White Lesions

Question 1

What are the four variables that contribute to the normal pink color of the oral mucosa?

Answer 1

Keratinization,
melanin pigment,
vascularity, and
epithelial thickness.

Question 2

What clinical term is often used to describe lesions appearing as white areas on the oral mucosa?

Answer 2

White patch.

Question 3

Such lesions may be associated with :

Answer 3

increased surface keratin layer ( Hyperkeratosis ).
Increased thickness of the epitheliums the thickened ( acanthosis).
Abnormal permeability .
Reduced vascularity.
coagulation and opacity of the superficial tissue.
pseudo membranes.

submucosal deposits or hyperkeratinization

Fibrin exudates and surface debris

Question 4

What is leukoedema and is it considered a disease?
And Etiology

Answer 4

a common oral mucosal condition that is considered a variation of normal rather than a disease.

To date, the cause of leukodema hasn’t been established.( suggest hereditary factors.)
Some - relationship between poor oral hygiene and abnormal
masticatory patterns

Question 5

What are the clinical features of leukoedema regarding age, sex, site, and race?

Answer 5

Age: Adults and children;
Sex: No sex predilection;
Site: Typically occurs bilaterally on the buccal mucosa and may extend onto the labial mucosa;
Race: More common in blacks than whites.

Question 6

What are the signs and symptoms of leukoedema?
Can leukoedema be rubbed off, and how can it be clinically diagnosed

Answer 6

It is asymptomatic

It cannot be rubbed off. It can be easily diagnosed clinically because the white appearance greatly diminishes يتضائل or disappears when the cheek is everted and stretched

Question 7

What are the key histopathologic features of leukoedema

Answer 7

parakeratinized, acanthotic
show marked intracellular oedema with small pyknotic nuclei in clear cytoplasm.
These cells are vacuolated and contain glycogen. مفرغه
There are no alterations in the germinative layers or changes in the underlying connective tissue

Question 8

What is white spongy nevus and how is it inherited?

Answer 8

also known as familial folded gingivostomatitis,
is a hereditary disorder transmitted as an autosomal dominant trait.
mutation in either keratin 4 or 13 genes, causing a defect in normal keratinization

Question 9

What are the clinical features of white spongy nevus regarding age, sex, and site

Answer 9

Age: Appears at birth or in early childhood sometimes during adolescence; المراهقه
Sex: No sex predilection;
Site: Most commonly affects the buccal mucosa bilaterally,
Extraoral mucosal sites are less commonly affected.

Question 10

: What are the signs and symptoms of white spongy nevus?

Answer 10

usually asymptomatic. The surface is shaggy or deeply folded اشعث مطوي with a wrinkled appearance. The edges are not well defined and merge gradually with

Question 11

What are the main histopathologic features of white spongy nevus

Answer 11

The epithelium is acanthotic with marked surface parakeratosis,
is marked intracellular oedema of the prickle cell layer (spongiosis),
often beginning in the parabasal region.
Oedematous cells are swollen with faintly stained eosinophilic or clear cytoplasm and pyknotic eccentric nuclei, giving a (basket weave appearance.

Question 12

What is Hereditary Benign Intraepithelial Dyskeratosis (HBID)

Answer 12

HBID, also known as Witkop’s disease, is a rare autosomal dominant hereditary condition.

Question 13

What are the clinical features of HBID regarding age, and site?

Answer 13

Age: Early onset during childhood (usually within the first year)
Site: Affects the oral

Question 14

What are the signs and symptoms of oral HBID?

Answer 14

Oral lesions consist of asymptomatic thick corrugated white plaques and folds of spongy mucosa,
Like white sponge nevas

Question 15

What is the most notable feature of HBID, and what are its signs and symptoms?

