White Lesions That Can Be Scraped Off Flashcards
Hairy tongue (coated tongue) ***
May be scraped off slightly, with difficulty
Hairy tongue is characterised by marked accumulation of keratin on the filiform papillae of the dorsal tongue resulting in a hairlike appearance. Represents:
— increase in keratin production OR
— decrease in normal keratin desquamation.
Most commonly affects the midline just anterior to the circumvallate papillae, sparing the lateral and anterior borders. The elongated papillae are usually brown, yellow or black as a result of growth of pigment-producing bacteria or staining from tobacco and food. Typically asymptomatic, although occasionally patients complain of a gagging sensation or a bad taste in the mouth. The diagnosis usually can be made from the clinical appearance, biopsy is unnecessary in most instances.
In some individuals, numerous bacteria and desquamated epithelial cells accumulate on the dorsal tongue surface, but without the hairlike filiform projections. Such cases are often designated as a coated tongue.
🐳 Coated tongue often is misdiagnosed as candidiasis and treated unnecessarily with antifungal medication.
🐳 Hairy leukoplakia typically occurs on the lateral border of the tongue. Hairy leukoplakia is caused by EBV and is usually associated with HIV infection or other immunosuppressive conditions.
🔬 characterised by marked elongation and hyperparakeratosis of filiform papillae. Usually, numerous bacteria can be seen growing on the epithelial surface.
Hairy or coated tongue is a benign condition. Any predisposing factors, such as tobacco, should be eliminated, and excellent oral hygiene should be encouraged. Periodic scraping or brushing with a toothbrush or tongue scraper can promote desquamation of the hyperkeratotic papillae and surface debris.
Pseudomembranous candidiasis ***
“Milk curd” or “cottage cheese” appearance; may leave red base when rubbed off
Characterised by the presence of adherent white plaques that resemble cottage cheese or curdled milk on the buccal mucosa, palate or dorsal tongue.
The white plaques are composed of tangled masses of hyphae, yeasts, desquamated epithelial cells, and debris.
- hypha is a long, branching, filamentous structure of a fungus.
The underlying mucosa may appear normal or erythematous. If bleeding occurs, then the mucosa has probably also been affected by another process, such as erosive lichen planus or cancer chemotherapy.
May be initiated by
— exposure to broad-spectrum antibiotics (thus eliminating competing bacteria) (acute expression) OR
— impairment of the patient’s immune system, such as the use of topical corticosteroids for treatment of oral immune-mediated conditions, or inhaled corticosteroids for treatment of asthma; HIV or immune dysfunctions in leukemic patients (slow-onset, long-standing).
Symptoms are usually relatively mild:
- burning sensation of the oral mucosa OR
- unpleasant taste in the mouth (salty/bitter)
Toothpaste or mouthwash reaction ***
Filmy whiteness; leaves normal appearing mucosa when rubbed off
Thermal / Chemical burn **
Pizza burn
Aspirin burn
Sloughing traumatic lesion **
Example: cotton roll “burn”.
Secondary syphilis *
Diphtheria *
Diphtheria *
