White Lesions: Reactive Lesions

Question 1

Reactive Lesions (6)

Answer 1

• Focal Hyperkeratosis
• White lesions associated with smokeless tobacco
• Nicotine Stomatitis
• Hairy leukoplakia
• Hairy Tongue
• Dentrifice-associated slough

Question 2

related to chronic rubbing or friction against an oral mucosal surface.

This results in a hyperkeratotic white lesion that is analogous to a callus on the skin.

Answer 2

Focal (Frictional) Hyperkeratosis

Question 3

occur in areas that are
commonly traumatized, such as the lips, lateral margins of the tongue, buccal mucosa along the occlusal line, and edentulous alveolar ridges

Chronic cheek or lip chewing may result in opacification (keratinization) of the affected area.

Chewing on edentulous alveolar ridges produces the same effect.

Answer 3

Focal (Frictional) Hyperkeratosis

Question 4

the primary microscopic change is hyperkeratosis

A few chronic inflammatory cells may be seen in the subjacent connective tissue

Answer 4

Focal (Frictional) Hyperkeratosis

Question 5

Control of the habit causing the lesion should result in clinical improvement.

No malignant
potential exists.

Answer 5

Focal (Frictional) Hyperkeratosis

Question 6

Direct contact of mucosa with smokeless tobacco and contaminants

Snuff form of tobacco most likely to induce lesions

Answer 6

White lesions associated with smokeless tobacco

Question 7

Slight to moderate parakeratosis, often in the form of spires or chevrons, is noted over the surface of the affected mucosa.

Superficial epithelium may demonstrate
vacuolization or edema.

A slight to moderate chronic inflammatory cell infiltrate is typically present.

Epithelial dysplasia may occasionally develop in these lesions, especially among long-time users of smokeless tobacco.

develop in the immediate area where the tobacco is habitually placed

The mucosa develops a granular to wrinkled hyperkeratotic appearance

Answer 7

White lesions associated with smokeless tobacco

Question 8

• Discontinuation
• Perform biopsy on persistent lesions (long exposure increases risk to carcinoma)

Answer 8

White lesions associated with smokeless tobacco

Question 9

• Caused by tobacco pipe, cigar, and cigarette smoking
• Opacification of the palate caused by heat and carcinogens
• Most severe changes are seen in patients who “reverse smoke”

Answer 9

Nicotine Stomatitis

Question 10

• Generalized white change (hyperkeratosis) seen in hard palate.
• Red dots in the palate represent inflamed salivary duct orifices

Answer 10

Nicotine Stomatitis

Question 11

• Discontinue tobacco habit
• Observe and examine all mucosal sites
• an indicator of potential significant epithelial change at sites other than the hard palate

Answer 11

Nicotine Stomatitis

Question 12

characterized by epithelial hyperplasia and hyperkeratosis.

The minor salivary glands
in the area show inflammatory change, and excretory ducts may show squamous metaplasia.

Answer 12

Nicotine Stomatitis

Question 13

Associated with local or systemic immunosuppression (esp. AIDS and organ transplantation)

Answer 13

Hairy Leukoplakia

Question 14

Represents an opportunistic infection by Epstein Barr virus

Answer 14

Hairy Leukoplakia

Question 15

well-demarcated white lesion that varies in architecture from a flat and plaquelike to a papillary/filiform, or a corrugated lesion

Most commonly seen on lateral tongue, often bilateral

Asymptomatic white lesion

Answer 15

Hairy Leukoplakia

Question 16

May occur before or after the diagnosis of AIDS

Answer 16

Hairy Leukoplakia

Question 17

May be secondarily infected by Candida albicans

Answer 17

Hairy Leukoplakia

Question 18

clinical differential diagnosis includes:

idiopathic leukoplakia,
frictional hyperkeratosis
(tongue chewing),
leukoplakia associated with tobacco use.

Other entities that might be considered are:
lichen planus,
lupus erythematosus,
hyperplastic candidiasis

Answer 18

Hairy Leukoplakia

Question 19

• investigation for HIV infection or other causes of systemic or local immunosuppression
• No specific treatment; cosmetically objectionable
• Antiviral and antiretroviral agents likely to cause lesion to regress

Answer 19

Hairy Leukoplakia

Question 20

filiform papillary overgrowth on the dorsal surface of the tongue of variable color

Answer 20

Hairy Tongue (Black hairy tongue)

Question 21

cause is not well understood; believed to be related to alterations in oral flora

Initiating Factors:
Use of broad-spectrum antibiotics, systemic corticosteroids,
hydrogen peroxide
Intense smoking
Head and neck therapeutic radiation

Answer 21

Hairy Tongue (Black hairy tongue)

Question 22

asymptomatic hyperplasia of the filiform papillae, with concomitant retardation of the normal rate of desquamation (overgrowth of filiform papillae and chromogenic
microorganisms)

Answer 22

Hairy Tongue (Black hairy tongue)

Question 23

color may range from
white to tan to deep brown or black

when extensive elongation of the papillae occurs, a gagging or a
tickling sensation may be felt

Answer 23

Hairy Tongue (Black hairy tongue)

Question 24

thick, matted surface that serves to trap bacteria, fungi, cellular debris,
and foreign material (Dense hairlike mat formed by hyperplastic papillae on the dorsal tongue surface)

Answer 24

Hairy Tongue (Black hairy tongue)

Question 25

presence of elongated filiform papillae over the dorsum of the tongue, with surface contamination by clusters of microorganisms and fungi.

The underlying lamina propria is generally mildly inflamed

Answer 25

Hairy Tongue

Question 26

Identify and eliminate initiating factor identified and eliminated

Brush/scrape tongue with baking soda

Little significance other than cosmetic appearance

Answer 26

Hairy Tongue

Question 27

believed to be a superficial chemical burn or a reaction to a component in the
dentifrice, possibly the detergent or flavoring compounds

Answer 27

Dentifrice-Associated Slough

Question 28

may be related to the use of essential oil–
containing mouth rinses

Answer 28

Dentifrice-Associated Slough

Question 29

• Clinically, it appears as a superficial whitish slough of the buccal mucosa, typically detected by the patient as oral peeling that easily swipes away
• The condition is painless and is not known to progress to anything significant

Answer 29

Dentifrice-Associated Slough

Question 30

White mucosal changes have been described in association with the use of toothpaste and mouthwashes containing the substance sanguinaria.

The alteration
is typically seen in the maxillary vestibule, although other
sites may be affected.

Answer 30

Dentifrice-Associated Slough

Question 31

The problem resolves with a switch to another, blander toothpaste or
mouth rinse.

Answer 31

Dentifrice-Associated Slough

Question 32

• Pale to silvery gray, glossy appearance, often with fissuring and wrinkling at right angles to the cutaneous vermilion junction.
• Slightly firm, bilateral swelling of the lower lip is common.
• Mottled areas of hyperpigmentation and keratosis are often noted, as well as superficial scaling, cracking, erosion, ulceration, and crusting.

Answer 32

Dentifrice-Associated Slough