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White Lesions ch. 13 - Coggle Diagram
White Lesions ch. 13
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Infections
Acute Pseudomembranous Candidiasis (Candidosis, Moniliasis, Thrush):
- Etiology: Candidiasis or candidosis is caused by species of Candida, usually albicans, which is a yeast-like fungus.
- Method of Transmission: While candidiasis is an infection, it is not highly transmissible. Candidiasis is considered an opportunistic infection.
- Extraoral Characteristics: Can occur in any epithelial surface of the body but is especially common in areas that are consistently warm and moist, such as the feet and areas where skin overlaps.
- Perioral and Intraoral Characteristics: manifests as multiple, raised, whitish, cordlike plaques with variable surrounding erythema. The plaques are always multiple, and it is not unusual for large areas of the oral mucosa to be affected. Patients are almost always symptomatic and complain of pain, discomfort, or burning. The plaques can be scrapped off with a tongue blade or stiff instrument, hence the designation pseudomembranous. Erythematous or bleeding bases are revealed if pseudomembrane is removed.
- Distinguishing Characteristics: The ability to scrape the pseudomembranes off is a diagnostic feature of this form of candidiasis. The dental hygienist almost never sees a "bleeding" base, since it would require scrapping the tissues hard enough to remove the entire thickness of epithelium down into the underlying connective tissue.
- Dental Implications: Candidiasis is an infection that needs to be diagnosed and treated. The tendency for this infection to occur in immunocompromised patients should prompt the dental professional to carefully review the patient's medical history for any sign of undiagnosed systemic problems.
- Treatment and Prognosis: Effective antifungal medications are used for treatment. Topical medications such as nystatin oral suspensions or clotrimazole troches. Effective systemic medication is also available, such as fluconazole.
- Source: Delong, Burkhart textbook, pg. 339-340.
Chronic Hyperplastic Candidiasis (Candidal Leukoplakia):
- Etiology: Hyperplastic candidiasis is also caused by a species of Candida, usually albicans.
- Method of Transmission: Chronic hyperplastic candidiasis, like pseudomembranous candidiasis, is not considered to be highly transmissible.
- Extraoral Characteristics: Not applicable
- Perioral and Intraoral Characteristics: Chronic hyperplastic candidiasis manifests as a thickened, often raised, whitish plaque that does not rub off. Lesions commonly affect the tongue or commissure. The lesions have no distinctive clinical features and are indistinguishable from leukoplakia. In fact, another term for the condition is candidal leukoplakia.
- Distinguishing Characteristics: Hyperplastic candidiasis cannot be clinically distinguished from other white lesions that do not wipe off.
- Dental Implications: This lesion is rare, but it is considered premalignant. Chronic forms of candidiasis are also an indication that the person's immune system may be deficient.
- Treatment and Prognosis: Tx include systemic antifungals, topical application of vitamin A/retinoids and B-carotenes, laser surgery, and conventional surgical excision. The treatment of these lesions is somewhat controversial, because treatment does not universally result in resolution of the lesion. Treatment does not necessarily prevent the development of epithelial dysplasia and progression to cancer.
- Source: Delong, Burkhart textbook, pg. 340-341.
Hairy Leukoplakia:
- Etiology: HL is caused by an infection with Epstein-Barr virus secondary to immunosuppression.
- Method of Transmission: Not applicable
- Extraoral Characteristics: Not applicable
- Perioral and Intraoral Characteristics: HL produces whitish plaques that do not rub off. They usually affect the lateral borders of the tongue, often bilaterally, where they appear as vertical, raised ridges or sometimes as irregular flattened lesions. Rarely, HL will affect mucosal surfaces other than the tongue. Patients are typically asymptomatic.
- Distinguishing Characteristics: HL characteristically presents as white plaques, often with vertical raised ridges, bilaterally on the tongue in immunosuppressed patients.
- Dental Implications: HL is a significant diagnosis because it is a relatively accurate predictor of rapid progression from HIV latent infection to AIDS.
- Treatment and Prognosis: Antiviral therapy often produces improvement or resolution of the lesion; however, recurrence is not uncommon. There is no evidence that HL has the potential for malignant transformation.
- Source: Delong, Burkhart textbook, pg. 341
Parulis:
- Parulis is a swelling of the gingiva caused by a draining sinus tract from an odontogenic infection of either periodontal or pulpal origin. The swelling is due to purulent exudate (pus), which is more yellowish than white. When pus is encountered clinically, the source of odontogenic infection should be determined and treated.
Variations of Normal
Leukoedema:
- Etiology: Sufficiently common that most authorities consider it a variation of normal rather than a pathologic condition.
- Method of Transmission: Not applicable
- Extraoral Characteristics: Not applicable
- Perioral and Intraoral Characteristics: Produces a whitish opaqueness, sometimes with fine wrinkles, of the mucosa. Invariably found on the buccal mucosa and is often bilaterally symmetrical, a feature suggesting a developmental origin. It does not rub off and characteristically disappears when the mucosa is stretched. Normally, the condition can be diagnosed by its characteristic clinical features.
- Distinguishing Characteristics: Manifests as thin whitish plaques on the buccal mucosa that will dissipate when the tissue is stretched.
- Dental Implications: None
- Treatment and Prognosis: No Tx is indicated.
- Source: Delong, Burkhart textbook, pg. 334
Fordyce Granules:
- Etiology: Are normal sebaceous glands that are found in the oral mucosa. Fordyce granules are a feature of normal development.
- Method of Transmission: Not applicable
- Extraoral Characteristics: Not applicable
- Perioral and Intraoral Characteristics: Fordyce granules appear as superficial yellowish-to-yellowish white, slightly elevated papules. They are found most commonly on the buccal mucosa and are often bilaterally symmetrical. Patients with these structures are asymptomatic.
- Distinguishing Characteristics: They are very distinctive in their clinical presentation. Once the clinician has observed them in several patients, he or she is not likely to mistake them for anything else.
- Dental Implications: None
- Treatment and Prognosis: These are normal anatomical findings and require no Tx.
- Source: Delong, Burkhart textbook, pg. 333-334.
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Immune System Disorders
Lichen Planus:
- Etiology: LP is a chronic immune-medicated mucocutaneous disorder. T lymphocytes are recruited to the skin or oral mucosa where they produce damage to the surface epithelium.
- Method of Transmission: Not applicable
- Extraoral Characteristics: The characteristic skin lesions are purplish, raised papules with a keratotic white surface pattern or very fine interlacing lines called Wickham striae. Lesions are also pruritic (itchy) and typically affect the legs and forearms.
- Perioral and Intraoral Characteristics: May appear as white lesions, red lesions, and ulcers. The reticular or striate form of LP is the most common and is characteristic of the various presentations. It produces a lacy pattern of Wickham striae that do not rub off. The lesions affect the buccal mucosa, usually bilaterally, but may also affect the gingiva. The reticular form of LP tends to be asymptomatic, but some patients will complain of a textural change. One of the most common sites to see LP is in the postbuccal mucosa in the lower mucobuccal fold, which is often traumatized form routine functioning. Koebner phenomenon (ability of a disease to affect chronically irritated tissue).
- Distinguishing Characteristics: Wickham striae observed bilaterally on the buccal mucosa and possibly on the gingiva are characteristic of this disorder.
- Dental Implications: LP is often confused with other pathologic processes. Symptomatic patients require diagnosis and treatment. There is controversy regarding the premalignant nature of LP, and case studies as well as editorials are published on both sides of this issue. All agree that the lesions should be carefully monitored.
- Treatment and Prognosis: Generally asymptomatic, and patients usually do not require treatment.
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