Answer 15

The most interesting feature is the ocular lesions, which appear as thick, opaque, foamy gelatinous plaques on the bulbar conjunctiva adjacent to the cornea,
sometimes involving the cornea. When active, patients may experience tearing, photophobia, and itching. Ocular lesions may vary seasonally, being most prominent in spring and regressing in summer or autumn

Question 16

What are the histopathologic features of HBID

Answer 16

parakeratin production (hyperkeratosis), epithelial hyperplasia and marked acanthosis,
and dyskeratotic cells (premature keratinization) waxy eosinophilic cells
dyskeratotic cells a cell-within-a-cell phenomenon.
Non-dyskeratotic cells are enlarged and oedematous with hydropic degeneration.
Normal cellular features are seen in the lower spinous and basal layers. The epithelial-connective tissue junction is well-defined,

Question 17

What is Follicular Keratosis, also known as Darier’s disease

Answer 17

It is an uncommon genodermatosis with striking skin involvement and relatively subtle oral mucosal lesions.

Question 18

How is Darier’s disease inherited?

Answer 18

condition is inherited as an autosomal dominant trait, though sporadic cases occur. حالات متفرقه

Question 19

What do the skin lesions of Darier’s disease consist of

Answer 19

Symmetrically distributed small erythematous, often pruritic papular lesions that coalesce, ulcerate, and crust. Coalesced areas form vegetating to verrucous growths due to excessive keratin formation. Keratin accumulation may have a foul odor due to bacterial degradation.

Question 20

What are some other signs of Darier’s disease besides skin lesions?

Answer 20

Thickening of palms and soles with pits and keratoses is not uncommon.

Fingernail changes can include fragility, longitudinal lines, and painful splintering

Question 21

What do the oral lesions of Darier’s disease look like

Answer 21

They are typically asymptomatic and consist of multiple flat topped papules. If numerous and confluent, they result in a cobblestone mucosal appearance. Prominent palatal lesions may resemble inflammatory papillary hyperplasia. Lesions may extend to the oropharynx and pharynx.
15الي50 ‎%‎ من الحلات

Question 22

What are the key histopathologic features of Darier’s disease

Answer 22

hyperkeratosis with a acanthosis, Intraepithelial clefting is seen as suprabasal lacunae containing acantholytic cells
. Specific benign dyskeratotic cells, corps ronds and corps grains,
Corps ronds are large abnormally keratinized cells with basophilic nuclei and eosinophilic cytoplasm with a clear perinuclear halo.
Corps grains are smaller flattened parakeratotic cells with pyknotic hyperchromatic nuclei

Question 23

What is frictional keratosis and what causes it?

Answer 23

Frictional keratosis, or focal hyperkeratosis, is a hyperkeratotic white lesion caused by chronic friction from irritants like a sharp tooth, cheek biting, or ill-fitting dentures

Question 24

What are the clinical features of frictional keratosis

Answer 24

It appears as an asymptomatic lesion that becomes dense and white with a roughened surface over time.site It occurs in areas commonly traumatized

And Morsicatio mucosae oris

Question 25

What is Morsicatio mucosae oris?

Answer 25

Morsicatio mucosae oris is a form of chronic oral frictional keratosis of the nonkeratinized oral mucosa, usually located on the buccal mucosa or lips (morsicatio buccarum, morsicatio labiorum)

Question 26

What are the histopathologic features of frictional keratosis?

Answer 26

hyperkeratosis. acanthosis. • Dysplastic epithelial changes are not seen in this simple frictional hyperkeratotic lesion. • Few chronic inflammatory cells may be seen in the subjacent connective

Question 27

What is nicotine stomatitis and what causes it?

Answer 27

Nicotine stomatitis is a common tobacco-related form of keratosis most typically associated with vipe and cigar smoking,

Question 28

What are the clinical features of nicotine stomatitis regarding age, sex, and site?

Answer 28

Age & Sex: Most often found in men older than 45 years; Site: Most common in the hard palate

Question 29

What are the signs and symptoms of nicotine stomatitis

Answer 29

erythematous-type reaction and overtime with increased keratinization → diffuse grey white palatal mucosa. numerous slightly elevated white papules with central red dots are noted. Such papules represent inflamed minor salivary glands and their ductal orifices.

