White Lesions Flashcards
white patch/plaque which cannot be removed by scraping
diagnosis by exclusion
clinical term; does not imply specific histopathology
not associated with specific histopathological diagnosis
Leukoplakia
due to absorption of nicotine from smokeless tobacco
Treatment: Cessation of smokeless tobacco.
Snuff dippers lesion
Or
Tobacco pouch keratosis
Or
Smokeless tobacco keratosis
risks of smokeless tobacco
Long-term use of smokeless tobacco is associated with loss of gingival and periodontal tissue, destruction of facial surface of alveolar bone, sugar content leads to dental caries, enamel and cementum staining, and halitosis.
Risk of squamous cell carcinoma, verrucuous carcinoma.
common in 90% of black adults
developmental
faint grayish-white, opalescent mucosa
bilateral buccal mucosa; labial mucosa
stretch cheek to diagnose
no treatment
Leukodema
acute trauma can produce white peeling or corrugated lesion
caused by physical or chemical irritants
appear as white patches with diffuse or irregular borders, underneath is raw, red, or bleeding
moveable mucosa more susceptible than attached
treatment: remove cause
traumatic white lesion/keratosis
Bilateral white line on buccal mucosa
2nd molar to canine region
Often associated with crenated tongue and may be a sign of pressure, bruxism, clenching, or sucking trauma
It develops in response to frictional activity of the teeth, which results in thickened (hyperkeratotic) epithelial changes
Hyperkeratosis of epithelium at inter-occlusal line
Treatment: No treatment required
Linea Alba (frictional keratosis)
caused by medications (aspirin, OTC, tooth whitening agents containing OTC)
acid etch materials, dental cavity varnishes (failure to use rubber dam)
short duration leads to white, wrinkled mucosa
increased duration leads to necrosis
remove necrotic material reveals red, bleeding CT
keratinized mucosa more resistant than non-keratinized
superficial necrosis resolves without scaring
chemical burns (traumatic white lesions)
treated with topical or systemic anti fungal medication for 2 weeks usu. produces resolution
Pseudomembranous candidiasis/ Thrush
sebaceous glands on oral mucosa; ectopic (since sebaceous glands are usu. on skin)
80% of population (so its prob normal anatomic variation)
Buccal mucosa; vermillion of upper lip
Multiple, yellow, yellow-white papules. They usually occur in multiples, forming clusters, plaques, or patches.
usu. adults, asymptomatic
No treatment
fordyce granules
cottage cheese, curdled milk appearance
tangled masses of hyphae, desquamated epithelial cells, debris
plaques on buccal mucosa/soft palate/ dorsal tongue
usu. asymptomatic
could have unpleasant taste,
blisters are plaques
Pseudomembranous candidiasis/ Thrush
1-5 years to develop
young adults and >65 years old
grey or grey-white translucent plaque
VESTIBULE pouch
Snuff dippers lesion
Or
Tobacco pouch keratosis
Or
Smokeless tobacco keratosis
Pain is absent. Histologic examination reveals hyperkeratosis. Chronic mechanical irritation Roughened keratotic surface Hyperplastic response "mucosal callus" Reversible after elimination of trauma
frictional keratosis
Includes benign, precancerous, malignant lesions. Most (80%) are benign; the rest are dysplastic (premalignant) or cancerous.
Malignant = 4-47% transformed (low due to excision)
Oral precancer = 85% of these lesions
Leukoplakia
rippled; “wet sand” effect when not distended
chevrons
Snuff dippers lesion
Or
Tobacco pouch keratosis
Or
Smokeless tobacco keratosis
due to hot foods or beverages
palate or posterior buccal mucosa
remnant of necrotic epithelium give white/yellow color
erythematous rim
thermal burns (traumatic white lesion)
buccal OR labial mucosa, unilateral or bilateral
can occur at any age
Initially, slightly raised irregular white plaques appear in a diffuse pattern that cover areas of trauma. Increased injury produces a hyperplastic response that increases the size of the plaque. A linear or striated pattern is sometimes observed that contains thick corrugated areas and intervening zones of erythema. Persistent injury leads to an enlarging plaque with irregular zones of traumatic erythema and ulcerations/erosions
Treatment: No treatment required; stop biting
Morsicatio buccarum
(morsicatio linguarum when in tongue)
(also a type of frictional keratosis)
- underlying mucosa is normal or erythematous
- due to exposure to broad spec antibiotic or impaired immunity
Pseudomembranous candidiasis/ Thrush
Name white lesions that CANNOT be SCRAPED off
frictional keratosis (traumatic white lesions, morsicatio buccarum, linea alba)
fordyce granules
leukoderma
reticular lichen planus
nicotine stomatitis
snuff dippers lesion/tobacco pouch keratosis/smokeless tobacco keratosis
leukoplakia
autoimmune, usu. middle aged women
more common form is “reticular”
ASYMPTOMATIC
posterior buccal bilaterally, lateral dorsal tongue, gingiva, palate
named for interlacing white lines (Wickham’s striae)
may appear as plaques or atrophy on dorsum of tongue
most affected sites is buccal mucosa
Tongue, lips, palate, gingiva and floor of mouth may also be affected
bilateral, and relatively symmetric lesions are common
(reticular) lichen planus
treatment for Snuff dipper’s lesion
when is biopsy required ?
stop using smokeless tobacco
translucent or early lesions will dissolve
biopsy if granular, nodular, densely white , ulcerated, indurated, hemorrhagic, and if persists 2-6 weeks after habit cessation
translucent or early lesions will dissolve
multiple discrete keratotic papule with depressed red centers (dilated and inflamed excretory duct openings of minor salivary glands
COBBLESTONE appearance of the palate
nicotine stomatitis “smoker’s palate”
not premalignant
males >45 years old
diffuse, grey white posterior palate
usually due to pope smoking (due to heat, not chemicals)
severity correlated with intensity and duration of smoking
treatment: stop smoking
biopsy: not/rarely needed
nicotine stomatitis “smoker’s palate”
Name all the white lesions that can be SCRAPED off
pseudomembranous candidiasis/thrush
traumatic white lesions/keratosis
thermal burns
chemical burns
