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Oral Pathology 1/2/16 > Lec 2: White Lesions > Flashcards

Lec 2: White Lesions Flashcards

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1
Q

White Surface Lesions 3 groups

A

Epithelial thickening
Surface debris
Subepithelial lesions

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2
Q

Epithelial thickening

A

Asymptomatic, rough, do not rub off

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3
Q

Surface debris

A

Symptomatic, rub off, underlying erythema

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4
Q

Subepithelial lesions

A

Asymptomatic, smooth to palpation, translucent

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5
Q

Keratinized tissue examples

A

Tongue
Hard Palate
Attached Gingiva
Outer lip (past Vermillion border)

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6
Q

Non-keratinized tissue

A 
Everywhere else that keratinized is not..
Buccal Mucosa
Labial Mucosa
Soft Palate
Floor of Mouth
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7
Q

White sponge nevus aka

A

Familial Epithelial Hyperplasia

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8
Q

White sponge nevus inheritance

A

autosomal dominant

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9
Q

Treatment for white sponge nevus?

A

None

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10
Q

Frictional keratosis

A

White lesion related to chronic rubbing or friction
Presumably a protective effect (~callous on skin)
Anywhere in oral cavity
Careful history taking and examination sufficient for diagnosis
Lesion should resolve or reduce after removal of causative agent
-Otherwise, no treatment necessary

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11
Q

Frictional keratosis usally seen in the

A

retromolar pad

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12
Q

Hairy tongue

A

Represents elongation of filiform papillae

Associated with lack of mechanical abrasion to tongue.

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13
Q

Hairy tongue treatment? prognosis?

A

brush or scrape the tongue

Prognosis: good

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14
Q

Hairy Leukoplakia

A

Epithelial thickening of the lateral surfaces of the tongue.

Present in immunocompromised patients, e.g. HIV/AIDS, transplant patients, et al.

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15
Q

Hairy Leukoplakia treatment? Prognosis?

A

Treatment: None other than to determine immune status of patient.
Prognosis: indicates poorly functioning immune system.

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16
Q

Oral Hairy Leukoplakia

A

Thickened parakeratin

Surface corrugations

Acanthotic epithelium

Superficial “baloon cells”

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17
Q

Leukoedema

A

Common, asymptomatic, variation of normal.

White, opalescent, filmy, folded surface, does not rub off, not rough

Distribution: bilateral buccal mucosa

More common in African Americans vs. more easily recognized in African Americans

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18
Q

Leukoedema-diagnose clinically?

A

white appearance decreases when tissue is stretched

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19
Q

Leukoedema-treatment?

A

no treatment

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20
Q

Erythema migrans aka? commonly seen on? appears? due to?

A

Aka geographic tongue, benign migratory glossitis

Commonly seen on anterior 2/3 of tongue and ventral and lateral surfaces.

Red patches with white border, well-demarcated

Due to atrophy of filiform papillae with elevated white border

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21
Q

Erythema migrans ass. with what sensation?

A

burning sensation

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22
Q

Erythema migrans treatment

A

Treatment is not needed. Topical steroids for symptomatic lesions.

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23
Q

Lichen planus common disease of over sensitivity reaction of?

A

T lymphocytes

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24
Q

Lichenoid Mucositis

A

Reaction to medication
Graft vs. Host Disease
Same clinical and microscopic appearance