Question 30

What are the histopathologic features of nicotine stomatitis?

Answer 30

• Epithelium → hyperorthokeratosis & moderate acanthosis • Connective tissue → mild, patchy chronic inflammation • Minor salivary glands → mild to severe inflammatory changes as: • Squamous metaplasia of the excretory ducts • Inflammatory exudates • Hyperplastic ductal epithelium • Ductal dilatation, acinar atrophy • Chronic inflammatory cells

Question 31

What causes white lesions associated with smokeless tobacco

Answer 31

chewing tobacco snuff ) in the mandibular vestibule India and Southeast Asi Oral mucosa responds to the irritating effects of tobacco Dysplastic changes may follow, with an associated risk of malignant change. This biologic alteration in tissues is thought to be a response to : - Tobacco constituents. - Other agents that are added to tobacco for flavouring or moisture retention. - Carcinogens such as nitrosamines and nitrosononicotine ( organic component of chewing tobacco and snuff ). - Alkaline PH of different forms of smokeless tobacco which ranges between 8.2 and 9.3

Question 32

What are the clinical features of smokeless tobacco-associated lesions regarding age, sex, and site

Answer 32

Age & Sex: Predominantly seen in white teenage males. مراهقين Site: Develop in the immediate area where tobacco is placed, most commonly the mucobuccal fold of the mandible in the incisor or molar region.

Question 33

What are the signs and symptoms of smokeless tobacco-associated lesions?

Answer 33

1 generally painless and asymptomatic, often discovered incidentally. 2New lesions are typically translucent plaque 3 advanced cases, becomes thickened and may appear leathery or nodular with a heavy folded character

Question 34

What are the histopathologic features of smokeless tobacco keratosis?

Answer 34

Not specifica Squamous epithelium is hyperkeratinized and acanthotic (epithelial hyperplasia). epithelium may demonstrate vacuolization or oedema. Salivary gland alterations are seen in 40 % of biopsy specimens. Such changes are primarily inflammatory and include acinar atrophy, interstitial fibrosis and dilated excretory ducts.

Question 35

What is actinic cheilitis and what causes it and most commonly affected

Answer 35

Actinic cheilitis, also known as solar cheilitis or actinic cheilosis, is a common premalignant alteration of the lower lip vermilion resulting from long-term or excessive exposure to ultraviolet sunlight. whites, especially those with fair skin. It is prevalent in those with outdoor occupations, leading to terms like farmer's lip and sailor's lip. بحار

Question 36

What is the pathogenesis of actinic cheilitis

Answer 36

degeneration of the lower lip vermilion secondary to regular and prolonged sun exposure. UV light exposure can cause mutations in p53 tumor suppressor genes.

Question 37

What are the clinical features of actinic cheilitis regarding age, sex, and site?

Answer 37

Age: Seldom occurs in persons younger than 45; Sex: Strong male predilection (up to 10:1 ratio); Site: Involves the vermilion portion of the lips, especially the lower lip

Question 38

What are the signs and symptoms of actinic cheilitis

Answer 38

Earliest changes include atrophy of the lower lip vermilion border, characterized by a smooth, pale to silvery grey, glossy appearance with often fissuring and wrinkling. As it progresses, rough scaly areas develop on the drier vermilion, which can thicken and appear leukoplakic, especially near the wet line. The scaly material can be peeled off but reforms within days.

Question 39

What are the histopathologic features of actinic cheilitis

Answer 39

The overlying epithelium is usually atrophic or focally and Various dysplastic changes (slight atypia to carcinoma in situ) may be seen. The underlying connective tissue shows striking basophilia (elastin replacement of collagen), known as solar (actinic)

Question 40

What is lichen planus and how common is it in the oral mucosa?

Answer 40

Lichen planus is a chronic dermatological disease that often affects the oral mucosa and is by far the commonest.

Question 41

What is the etiology of oral lichen planus?

