white lesions part 1 (developmental and reactive)

Question 1

clinical presentation of fordyce granules

Answer 1

• ectopic sebaceous glands on oral mucosa
• multiple
• small (1-2mm)
• white or yellow white papules
• asymptomatic

Question 2

2 types of developmental white lesions

Answer 2

1) fordyce granules
2) leukoedema

Question 3

3 locations of fordyce granules

Answer 3

1) buccal mucosa
2) lateral portion of vermillion border of lip
3) retromolar areas

Question 4

fordyce granules resemble ___ found in skin but lack ____ (histopatho)

there are ___ lobules seen beneath ____ surface, communicating with the surface via _____

Answer 4

1) sebaceous glands
2) hair follicles
3) acinar
4) epithelial
5) central duct

Question 5

sebaceous cells in lobules of fordyce granules are what shape and what features?

Answer 5

polygonal shape
centrally located nuclei, abundant foamy cytoplasm

Question 6

clinical presentation of leukoedema

Answer 6

• oral condition, of unknown cause
• folded surface -> wrinkles and streaks
• diffuse, greyish white, milky, opalescent
• does not rub off, but disappears on stretching of mucosa

Question 7

location of leukoedema

Answer 7

• bilateral buccal mucosa
• floor of mouth (rare)

Question 8

histopatho findings of leukoedema

Answer 8

1) acanthosis
2) intracellular oedema of spinous layer (keratinocyte oedema)
3) large vacuolated cells with pyknotic nuclei

Question 9

what is acanthosis

Answer 9

the increase in thickness of epithelium and elongation of rete ridges

Question 10

DDX of leukoedema , how to distinguish?

Answer 10

1) leukoplakia
2) oral lichen planus (OLP)
3) oral candidiasis
4) submucous fibrosis

dfferentiate because this will disappear when stretched

Question 11

6 types of reactive white lesions

Answer 11

1) BARK benign alveolar ridge keratosis
2) fricitional hyperkeratosis – linea alba
3) frictional hyperkeratosis – morsicato buccarum (chronic mucosal chewing)
4) nicotinic stomatitis
5) coated tongue/ hairy/ black hairy tongue
6) smokeless tobacco lesions

Question 12

aetiology of BARK

Answer 12

benign alveolar ridge keratosis
occurs due to chronic mehanical irritation, due to opposing dentition or reaction to trauma of impacted food on mucosa

Question 13

clinical presentation of BARK

Answer 13

poorly demarcated white plaque

Question 14

location of BARK

Answer 14

• keratinised mucosa of alveolar ridge
• retromolar pad

Question 15

linea alba is more common in females or males

Answer 15

female

Question 16

aetiology of linea alba

Answer 16

due to frictional irritation from repetitive interdigitation of teeth

Question 17

clinical presentation of linea alba

Answer 17

• usually bilateral
• uniform, adherent horizontal white line
• rough and frayed surface
• may be scalloped
• more prominent adjacent to posterior teeth

Question 18

location of linea alba

Answer 18

• buccal mucosa, along occlusal plane
• more prominent adjacent to posterior teeth

Question 19

etiology of morsicato buccarum

Answer 19

unintentional habit of cheek biting

Question 20

clinical presentation of morsicato buccarum

Answer 20

-usually bilateral
- shredded, white area
- irregular ragged surface with tags of epithelium that peel off
- may have erytehma, erosion or ulceration

Question 21

location of morsicato buccarum

Answer 21

• buccal mucosa ( more common at anterior)
• lateral border of tongue
• labial mucosa (rare or upper lip mucosa)

Question 22

histopatho of BARK, linea alba and morsicato buccarum

Answer 22

• hyperkeratosis and acanthosis
• keratinocyte oedema
• no/mild inflammatory infiltrate
• no dysplasia

Question 23

what is the difference between hyperkeratosis and acanthosis

Answer 23

hyperkeratosis is thickened keratin layer of surface epithelium

acanthosis is thickened spinous layer of surface epithelium

Question 24

nicotinic stomatitis usually in male or female

Answer 24

male >45 yo

Question 25

etiology of nicotinic stomatitis

Answer 25

- due to cigar and pipe smoking, develops in response to heat from smoke (rather than the chemicals) - also seen in long term consumption of very hot beverages