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25
Lichen planus mostly affects
Middle-aged | females (3:2)>males
26
Lichen planus 6 P's of skin features sometimes present
``` Planar Purple Pruritic Polygonal Plaque Papule ```
27
Lesions are _____; most typically _____ on the buccal mucosa
multifocal; bilaterally
28
Lichen planus 2 types of presentation? more common form?
Reticular Pattern*** | Erosive Pattern
29
Reticular Pattern
Wickham’s stria: white lacy network pattern with underlying erythema White plaques sometimes present multifocal lesions
30
Erosive Pattern
Central area of ulceration that is painful Areas of pseudomembrane centrally may be present Wickham’s stria may be present May present as desquamative gingivitis
31
Erosive lichen planus presents
Painful ulcers sometimes present
32
Lichen Planus-reticular pattern sign
Wickham's straie
33
Litchen Planus-reticular pattern-mamagement/treatment?
White lesions are asymptomatic and are not treated | If burning occurs, treated with topical corticosteroids
34
Litchen Planus-erosive pattern-management/treatment?
Topical corticosteroids Flare-ups require reapplication of drugs or prophylactic treatment Severe cases require systemic corticoid therapy
35
The importance of a thorough history, careful physical examination and clinicopathological correlation is critical-true or false?
True
36
Lichenoid Mucositis reacts to what?
amalgam and cinnamon (in gum, seasoning)
37
Currently, is lichen planus considered a pre-malignant disease aka can it lead to oral cancer?
NO
38
Nicotinic stomatitis presents
on hard palate of people who smoke. | Seen mainly in pipe or cigar smokers
39
Treatment for nicotinic stomatitis
No treatment needed
40
Nicotinic stomatitis has almost no potential (on hard palate) for transformation to squamous cell carcinoma-true or false?
true
41
Nicotinic stomatitis response to ____ rather than chemicals
heat
42
Reverse smoker's palate
Cigars/cigarettes smoked with lit inside mouth Pronounced nicotinic stomatitis
43
Reverse smoker's palate has significant risk of
dysplasia or carcinoma
44
Linea alba-caused by?
Pressure, frictional irritation or sucking trauma from the facial surfaces of the teeth. Common alteration of buccal mucsoa
45
Is linea alba usually bilateral and unilateral?
usually bilateral
46
Linea alba-treatment?
No treatment necessary
47
White linear thickening at the level of the occlusal plane is an example of?
Linea alba
48
Morsicatio Buccarum is
chronic check chewing
49
Chronic cheek chewing of labial mucosa =
morsicatio labiorum
50
Chronic cheek chewing of tongue=
morsicatio linguarum
51
Morsicatio Buccarum is usually unilateral or bilateral?
bilateral
52
Morsicatio Buccarum treatment?
No treatment necessary. | Lateral acrylic shields connected by facial steel wire.
53
Thickened, shredded, areas of white hyperkeratosis describes what?
Morsicatio Buccarum
54
a white patch or plaque that cannot be characterized clinically or pathologically as any other disease describes
Leukoplakia
55
Leukoplakia is a term that is strictly a _____ and does not imply a specific diagnosis
clinical term
56
Lesions that must be excluded before the term “leukoplakia” can be used
``` White sponge nevus Frictional keratosis Hairy tongue and hairy leukoplakia Leukoedema Geographic tongue (erythema migrans) Lichen planus/Lichenoid mucositis Tobacco pouch hyperkeratosis Nicotine stomatitis Morsicatio (chronic chewing on tissue) ```
57
Clinical Significance of “Leukoplakia”-done by microscopic diagnosis of a biopsy. Microscopic diagnosis will be one of the following:
Hyperkeratosis Epithelial dysplasia Carcinoma-in-situ Superficial squamous cell carcinoma
58
Hyperkeratosis
a callous; not premalignant; does not need removal
59
Epithelial Dysplasia is
Atypical cells confined to the cells of the epithelium
60
Treatment if epithelial dysplasia is considered premalignant for mild, moderate, and severe?
Mild usually not removed Moderate may be removed Severe must be removed
61
Enlarged nuclei/cells, Increased nuclear-to-cytoplasmic ratio, Hyperchromatic nuclei, Pleomorphic cells, Increased/abnormal mitotic activity are examples of
epithelial dysplasia
62
