentation is classical
  • biopsy
  • swab if suspect super-added candida
  • blood tests if associated disease suspected
58
Q

What is this?

A

lichen planus skin lesions

59
Q

What areas are lichen planus skin reactions classically found on?

A

flexor surfaces of wrists/forearms

60
Q

What is this?

A

lichen planus nail involvement, vertical ridges on nails

61
Q

What is this?

A

lichen planus scalp involvement

62
Q

What is the initial non-pharmacological management of lichen planus in primary care?

A
  • explanation of diagnosis
  • ask re. other site involvement and refer if necessary
  • advise that potentially malignant
  • counsel re. smoking cessation and alcohol moderation
  • baseline photographs
  • consider need for referral to secondary care if concerns re:
    • possible malignancy
    • diagnosis
    • ability to manage in primary care
63
Q

Is oral lichen planus a potentially malignant disorder?

A

yes - 1% rate over 10 years

64
Q

What are indicators of orla lichen planus becoming malignant?

A

indicators may include tongue involved tissue, atrophic and erosive pattern but can occur in any type

aa BDS M6 - Oral medicine (4 decks)

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