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BDS4 Oral Medicine > White lesions > Flashcards

White lesions Flashcards

1
Q

What are the possible causes of white lesions

A
  • hereditary
  • smoking/frictional
  • lichen planus
  • lupus erythematosus
  • GVHD
  • candidal leukoplakia
  • carcinoma
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2
Q

What is an example of hereditary oral white lesions

A

white sponge nevus

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3
Q

What is smoking/frictional keratosis

A

irritation to the mucosa
irritation causes thickening of keratin layer
this obstructs the visibility to connective tissue so whiter skin/mucosa

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4
Q

What is the structure of the skin

A

epidermis
dermis
hypodermis

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5
Q

What are the layers of epithelium in the skin

A

stratum corneum
stratum lucidum (thick skin)
stratum granulosum
stratum spinosum
stratum germinativum

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6
Q

What are the types of oral mucosa

A
  • masticatory
  • lining
  • gustatory
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7
Q

Describe the features of masticatory mucosa

A
  • subjected to friction and compression
  • (para)keratinized
  • thick lamina propria
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8
Q

Where is masticatory mucosa present

A

areas of high friction
gingiva & hard palate

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9
Q

What is lining mucosa

A

mobile and distensible
non-keratinized
loose lamina propria and wide sub mucosa
more rapid turnover

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10
Q

Where is lining mucosa present

A

lip, cheeck, floor of mouth, soft palate, ventral surface of tongue

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10
Q

Where is lining mucosa present

A

lip, cheeck, floor of mouth, soft palate, ventral surface of tongue

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11
Q

What is gustatory epithelium

A

similar to masticatory
keratinized (mostly)
present only on dorsum of tongue
characterized by papillae, some containing taste buds

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12
Q

Is the vermillion border of the lip keratinized or unkeratinized

A

keratinized

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13
Q

Is junctional epithelium keratinized or unkeratinized

A

unkeratinized

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14
Q

Is sulcular epithelium keratinized or unkeratinized

A

unkeratinized

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15
Q

What is the structure of the oral mucosa

A

epithelium
lamina propria
submucosa
bone

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16
Q

What are the layers of epithelium in the oral epithelium

A

stratum corneum
stratum grnaulosum
stratum spinosum
stratum germinativum

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17
Q

What are the papillae of the tongue

A

fungiform
filiform
vallate

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18
Q

What is parakeratosis

A

incomplete maturation of epidermal keratinocytes resulting in abnormal retention of nuclei in the stratum corneum

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19
Q

What is orthokeratosis

A

thickening of keratin layer with preserved keratinocyte maturation

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20
Q

What is acanthosis

A

elongation of rete ridges due to thickening of the spinous layer +/- enlargement of rete pegs

21
Q

What are the two reasons behind why white lesions appear white

A
  • thickening of mucosa/keratin
  • reduced blood supply in tissues
22
Q

What is leukoplakia

A

white patch
cannot be wiped off
no other cause attributed

23
Q

What can be used to describe the leukoplakia

A

is it homogenous or non-homogenous

24
Q

How may homogenous leukoplakia appear

A

most common
uniformly white plaques
common in cheek
low malignant potential

25
Q

How may non-homogenous leukoplakia appear

A
  • nodular, speckles, verrucous
  • often seen in eroded areas
  • high risk of malignant transformation
26
Q

What % of leukoplakias become malignant

A

2-5%

27
Q

What sites are high risk for malignant tranformation of leukoplakias

A

soft palate complex
ventrolateral tongue
floor of mouth

28
Q

What is keratosis

A

Increased keratin producing clinical white lesion

29
Q

How does keratosis appear histologically

A

benign hyperplasia
often w/ ortho/para keratosis

30
Q

What are the main two types/causes of keratosis

A

frictional e.g linea alba
tobacco - smoker’s keratosis

31
Q

Is keratosis at high risk of malignant transformation

A

Not really
Smoking is a risk factor for OC however

32
Q

What are the main types of candida infection

A
  • pseudomembranous (acute/chronic)
  • erythematous (acute/chronic)
  • chronic hyperplastic
  • angular cheilitis
33
Q

What is acute pseudomembranous candidosis known as

A

thrush

34
Q

What are predisposing factors to acute pseudomembranous candidosis

A
  • antibiotic use
  • corticosteroid use
  • hyposalivation
  • systemic disease e.g terminally ill px
35
Q

What is the most common organism in acute pseudomembranous candidosis

A

c. albicans

36
Q

How does acute pseudomembranous candidosis appear clinically

A
  • white plaques which can be wiped off w/ gauze to reveal a raw erythematous and sometimes bleeding base
37
Q

What is chronic hyperplastic candidosis also known as

A

candidal leukoplakia

38
Q

How does chronic hyperplastic candidosis appear clinically

A

Persistant white/ speckled red and white lesion

39
Q

What is chronic hyperplastic candidosis characterized by histologically

A
  • parakeratosis
  • chronic intraepithelial inflammation
  • fungal hyphae invading superficial layers of epithelium
40
Q

Which type of candida infection has high risk of malignant transformation

A
  • chronic hyperplastic candidosis
41
Q

What is the malignant transformation of candidal leukoplakia

A

9-40%

42
Q

What is the main species present in chronic hyperplastic candidosis

A

candida albicans

43
Q

What is the management of chronic hyperplastic candidosis

A
  • control risk factors e.g tobacco/alcohol use
  • manage iron/folate deficiency
  • use of antifungals
  • excision if dysplasia more than mild
  • regular follow up
44
Q

What is the prescription for candida infection (thrush, candidal leukoplakia, erythematous candidosis)

A

7 day regimen of:
* fluconazole 50mg 7 capsules
OR
* miconazole gel 20mg/g, pea size amount after food 4 times daily

45
Q

What is the maximum administration of fluconazole for oral candida

A

14 days

46
Q

Which patients is fluconazole/miconazole contra-indicated in

A
  • warfarin/statin patients
47
Q

If fluconazole/miconazole is contraindicated, what should oral candida patients be prescribed

A
  • nystatin
  • 100,000 units/ml
  • 1 ml after food 4 times daily for 7 days
48
Q

How should patients use nystatin

A
  • rinse suspension around mouth
  • retain near lesion for 5 mins
  • swallow
49
Q

What is oral herpes usually caused by

A

HSV1

50
Q

How does oral herpes tend to present

A
  • herpetic stomatitis
  • fever/malaise
  • oral vesicles breaking down to leave ulcers
  • gingival oedema
  • enlarged cervical lymph nodes
51
Q

When should you refer a white lesion

A
  • be more wary of red and white lesions
  • if the lesion is becoming more thick and raised, refer
  • refer if lesion is without cause, especially if in the following areas
    1. lateral tongue
    1. anterior FOM
    1. soft palate

BDS4 Oral Medicine (17 decks)

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