White Lesions: Reactive Lesions Flashcards
Reactive Lesions (6)
- Focal Hyperkeratosis
- White lesions associated with smokeless tobacco
- Nicotine Stomatitis
- Hairy leukoplakia
- Hairy Tongue
- Dentrifice-associated slough
related to chronic rubbing or friction against an oral mucosal surface.
This results in a hyperkeratotic white lesion that is analogous to a callus on the skin.
Focal (Frictional) Hyperkeratosis
occur in areas that are
commonly traumatized, such as the lips, lateral margins of the tongue, buccal mucosa along the occlusal line, and edentulous alveolar ridges
Chronic cheek or lip chewing may result in opacification (keratinization) of the affected area.
Chewing on edentulous alveolar ridges produces the same effect.
Focal (Frictional) Hyperkeratosis
the primary microscopic change is hyperkeratosis
A few chronic inflammatory cells may be seen in the subjacent connective tissue
Focal (Frictional) Hyperkeratosis
Control of the habit causing the lesion should result in clinical improvement.
No malignant
potential exists.
Focal (Frictional) Hyperkeratosis
Direct contact of mucosa with smokeless tobacco and contaminants
Snuff form of tobacco most likely to induce lesions
White lesions associated with smokeless tobacco
Slight to moderate parakeratosis, often in the form of spires or chevrons, is noted over the surface of the affected mucosa.
Superficial epithelium may demonstrate
vacuolization or edema.
A slight to moderate chronic inflammatory cell infiltrate is typically present.
Epithelial dysplasia may occasionally develop in these lesions, especially among long-time users of smokeless tobacco.
develop in the immediate area where the tobacco is habitually placed
The mucosa develops a granular to wrinkled hyperkeratotic appearance
White lesions associated with smokeless tobacco
- Discontinuation
- Perform biopsy on persistent lesions (long exposure increases risk to carcinoma)
White lesions associated with smokeless tobacco
- Caused by tobacco pipe, cigar, and cigarette smoking
- Opacification of the palate caused by heat and carcinogens
- Most severe changes are seen in patients who “reverse smoke”
Nicotine Stomatitis
- Generalized white change (hyperkeratosis) seen in hard palate.
- Red dots in the palate represent inflamed salivary duct orifices
Nicotine Stomatitis
- Discontinue tobacco habit
- Observe and examine all mucosal sites
- an indicator of potential significant epithelial change at sites other than the hard palate
Nicotine Stomatitis
characterized by epithelial hyperplasia and hyperkeratosis.
The minor salivary glands
in the area show inflammatory change, and excretory ducts may show squamous metaplasia.
Nicotine Stomatitis
Associated with local or systemic immunosuppression (esp. AIDS and organ transplantation)
Hairy Leukoplakia
Represents an opportunistic infection by Epstein Barr virus
Hairy Leukoplakia
well-demarcated white lesion that varies in architecture from a flat and plaquelike to a papillary/filiform, or a corrugated lesion
Most commonly seen on lateral tongue, often bilateral
Asymptomatic white lesion
Hairy Leukoplakia
May occur before or after the diagnosis of AIDS
Hairy Leukoplakia
May be secondarily infected by Candida albicans
Hairy Leukoplakia
clinical differential diagnosis includes:
idiopathic leukoplakia,
frictional hyperkeratosis
(tongue chewing),
leukoplakia associated with tobacco use.
Other entities that might be considered are:
lichen planus,
lupus erythematosus,
hyperplastic candidiasis
Hairy Leukoplakia
- investigation for HIV infection or other causes of systemic or local immunosuppression
- No specific treatment; cosmetically objectionable
- Antiviral and antiretroviral agents likely to cause lesion to regress
Hairy Leukoplakia
filiform papillary overgrowth on the dorsal surface of the tongue of variable color
Hairy Tongue (Black hairy tongue)
cause is not well understood; believed to be related to alterations in oral flora
Initiating Factors:
Use of broad-spectrum antibiotics, systemic corticosteroids,
hydrogen peroxide
Intense smoking
Head and neck therapeutic radiation
Hairy Tongue (Black hairy tongue)
asymptomatic hyperplasia of the filiform papillae, with concomitant retardation of the normal rate of desquamation (overgrowth of filiform papillae and chromogenic
microorganisms)
Hairy Tongue (Black hairy tongue)
color may range from
white to tan to deep brown or black
when extensive elongation of the papillae occurs, a gagging or a
tickling sensation may be felt
Hairy Tongue (Black hairy tongue)
thick, matted surface that serves to trap bacteria, fungi, cellular debris,
and foreign material (Dense hairlike mat formed by hyperplastic papillae on the dorsal tongue surface)
Hairy Tongue (Black hairy tongue)
presence of elongated filiform papillae over the dorsum of the tongue, with surface contamination by clusters of microorganisms and fungi.
The underlying lamina propria is generally mildly inflamed
Hairy Tongue
Identify and eliminate initiating factor identified and eliminated
Brush/scrape tongue with baking soda
Little significance other than cosmetic appearance
Hairy Tongue
believed to be a superficial chemical burn or a reaction to a component in the
dentifrice, possibly the detergent or flavoring compounds
Dentifrice-Associated Slough
may be related to the use of essential oil–
containing mouth rinses
Dentifrice-Associated Slough
- Clinically, it appears as a superficial whitish slough of the buccal mucosa, typically detected by the patient as oral peeling that easily swipes away
- The condition is painless and is not known to progress to anything significant
Dentifrice-Associated Slough
White mucosal changes have been described in association with the use of toothpaste and mouthwashes containing the substance sanguinaria.
The alteration
is typically seen in the maxillary vestibule, although other
sites may be affected.
Dentifrice-Associated Slough
The problem resolves with a switch to another, blander toothpaste or
mouth rinse.
Dentifrice-Associated Slough
- Pale to silvery gray, glossy appearance, often with fissuring and wrinkling at right angles to the cutaneous vermilion junction.
- Slightly firm, bilateral swelling of the lower lip is common.
- Mottled areas of hyperpigmentation and keratosis are often noted, as well as superficial scaling, cracking, erosion, ulceration, and crusting.
Dentifrice-Associated Slough
