White Lesions Flashcards
1
Q
White surface lesions are divided into 3 groups based on their clinical features:
A
-
Epithelial thickening
- Asymptomatic, rough, do not rub off
-
Surface debris
- Symptomatic, rub off, underlying erythema
-
Subepithelial lesions
- Asymptomatic, smooth palpation, translucent
2
Q
Keratinized tissues
A
- Tongue
- Hard palate
- Attached gingiva
- Outer lip (past vermillion border)
3
Q
Non-keratinized tissues
A
- Everywhere else that isn’t the tongue, hard palate, attached gingiva, or outer lip (past vermillion border)
- Buccal mucosa
- Labial mucosa
- Soft palate
- Floor of the mouth
4
Q
What gives white lesions their color?
A
Excessive keratin build up
5
Q
White Sponge Nevus
A
Familial Epithelial Hyperplasia
- Autosomal Dominant inheritance
- Mutation of keratin genes
- Abnormal keratin production
- Presents as multiple white rough surface lesions throughout the oral cavity
- May involve anal and genital mucosa
- Appears in early childhood
- Not malignant
- Tx: None
6
Q
Frictional Keratosis
A
- Related to chronic rubbing or friction
- Anywhere in the oral cavity
- Careful history taking and examination sufficient for dx
- Tx: Lesion should resolve or reduce after removal of causative agent. Otherwise, no tx needed
7
Q
Hairy Tongue
A
- Represents elongation of filiform papillae due to accumulation of keratin on the dorsum of the tongue
- Associated with lack of mechanical abrasion to tongue
- Tx: Brush/scrape tongue
- Px: Good
8
Q
Hairy Leukoplakia
A
- Epithelial thickening of the lateral surfaces of the tongue
- Present in immunocompromised patients i.e. HIV, AIDS, transplant patients, etc
- Tx: None, other than to determine the immune status of the patient
- Px: Indicates poorly functioning immune system
9
Q
Lichen Planus
A
- Common dermatologic disease that often affect oral mucosa
- Oversensitivity rxn of T lymphocytes
- Most patients are middle-aged adults; 3:2 F:M
- Skin features sometimes present:
- Planar
- Purple
- Pruritic
- Polygonal
- Plaque
- Papule
- Oral features
- Lesions are multifocal; typically bilateral on the buccal mucosa
- Reticular Pattern
- Erosive Pattern
- Lesions are multifocal; typically bilateral on the buccal mucosa
10
Q
Lichen Planus: Reticular Pattern
A
- Wickham’s Striae: white lacy pattern with underlying erythema
- White plaques sometimes present
- Asymptomatic and are not tx’d
- More common form
- Multifocal lesions; usually bilateral
- Wax and wane over wks/mos
- Tx: If burning, rx topical corticosteroid
11
Q
Lichen Planus: Erosive Pattern
A
- Central area of ulceration that is painful
- Areas of pseudomembrane centrally may be present
- Multifocal; usually bilateral
- Wickham’s striae may be present
- Less common, but more significant and painful
- Central erosion/pseudomembrane w/ erythema and possibly Wickham’s striae
- May present as desquamative gingivitis
- Tx: Topical corticosteroids. Flare-ups require reapplication of drugs or prophy tx. Severe cases rx systemic corticoid tx
12
Q
Leukoedema
A
- Common, asymptomatic, variation of normal
- White, opalescent, filmy, folded surface, does not rub off, rough
- Distribution: bilateral buccal mucosa
- More common in AA vs. more easily recognized in AA population
- Dx clinically: white appearance decreases when tissue is stretched
- Tx: None
13
Q
Erythema Migrans
A
- AKA geographic tongue, benign migratory glossitis
- Commonly seen on anterior 2/3 of tongue and ventral and lateral surfaces
- Red patches with white border
- Due to atrophy of filiform papillae w/ elevated white border
- Presents as multiple, well-demarcated, irregular red patches with sharply defined, tortuous, yellow-white border
- Lesions resolve in some areas and appear in other areas = migratory
- Usually asymptomatic
- Can be associated with burning sensation
- Cause is unknown
- Tx: None. Topical steroids for symptomatic lesions
14
Q
Lichenoid Mucositis/Rxn
A
-
Looks like lichen planus bc of inflammation in the mucosa
- Clinical and microscopic findings are similar
- Causes
- Rxn to flavoring agents (cinnamon, mint, etc)
- Rxn to medicine
-
Graft vs. Host Disease
- Immune system is attacking the host
- Can be focal or multifocal
15
Q
Nicotinic Stomatitis
A
- Present on hard palate of smokers - mainly pipe or cigar
-
Almost no potential (on hard palate) for transformation to squamous cell carcinoma
- Response to heat rather than chemicals
- Tx: None needed
- Reverse Smoker’s Palate = pronounced nicotinic stomatitis
- Significant risk of dysplasia or carcinoma
16
Q
Linea Alba
A
- Common alteration of buccal mucosa
- Pressure, frictional irritation, sucking trauma from facial surfaces of the teeth
- Usually bilateral
- Tx: N/A
17
Q
Morsicatio Buccarum
A
-
Chronic cheek chewing
- Labial mucosa = morsicatio labiorum
- Tongue = morsicatio linguarum
- Usually bilateral
- Tx: N/A
- Lateral acrylic shields connected by steel wire
20
Q
Oral thrush - Pseudomembranous Candidosis
A
- White plaques rub off, leaving an erythematous base
- Best recognized form
- Pain or burning sensation
- Often associated w/ xerostomia, abx, and/or decreased host resistance
- Common opportunistic oral mycotic infection
- Most common oral fungal infection in humans
- Component of normal oral microflora
- Predisposing factors
- Immunodeficiency; acquired immunosuppression; endocrine disturbances; diabetes mellitus; corticosteroid tx; systemic abx tx; xerostomia; poor OH
22
Q
Burn
A
- Heat, cold, chemicals
- Area of yellow-white epithelial necrosis
- Supporting hx
23
Q
Chemical Injury
A
- Chemicals/drugs in prolonged contact w/ oral tissues
- Pain in area of application
- Children/psychiatric pts may hold meds in their mouth
- Topicals for pain can compound the problem
24
Q
Dentrifice-Associated Slough
A
- Painless, gray-white gelatinous membranes on gingiva, vestibule, floor of mouth and lips
- Most obvious in the morning
- Associated w/ SLS and pyrophosphates found in some dentrifices and mouth rinses
- May cause burning sensation
28
Q
Subepithelial Fibrosis (Scar)
A
- Usually poorly defined
- H/o injury or surgery
- Tx: N/A
29
Q
Fordyce Granules
A
- Represent ectopic sebaceous glands
- Yellow-granular plaques and nodules present in clusters
- Most commonly located on the buccal mucosa & lip
- Dx based on clinical basis
- Tx: N/A