Question 26

clinical presentation of nicotinic stomatitis

Answer 26

- diffuse grey/ white mucosa (reactive keratosis) - elevated papule with punctate red centres (inflamed minor salivary gland duct orifices) - painless

Question 27

location of nicotinic stomatits

Answer 27

hard palate

Question 28

histopatho findings of nicotinic stomatitis - ____ and acanthosis - ________ inflammation of subepithelial CT and _______ - squamous metaplasia of ______ - inflammatory exudate within _______ - no/ got dysplasia ?

Answer 28

- hyperkeratosis and acanthosis - mild, patchy chronic inflammation of subepithelial CT and mucous glands - squamous metaplasia of excretory ducts - inflammatory exudate within duct lamina - no dysplasia

Question 29

histopatho findings of nicotinic stomatitis - hyperkeratosis and ______ - mild, patchy chronic inflammation of ______ and ________ - ______- of excretory ducts - ___________ within duct lamina - no/ got dysplasia

Answer 29

hyperkeratosis and acanthosis - mild, patchy chronic inflammation of subepithelial CT and mucous glands - squamous metaplasia of excretory ducts - inflammatory exudate within duct lamina - no dysplasia

Question 30

management of nicotinic stomatisis

Answer 30

- reversible with cessation of habit (1-2 weeks) - no malignant potential but any lesion that persist after 1 month of cessation, then we will suspect true leukoplakia and do biopsy

Question 31

etiology of coated/ hairy/ black hairy tongue and predisposing factors

Answer 31

accumulation of keratin on filiform papillae (usually due to decrease in normal keratin desquamation) predisposing factors: smoking, AB, hyposalivation, dehydration, oral inactivity, poor OH

Question 32

difference in clinical presentation of coated and hairy tongue

Answer 32

coated tongue: thickened, matted appearance hairy tongue: elongated, hair like filiform papille projections

Question 33

clinical presentation of hairy tongue - (colour) due to (reason) - asymptomatic/ symptomatic - px may complain of ___ sensation, and __-

Answer 33

- brown/ yellow/ black due to chromogenic bacteria, food, tobacco - asympt - px complain of gagging sensation, bad breath and taste in mouth

Question 34

location of coated/ hairy tongue

Answer 34

dorsal tongue (usually midline anterior to circumvallate papillae)

Question 35

histopatho findings of hairy/coated tongue - ___ of filiform papillae - many bacterial colonies on ___

Answer 35

- elongation and hyperkeratosis - epithelial surface

Question 36

management of hairy coated tongue

Answer 36

- benign - eliminate predisposing factors - improve OH (scrape tongue) -> promote desquamation of hyperkeratotic papillae and surface debri

Question 37

etiology of smokeless tobacco lesions

Answer 37

due to use of topical tobacco on oral mucosa

Question 38

clinical presentation of early smokeless tobacco lesions

Answer 38

- poorly demarcated white plaque - granular, wrinkled - mild peripheral erythema - soft and velvety - painless

Question 39

clinical presentation of late smokeless tobacco lesions

Answer 39

- severe liao so got extensive white thickening - leathery/ nodular

Question 40

location of smokless tobacco lesions

Answer 40

- buccal sulcus, vestibule areas - mucosa directly in contact with tobacco used

Question 41

histopatho findings of smokeless tobacco lesions - specifc/ non specific - hyperkeratosis & ___ - may have intracellular ___ (oedema) of ____ superficial cells - no/ got dysplasia

Answer 41

- not specific - acanthosis - intracellular vacuolisation of glycogen rich superficial cells - no or mild dysplasia

Question 42

management of smokeless tobacco lesions

Answer 42

- reversible with cessation of habit ( 2 weeks) - any lesion that persists after 6 weeks of cessation, we suspect true leukoplakia and should do biopsy