Answer 41

Oral lichen planus is a known T-cell mediated chronic inflammatory response affecting the oral mucosa. The exact etiology is unknown, but implicated factors include genetic predisposition, infective agents, systemic diseases, vitamin deficiencies, psychiatric disorders or stresses. f systemic diseases, such as diabetes mellitus, hypertension, ulcerative colitis include genetic predisposition, infective agents, systemic diseases, vitamin deficiencies and psychiatric disorders or stresses. and liver diseases (such as hepatitis C)

Question 42

What are the proposed pathophysiological mechanisms of oral lichen planus?

Answer 42

The two are antigen-specific and non-specific. The antigen-specific mechanism suggests antigen presentation leads to activation of CD4+ helper T cells, releasing pro-inflammatory cytokines (TNF-$\alpha$, IFN$\gamma$), which induces a CD8+ T cell-mediated cytotoxic reaction against basal cells resulting in keratinocyte apoptosis. The non-specific mechanism suggests mast cell activation releases pro-inflammatory mediators and upregulates matrix metalloproteinases, leading to T cell infiltration, basement membrane disruption, and keratinocyte apoptosis.

Question 43

What are the six clinical subtypes of OLP, and which are most common?

Answer 43

reticular, papular, plaque, atrophic, erosive, and bullous. They can occur individually or in combination. The most common presentations are reticular, erosive, and plaque subtypes.

Question 44

Describe the appearance of reticular OLP.

Answer 44

Reticular OLP has the most characteristic manifestation, displaying a white lacy network (Wickham striae) with hyperkeratotic plaques.

Question 45

Describe the appearance of erosive or atrophic OLP.

Answer 45

Erosive or atrophic OLP typically presents with erythema and ulcerations, often associated with pain and sensitivity. Reticular keratotic striae may be present at the periphery.

Question 46

Describe the appearance of papular or plaque OLP.

Answer 46

The papular or plaque subtypes appear as white keratotic papules or plaques that may resemble leukoplakia.

Question 47

What is the typical distribution and common sites for OLP?

Answer 47

OLP typically has a(bilateral )distribution and most commonly appears on the buccal mucosa, tongue, and gingiva, followed by the labial mucosa and lower lip.oral وخلاص

Question 48

What is the Koebner phenomenon and how might it relate to OLP?

Answer 48

The Koebner phenomenon is when lesions develop at sites of mechanical trauma دي المهم. It may explain why lesions appear more commonly on the buccal mucosa and tongue, which are prone to trauma.oral برضو

Question 49

What are the characteristic histopathologic features of oral lichen planus?

Answer 49

saw-tooth pattern.اسنان المنشار colloid, hyaline or civatte bodies. eosinophilic band lymphocytic band ) liquefaction degeneratio

Question 50

What is the classic and most common presentation of oral candidiasis?

Answer 50

Pseudomembranous candidiasis, also known as oral thrush.

Question 51

What are common methods for identifying Candida?

Answer 51

10% potassium hydroxide stain and culture with Sabouraud dextrose agar.

Question 52

Who is most susceptible to acute pseudomembranous candidiasis?

Answer 52

بتتقشر دا اللي متحتاج تعرفه بس

Question 53

Can hyperplastic candidiasis be easily wiped off?

Answer 53

No, unlike oral thrush, hyperplastic candidiasis cannot be easily wiped off. Severe dysplasia or malignant Increase risk malignant

Question 54

How does acute atrophic candidiasis present clinically?

Answer 54

It presents as generalized or localized erythema on the oral mucosa, most commonly on the palate, but also on the buccal mucosa and dorsum of the tongue.

Question 55

What are the risk factors for acute atrophic candidiasis?

Answer 55

It is frequently secondary to broad-spectrum antibiotic treatment. Other risk factors include corticosteroids, HIV disease, iron deficiency anemia, vitamin B12 deficiency, and uncontrolled diabetes mellitus.

Question 56

How common is denture stomatitis and what are the risk factors? Chronic

Answer 56

It is a common condition with an incidence up to 65%. Risk factors include poorly fitted dentures, prolonged use of dentures (especially wearing them for 24 hours), and poor oral hygiene.