White Lesions

Question 1

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

Answer 1

Leukoplakia

Question 2

due to absorption of nicotine from smokeless tobacco

Treatment: Cessation of smokeless tobacco.

Answer 2

Snuff dippers lesion

Or

Tobacco pouch keratosis

Or

Smokeless tobacco keratosis

Question 3

risks of smokeless tobacco

Answer 3

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.

Question 4

common in 90% of black adults
developmental

faint grayish-white, opalescent mucosa
bilateral buccal mucosa; labial mucosa

stretch cheek to diagnose

no treatment

Answer 4

Leukodema

Question 5

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

Answer 5

traumatic white lesion/keratosis

Question 6

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

Answer 6

Linea Alba (frictional keratosis)

Question 7

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

Answer 7

chemical burns (traumatic white lesions)

Question 8

treated with topical or systemic anti fungal medication for 2 weeks usu. produces resolution

Answer 8

Pseudomembranous candidiasis/ Thrush

Question 9

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

Answer 9

fordyce granules

Question 10

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

Answer 10

Pseudomembranous candidiasis/ Thrush

Question 11

1-5 years to develop
young adults and >65 years old
grey or grey-white translucent plaque
VESTIBULE pouch

Answer 11

Snuff dippers lesion

Or

Tobacco pouch keratosis

Or

Smokeless tobacco keratosis

Question 12

Pain is absent. 
Histologic examination reveals hyperkeratosis. 
Chronic mechanical irritation
Roughened keratotic surface
Hyperplastic response "mucosal callus"
Reversible after elimination of trauma

Answer 12

frictional keratosis

Question 13

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

Answer 13

Leukoplakia

Question 14

rippled; “wet sand” effect when not distended

chevrons

Answer 14

Snuff dippers lesion

Or

Tobacco pouch keratosis

Or

Smokeless tobacco keratosis

Question 15

due to hot foods or beverages
palate or posterior buccal mucosa
remnant of necrotic epithelium give white/yellow color
erythematous rim

Answer 15

thermal burns (traumatic white lesion)

Question 16

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

Answer 16

Morsicatio buccarum
(morsicatio linguarum when in tongue)

(also a type of frictional keratosis)

Question 17

• underlying mucosa is normal or erythematous

- due to exposure to broad spec antibiotic or impaired immunity

Answer 17

Pseudomembranous candidiasis/ Thrush

Question 18

Name white lesions that CANNOT be SCRAPED off

Answer 18

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

Question 19

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

Answer 19

(reticular) lichen planus

Question 20

treatment for Snuff dipper’s lesion

when is biopsy required ?

Answer 20

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

Question 21

multiple discrete keratotic papule with depressed red centers (dilated and inflamed excretory duct openings of minor salivary glands
COBBLESTONE appearance of the palate

Answer 21

nicotine stomatitis “smoker’s palate”

Question 22

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

Answer 22

nicotine stomatitis “smoker’s palate”

Question 23

Name all the white lesions that can be SCRAPED off

Answer 23

pseudomembranous candidiasis/thrush
traumatic white lesions/keratosis
thermal burns
chemical burns