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White Lesions (13) - Coggle Diagram

- - - - Chronic cheek chewing induces hyperkeratosis; continued chewing abrades the tissue, leaving a whitish irregular/macerated, white roughened surface. Usually bilateral; may produce area of redness. Lesions are confined to the occlusal plane and not located in the mucobuccal folds.
    - - Disruptive oral habits, such as cheek biting, should be discouraged. Long-term inflammation is detrimental to any mucosal tissue.
    - - Not applicable
    - - Diagnosis can be made from clinical features and can be confirmed by questioning patient. Not considered premalignant; no treatment indicated.
    - - Physical irritation (frictional keratosis) causes the lesions associated with cheek or lip chewing
  - - - Production of keratosis of the palatal mucosa and irritation of the minor salivary gland ducts as they exit onto the pallet. The inflammation results in small elevations with central erythema. Appears as whitish palate with small red dots (and combined with a history of smoking).
    - - Not pre-malignant, but risks development of oral cancer. Use the lesion as educational opportunity to show patient visible consequences of tobacco habit. Treatment plan should include tobacco cessation
    - - Not applicable
    - - Nicotine stomatitis is diagnosed by it's clinical features with confirmation of the patients smoking habit. Changes will resolve when habit ceases. Lesion is not considered pre-malignant, except in case of reverse smoking.
    - - Heavy smoking can lead to keratinization on palatal mucosa - a more frequent occurrence with pipe smokers. It may play a greater role than the irritation from combustion products e.g.reverse smoking
  - - - A linear white line along the occlusal plane of the buckle mucosa. Usually bilateral, slightly raised, and occasionally scalloped, corresponding to the embrasures between the teeth.
    - - None.
    - - Not applicable
    - - No treatment is indicated. Not pre-malignant
    - - Localized form of frictional keratosis due to irritation of the cheek during function. May be an indicator of bruxism or clenching.
  - - - None.
    - - Correct predisposing factors. Debridement with a toothbrush or tongue scraper is helpful.
    - - Hair-like projections can be whitish or, more commonly, brown or black. Does not produce symptoms but is unsightly. Elongated papillae encourages continued growth of bacteria which may lead to halitosis.
    - - Not applicable
    - - Unknown, but several risk factors include antibiotics, therapeutic radiation therapy, smoking, oxygenating mouth rinses/peroxide, overgrowth of oral flora.
  - - - Not applicable
    - - Varies in size; whitish plaque that does not rub off. Keratinization represents duration of irritation
    - - Physical irritation of mucosa.
    - - Cause should be identified and illuminated. Factitious injuries may be associated with psychiatric disorders. Unresolving may indicate leukoplakia
    - - Hyperkeratosis will resolve once irritant is identified and removed. Clinical resolution will confirm presumptive clinical diagnosis
  - - - Most chemical and thermal burns manifest as white plaques of different sizes. Early or mild lesions do not rub off; more severe lesions may be removed with pressure from a tongue blade making the tissue bleed.
    - - Chemical and thermal burns may be confused with other pathologic conditions. Patient should be educated about proper use of medications such as aspirin.
    - - Not applicable
    - - Lesion will heal once offending chemical is withdrawn or more hot substances do not traumatize tissue.
    - - Caustic chemicals or drugs Many of which are not intended for topical placement on oral mucosa. Best example is aspirin burn; others are finals, silver nitrate, and hydrogen peroxide. Other burns may be caused by hot foods, implements, or electric currents.
  - - - Characteristic appearance; depapillated areas (areas of atrophy with loss of filiform papillae) Located on dorsal surface; either erythematous or pink, surrounded by yellowish white lines at margins. Areas heal and lesions reappear at new sites, hence migrating. May burn.
    - - GT can be confused with other pathologic conditions. May cause alarm and patients.
    - - Not applicable
    - - Not pre-malignant. Asymptomatic patients do not require treatment; symptomatic patients may use topical corticosteroids.
