White Lesions Flashcards
White Sponge Nevus
- General aspects
General:
- hereditary autosomal dominant
- appears in childhood, progresses till 2nd decade and becomes stable and persists entire life
White Sponge Nevus
- Clinical
- Oral
Clinically and orally:
- only on mucosa (mostly jugal m.)
- side of the tongue I
- labial mucosa
- floor & alv. mucosa
- corrugated
- spongy
- symmetrical
- size varies depending on one period of time to another
- asymptomatic, painless
- Does not disappear when m. retracted
White Sponge Nevus
- Diagnosis
- Differential Diagnosis
Diagnosis:
- anamnesis
- clinical data
- histo-exam (if px insists)
White Sponge Nevus
- Treatment
Treatment:
- Not needed, because:
- asymptomatic
- painless
- benign
Traumatic Keratosis
(Frictional Hyperplasia)
- General
General:
It’s a projective tissue reaction at the prolonged action of minor traumatic factors
- Thickened white lesion w/local rash
- like the name says caused by local frictional forces
Traumatic Keratosis
(Frictional Hyperplasia)
- Clinical
- Diagnosis
Clinical:
- on jugal mucosa occlusal Pläne of teeth
- lips
- side of tongue
Cause: 1) root rests
2) orthodontic applications
3) sharp edges
4) aggressive lip/cheek biting
5) using edent. ridge for mastication
Diagnosis: clinical exam
Traumatic Keratosis
(Frictional Hyperplasia)
- Treatment
Treatment:
Remove etiological agent
+
follow up
Nicotinic Stomatitis
- General
General:
- Reactive lesion caused by prolonged irritation of heat and chemicals resulted from tobacco burning
- mostly in middle aged men, heavy smokers
Nicotinic Stomatitis
- Clinical
Clinical: 3 stages
1) diffused erythema
2) hyperkeratinized epithelium
3) thicker white-grayish mucosa
- opening of salivary ducts dilate, inflame & Show red small dots (1-5mm)
- ONLY on hard palate
- chronic case: - fissures
- pavement aspect
Nicotinic Stomatitis
- Histopathology
Histopathology:
- thickened epithelium: ^^orthokeratin layer
- moderate acanthosis
- cellular atypia
- salivary ducts: squamous metaplasia and inflammation
Nicotinic Stomatitis
- Treatment
Treatment:
- Quit smoking!
- heals in a long period of time
Solar Cheleitis
(Actinic Chelitis)
- General
General:
- caused by prolonged exposure to solar radiations
- affects ONLY lower lip
- mostly in white men >40 y.o. spending long time outside (farmer, constructor)
Solar Cheleitis
- Clinical
Acute: : Mild keratosis
Solar Cheleitis
- Diagnosis
- Differential Diagnosis
Diagnosis:
- Histopathological exam
- Toluidine blue staining + Biopsy
(Because cancerous lesion)
Differential Diagnosis:
- Exfoliative chelitis (lip biting)
- Allergic chelitis
- Lupus erythema
- Carcinoma
Solar Cheleitis
- Treatment
Preventive Treatment:
- avoid sun
- apply para-amino-benzoic-acid
- Zink oxide and Titanium dioxide
Idiopathic Leukoplakia
- General
Any white stain/ plaque on oral m. that can NOT be removed, by wiping & is not classified into other disease
- it’s a thickening of mucosa through huperkeratinization w/ cancerous potential
Idiopathic Leukoplakia
- Etiology
mainly UNKNOWN
Could be:
Tobacco
Idiopathic Leukoplakia
- Appearance
Location:
- buccal mucosa
-tongue
- palate
- Lips
- floor of the mouth
Size: varies from 0,5 to all oral cavity
Colour: translucent white, white yellow to grey
Surface: neat & homogenous
Thin & friable
Nodular or Stained
VerrucousIdiopathic Leukoplakia
- Forms
Homogenous
&
Non-homogenous:
1. Erythroleukoplakia (red in middle)
2. Nodular leukoplakia (Raspberry like)
3. Verrucous leukoplakia (cowliflower like Tumor)Idiopathic Leukoplakia
- Histopathology
- varied forms of hyperorthokeratosis
- hyperkeratosis
- acanthosis
- mild/medium/high epithelial Dysplasia
- 5% can be invasive carcinomas w/squamous cells
Idiopathic Leukoplakia
- Clinical
non-homogenous:
- 60% present Candida albicans
- 50% present epithelial Dysplasia
»_space; malignant transformation
All lesions:
-4-6% has cancerous tendency
- asymptomatic
- burning sensation when irritant comes in contact with lesions presenting cracks ulcerations, erosions
Idiopathic Leukoplakia
- Differential Diagnosis
- All keratotic lesions
- lichen planus
- leukoedema
- white Sponge Nevus
- chronic hyperplastic candidiasis
Idiopathic Leukoplakia
- Treatment
1) remove irritating factors
2) antifungal therapy 1-2w+ re-evaluation
3) Biopsy (excision)
In case of Dysplastic absence:
-local or systemic adm. of retinoid &
Hairy Leukoplakia
- General
- Etiology
Is a white patch on the side of the tongue in immonucompromised patients eg. HIV patients caused by the Epstein Barr virus
Hairy Leukoplakia
- Clinical aspects and symptoms
Located almost exclusively on the side of the tongue
Hairy Leukoplakia
- Histopathology
Acanthosis and Hyperkeratinization
Hairy Leukoplakia
- Diagnosis
- Differential Diagnosis
Diagnosis:
Anamnesis and Clinical exam
Differential Diagnosis:
- idiopathic leukoplakia
- candidiasis
- Frictional keratosis
- hypertrophic lichen planus
Hairy Leukoplakia
- Treatment
Treatment: is non-specific and
Note that the lesion reappears after treatment is stopped
1) pedophyllin -topical (antiviral/keratolytic)
2) Tretinoin gel/sol. Retin-A + Acyclovir
3) Antiretroviral meds AZT (HIV treatment)
Zidovudine
Hairy Tongue
- General
- Etiology
Hairy tongue is when a buildup of filiform papillae forms on the tongue, creating a layer of “hair”.
HYPERTROPHY & Elongation of filiform papillae on the dorsal side of tongue.
In adults it is also called black tongue.
The Etiology is unknown
Hairy Tongue
- predisposing factors
- Long Time use of antibiotics
- systemic corticosteroid therapy
- oxidant mouthwash agents
- salivary pH modification
- intense smoking
- poor oral hygiene
- Candida albicans infection
Hairy Tongue
- Diagnosis
Clinical Data + view
Hairy Tongue
- Treatment
1) scraping w/wooden spatula
2) mouthwash(hydrogen peroxide & Zink oxide
3)
Geographic tongue
- General
- Etiology
- Benign inflammatory condition caused by dekeratinization and desquamation of filiform papillae
- Etiology unknown; predisposing factors: emotional stress, nutritional def., hereditary
- 2% teenagers and young adults, mostly women and teenager
