white lesions part 1 (developmental and reactive) Flashcards
clinical presentation of fordyce granules
- ectopic sebaceous glands on oral mucosa
- multiple
- small (1-2mm)
- white or yellow white papules
- asymptomatic
2 types of developmental white lesions
1) fordyce granules
2) leukoedema
3 locations of fordyce granules
1) buccal mucosa
2) lateral portion of vermillion border of lip
3) retromolar areas
fordyce granules resemble ___ found in skin but lack ____ (histopatho)
there are ___ lobules seen beneath ____ surface, communicating with the surface via _____
1) sebaceous glands
2) hair follicles
3) acinar
4) epithelial
5) central duct
sebaceous cells in lobules of fordyce granules are what shape and what features?
polygonal shape
centrally located nuclei, abundant foamy cytoplasm
clinical presentation of leukoedema
- oral condition, of unknown cause
- folded surface -> wrinkles and streaks
- diffuse, greyish white, milky, opalescent
- does not rub off, but disappears on stretching of mucosa
location of leukoedema
- bilateral buccal mucosa
- floor of mouth (rare)
histopatho findings of leukoedema
1) acanthosis
2) intracellular oedema of spinous layer (keratinocyte oedema)
3) large vacuolated cells with pyknotic nuclei
what is acanthosis
the increase in thickness of epithelium and elongation of rete ridges
DDX of leukoedema , how to distinguish?
1) leukoplakia
2) oral lichen planus (OLP)
3) oral candidiasis
4) submucous fibrosis
dfferentiate because this will disappear when stretched
6 types of reactive white lesions
1) BARK benign alveolar ridge keratosis
2) fricitional hyperkeratosis – linea alba
3) frictional hyperkeratosis – morsicato buccarum (chronic mucosal chewing)
4) nicotinic stomatitis
5) coated tongue/ hairy/ black hairy tongue
6) smokeless tobacco lesions
aetiology of BARK
benign alveolar ridge keratosis
occurs due to chronic mehanical irritation, due to opposing dentition or reaction to trauma of impacted food on mucosa
clinical presentation of BARK
poorly demarcated white plaque
location of BARK
- keratinised mucosa of alveolar ridge
- retromolar pad
linea alba is more common in females or males
female
aetiology of linea alba
due to frictional irritation from repetitive interdigitation of teeth
clinical presentation of linea alba
- usually bilateral
- uniform, adherent horizontal white line
- rough and frayed surface
- may be scalloped
- more prominent adjacent to posterior teeth
location of linea alba
- buccal mucosa, along occlusal plane
- more prominent adjacent to posterior teeth
etiology of morsicato buccarum
unintentional habit of cheek biting
clinical presentation of morsicato buccarum
-usually bilateral
- shredded, white area
- irregular ragged surface with tags of epithelium that peel off
- may have erytehma, erosion or ulceration
location of morsicato buccarum
- buccal mucosa ( more common at anterior)
- lateral border of tongue
- labial mucosa (rare or upper lip mucosa)
histopatho of BARK, linea alba and morsicato buccarum
- hyperkeratosis and acanthosis
- keratinocyte oedema
- no/mild inflammatory infiltrate
- no dysplasia
what is the difference between hyperkeratosis and acanthosis
hyperkeratosis is thickened keratin layer of surface epithelium
acanthosis is thickened spinous layer of surface epithelium
nicotinic stomatitis usually in male or female
male >45 yo
etiology of nicotinic stomatitis
- due to cigar and pipe smoking, develops in response to heat from smoke (rather than the chemicals)
- also seen in long term consumption of very hot beverages
clinical presentation of nicotinic stomatitis
- diffuse grey/ white mucosa (reactive keratosis)
- elevated papule with punctate red centres (inflamed minor salivary gland duct orifices)
- painless
location of nicotinic stomatits
hard palate
histopatho findings of nicotinic stomatitis
- ____ and acanthosis
- ________ inflammation of subepithelial CT and _______
- squamous metaplasia of ______
- inflammatory exudate within _______
- no/ got dysplasia ?
- hyperkeratosis and acanthosis
- mild, patchy chronic inflammation of subepithelial CT and mucous glands
- squamous metaplasia of excretory ducts
- inflammatory exudate within duct lamina
- no dysplasia
histopatho findings of nicotinic stomatitis
- hyperkeratosis and ______
- mild, patchy chronic inflammation of ______ and ________
- ______- of excretory ducts
- ___________ within duct lamina
- no/ got dysplasia
hyperkeratosis and acanthosis
- mild, patchy chronic inflammation of subepithelial CT and mucous glands
- squamous metaplasia of excretory ducts
- inflammatory exudate within duct lamina
- no dysplasia
management of nicotinic stomatisis
- reversible with cessation of habit (1-2 weeks)
- no malignant potential but any lesion that persist after 1 month of cessation, then we will suspect true leukoplakia and do biopsy
etiology of coated/ hairy/ black hairy tongue and predisposing factors
accumulation of keratin on filiform papillae (usually due to decrease in normal keratin desquamation)
predisposing factors: smoking, AB, hyposalivation, dehydration, oral inactivity, poor OH
difference in clinical presentation of coated and hairy tongue
coated tongue: thickened, matted appearance
hairy tongue: elongated, hair like filiform papille projections
clinical presentation of hairy tongue
- (colour) due to (reason)
- asymptomatic/ symptomatic
- px may complain of ___ sensation, and __-
- brown/ yellow/ black due to chromogenic bacteria, food, tobacco
- asympt
- px complain of gagging sensation, bad breath and taste in mouth
location of coated/ hairy tongue
dorsal tongue (usually midline anterior to circumvallate papillae)
histopatho findings of hairy/coated tongue
- ___ of filiform papillae
- many bacterial colonies on ___
- elongation and hyperkeratosis
- epithelial surface
management of hairy coated tongue
- benign
- eliminate predisposing factors
- improve OH (scrape tongue) -> promote desquamation of hyperkeratotic papillae and surface debri
etiology of smokeless tobacco lesions
due to use of topical tobacco on oral mucosa
clinical presentation of early smokeless tobacco lesions
- poorly demarcated white plaque
- granular, wrinkled
- mild peripheral erythema
- soft and velvety
- painless
clinical presentation of late smokeless tobacco lesions
- severe liao so got extensive white thickening
- leathery/ nodular
location of smokless tobacco lesions
- buccal sulcus, vestibule areas
- mucosa directly in contact with tobacco used
histopatho findings of smokeless tobacco lesions
- specifc/ non specific
- hyperkeratosis & ___
- may have intracellular ___ (oedema) of ____ superficial cells
- no/ got dysplasia
- not specific
- acanthosis
- intracellular vacuolisation of glycogen rich superficial cells
- no or mild dysplasia
management of smokeless tobacco lesions
- reversible with cessation of habit ( 2 weeks)
- any lesion that persists after 6 weeks of cessation, we suspect true leukoplakia and should do biopsy