Carcinoma in situ: cancer confined to the _____; will eventually _____; must be ______
epithelium, invade, removed
63
Does superficial squamous cell carcinoma need o be removed?
Yes
64
Clinically, leukoplakia means
white patch/area
65
Why is leukoplakia considered a precancerous or premalignant lesion because
the frequency of transformation of all “leukoplakias” into malignancy (~4%) is greater than the risk associated with normal mucosa
66
Most “leukoplakias” are ______ without dysplasia or cancer
hyperkeratosis
67
White Surface Debris Lesions
Candidosis Burning Dentifrice-associated slough
68
Candidosis is a
Common opportunistic oral mycotic infection
69
Most common oral fungal infection in humans
Candidosis
70
Agent for candidosis
Candida albicans
71
British and older term for candidosis
British= candidosis | Older term=monoliasis
72
Candidosis is a component of normal oral microflora in what percentage in patients? those older than 60 years old?
In 30-50% of patients | Up to 60% in patients older than 60
73
Predisposing factors of candidosis?
``` Immunodeficiency Acquired immunosuppression Endocrine disturbances Diabetes mellitus Corticosteroid therapy Systemic antibiotic therapy Xerostomia Poor oral hygiene ```
74
Pseudomembranous candidosis (thrush) symptoms?
White plaques that rub off leaving an erythematous base (can scrape them off) Pain or burning sensation
75
Thrush associated with?
xerostomia, antibiotics and/or decreased host resistance
76
Thrush plaques made of?
yeast, hyphae, epithelial cells and debris
77
Chronic Hyperplastic Candidiasis is seen as a?
white patch that CANNOT be removed. | Least common form and somewhat controversial
78
Chronic Hyperplastic Candidiasis most common in
anterior buccal mucosa
79
Erythematous Candidosis (Red Variations examples)
Acute Erythematous Candidosis Chronic Erythematous Candidosis Angular Cheilitis Median Rhomboid Glossitis
80
Candidosis can be confirmed with a
cytology smear
81
Topical antifungal medications
Nystatin rinse or ointment Clotrimazole rinse or troches Ketoconazole cream
82
Systemic antifungal medications
Ketoconazole (Nizoral) tablets | Fluconazole (Diflucan) tablets
83
Candidosis can be confused with
dried saliva food debris superficial sloughing due to sodium lauryl sulfate
84
Dentifrice-assocaited slough symptoms?
Painless, grayish-white gelatinous membranes on gingiva, vestibule, floor of mouth and lips
85
Dentifrice-associatged slough most apparent when?
immediately upon arising in morning
86
Dentifrice-associated slough associated with?
sodium lauryl sulfate (SLS) and pyrophosphates found in some dentifrices and mouthrinses
87
Dentifrice-associated slough resolves by?
switching off toothpaste with SLS
88
Chemical injury is
Chemicals/drugs come in prolonged contact with oral tissues that may cause pain in area of application
89
Chemical injury examples
Children and psychiatric patients may hold medications in mouth Topical products for mouth pain can compound problem
90
Mucosa develops white, wrinkled appearance. Removal of necrotic epithelium reveals red, bleeding tissue is an example of
chemical injury
91
Burn can be caused by?
heat, cold, or chemicals
92
Burns appear as a
Area of yellow-white epithelial necrosis
93
Subepithelial white spots (3)
Congenital cysts Subepithelial fibrosis (scar) Fordyce granules
94
Congenital cysts (2)
1. Palatal cysts of the newborn e.g, Bohn’s nodules, Epstein’s pearls 2. Gingival cysts of the newborn
95
Epstein’s pearls
palatal shelves fusing at midline entrap small islands of epithelium
96
Bohn’s nodules
Epithelial remnants from minor salivary glands of palate entrapped below the surface
97
Gingival cyst of the newborn
Entrapment of dental lamina Appearance similar to palatal variant Dental lamina cyst & congenital keratotic cysts Resolve spontaneously: no treatment
98
SUBEPITHELIAL FIBROSIS(SCAR)
Usually poorly defined Patient usually has a history of injury or surgery No treatment needed
99
FORDYCE GRANULES represent and present
Represent ectopic sebaceous glands | Yellow, granular plaques and nodules present in clusters

Oral Pathology 1/2/16 (11 decks)

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