White Patches

Question 1

On clinical examination you find white greyish patches which merge with surrounding normal appearing mucosa. They are firmly adherent. No association with erythemo or ulceration.
Their surface is folded, soft and spongy.
Can affect any area of the oral mucosa
What could you predict it is?

Answer 1

White sponge nevus

Question 2

white sponge nevus is inherited? true or false

Answer 2

true

Question 3

white sponge nevus is potenially malignant true or false?

Answer 3

false - not a potentially malignant disorder

Question 4

what is the aetiology of leukoedema?

Answer 4

idiopathic (cause unknown) but thought to be secondary to low grade mucosal irritation causing intracellular oedema of the epithelial cells

Question 5

Asymptomatic
Soft on palpation
found usually on the buccal and labial mucosa
what is your prediction?

Answer 5

leukoedema

Question 6

What should patients with epitheliolysis (oral mucosal peeling) avoid?

Answer 6

SLS (sodium lauryl sulphate)) containing products

Question 7

what is the aetiology of epitheliolysis (oral mucosal peeling)

Answer 7

secondary to mucosal irritation by toothpaste, mouthwashes

Question 8

during assessment you notice strands of gelatinous milky white material removeably by wiping, no significant abnormality of underlying tissue and otherwise asymptomatic
what is your predication?

Answer 8

epitheliolysis

Question 9

patient comes in having had either frictional, chemical or thermal irritation to the side of their tongue,
on inspection the area feels
rough/rigid
the white patch is not removed by rubbing
what is your suspicion?

Answer 9

traumatic keratosis

Question 10

what does this present as?

Answer 10

Stomatitis nicotina (nicotine stomatitis)

Question 11

true or false: stomatitis nicotina is potentially malignant

Answer 11

false

Question 12

what is the aetiology of oral lichen planus/lichenoid reactions?

Answer 12

75% of cases - unknown
25% of cases - reaction to medication, dental materials

Question 13

what are the signs of oral lichen planus

Answer 13

• can occur at any site, but tongue buccal mucosa and gingiva most commonly affected
• usually bilateral if lichen planus
• palatal mucosa rarely affected unless lichnoid drug reaction
• white and red lesions exhibiting one or more of the following terms:
• reitcular/papular
• atrophic
• erosive
• plaque
• bullous (blister)
• not localised to tobacco sites
• not adjacent to restoration
• not corrolate with start of medicatioon

Question 14

what are the range of symptoms that oral lichen planus/lichenoid reactions can present as?

Answer 14

• asymptomatic
• affected areas may feel rough
• soreness only on eating (spicy, salty, acidic, rough, hot food, and tooth brushing)
• soreness present at all times exasberated by above factors
• symptoms tend to wax and wane in severity
• stress may be an exacerbating factor

Question 15

other than the mouth what other sites may be involved in oral lichen planus/lichenoid reactions?

Answer 15

skin
scalp
nails
genital - especially females
less common
- oesophagus
- larnyx
- anus
- bladder
- eyelids
- lacrimal glands

Question 16

what is the initial non-pharmocolgical management in primary care?

Answer 16

explanation of diagnosis
ask regarding other site involvement - refer where necessary
advise that potentially malignant
smoking cessation and alcohol
baseline photographs
consider referral to secondary care

Question 17

give some examples of lichenoid drug reactions?

Answer 17

ACE inhibitors
Beta blockers
diuretics
NSAIDs
Hypoglycemics
Anticonvulsants
Biologics
Tyrosine kinase inhibitors

Question 18

what is graft versus host disease?

Answer 18

often after transplant, the donors immune cells (graft) recognise the recipient (host) as foreign and attack

Question 19

what are risk factors for malignant transformation of lichen planus/lichenoid reactions?

Answer 19

• Tongue lesions
  
  • Alcohol consumption
  • Smoking
  • Atrophic-erosive lesions
  • Hepatitis c infection
• Females

Question 20

what are some other diseases associated with lichen planus

Answer 20

• Systemic lupus erythematosus
  
  • Sjogrens syndrome
  • Dermatomyosistis
  • Vitiligo
  • Alopecia
  • Celiac disease
  • Type 1 diabetes
    Autoimmune thyroiditis

Question 21

what white patch is strongly associated with AIDS or immunosuppressed patients

Answer 21

hairy leukoplakia

Question 22

Hairy leukoplakia is a condition causing white, fuzzy patches on the tongue, often appearing as folds or ridges, what is it primarily caused by?

Answer 22

epstein barr virus (human herpes virus 4)

Question 23

what condition would you expect in a patient with a white patch which can be removed by scraping leaving an erythematous/bleeding base?

Answer 23

acute pseudomembranous candidosis (thrush)

Question 24

what are some underlying local and/or systemic predisposing factors for acute pseudomembranous canidosis (thrush)

Answer 24

• dry mouth
• steroid inhaler use
• anaemia
• nutritional deficiency
• diabetes
• immunosuppressed/immunocompromised
• extremes of ages

Question 25

how does chronic hyperplastic candidosis present as?

Answer 25

firmly adherent white plaques which may have a speckled or nodularity appearance ] commussure/anterior region of buccal mucosa is most commonly affected, often bilateral

Question 26

what is a significant aetiological factor for chronichyperplastic candidosis?

Answer 26

smoking

Question 27

what is the difference between acute pseudomembranous candidosis and chronic hyperplastic candidosis?

Answer 27

acute pseudomembraneous you can wipe away the white plaques whereas chronic hyperplastic they are firmly adherant