    - - Unknown
- - - - Produces whitish plaques that do not rub off; usually affects lateral borders of tongue, often bilaterally; appear as vertical, raised ridges or sometimes as a regular flat and lesions
    - - Significant for HIV patients as a predictor of rapid progression from HIV latent infection to AIDS
    - - Not applicable
    - - Antiviral therapy helps resolve lesion; recurrence is common
    - - Caused by infection with Epstein bar virus secondary to immunosuppression. Also linked to the immunosuppression associated with HIV.
  - - - Manifest as a thickened, often raised, whitish plaque that does not rub off. Lesions often affect tongue or commisures; no distinctive clinical features; indistinguishable from leukoplakia; also called candidal leukoplakia
    - - Rare, but considered pre-malignant. Chronic forms of candidiasis indicate immune deficiencies.
    - - Not considered to be highly transmissible.
    - - Treatments include systemic antifungal's, topical application of vitamin A/retinoids and beta carotene, laser surgery, and conventional surgical excision. Treatment may not prevent development of dysplasia and progression to cancer; only this form of candidiasis shows malignant potential; erythematous or pseudomembranous types are unrelated to oral cancer.
    - - Also caused by species of Candida, usually albicans.
  - - - Can appear on surface of body on warm and moist areas. Manifest in mouth as multiple, raised, whitish, cordlike plaques with variables surrounding erythema. Plaques are always multiple; large areas of mouth affected. Patients may complain of pain, discomfort, or burning. Ability to scrape the pseudomembranes off is a diagnostic feature of this form of candidiasis.
    - - Needs to be diagnosed and treated. Tends to occur in immunocompromise patients; review medical history for sign of undiagnosed systemic problems.
    - - Not highly transmissible; an opportunistic infection.
    - - Antifungal medications are used: nystatin oral suspension; clotrimazole trochest; flucanazole
    - - Caused by candida, usually albicans. Candida is a part of normal oral flora. Predisposing factors are usually present that alter oral environment or systemic status of host to allow infection. Common predisposing factors are systemic broad spectrum antibiotic therapy, systemic, topical, or aerosolized corticosteroid use, smoking, xerostomia, immune system disorders, and diabetes.
- - - - Not found extra-orally. They appear as superficial yellow to yellowish-white, slightly elevated populace. Most commonly found on buckle mucosa usually bilaterally symmetrical.
    - - None
    - - Not applicable
    - - Normal anatomic finding. No treatment required. Can use as educational moment.
    - - Sebaceous glands of normal development
  - - - Not pathologic - variation of normal.
    - - Not applicable
    - - Not found extra-orally. Leukoedema produces a whitish opaqueness, sometimes with fine wrinkles of the mucosa. Usually found on the buccal mucosa; often bilaterally symmetrical. It does not rub off and disappears when the mucosa is stretched. Normally found in blacks and dark skinned individuals
    - - None.
    - - Nonrequired. Can use as an educational moment.
- - - - Variety of shapes and sizes; may feel leathery;Leukoplakias of lower lip are usually related to chronic sun damage (actinic or solar keratosis);May also have areas of redness, ulceration, or pebbly or Veracruz surface. May be described as speckled leukoplakia, verrucous leukoplakia or proliferative verrucous leukoplakia; Not distinguishable from other white lesions that do not rub off
    - - None
    - - Not applicable
    - - Biopsies should be performed on leukoplakias, since microscopic examination is the only way to accurately assess the presence of epithelial dysplasia; Non-dysplastic lesions are best managed by eliminating or altering risk factors such as tobacco use
    - - Most important etiological factor is tobacco, both smoked and topical; diagnosed by exclusion
  - - - None
    - - First stage involves generalized stomatitis manifesting as erythematous mucosal tissues with numerous vesicles in ulcers. Second or fibrosis stage is marked by accumulation of collagen fibersA white marble like appearance on the buckle in labia mucosa form from fibrous bands of tissue.
    - - Believed to have a multi factorial etiology; risk factors include beetle nut chewing, genetic predisposition and genetic mutation, and nutritional deficiencies.
    - - Patients who habitually chew beetle night should be encouraged to stop, have regular examinations, and be told about complications of 0SF
    - - No effective treatment; process is irreversible; surgery may be necessary to treat severe trismus by releasing the fibrous bands; prognosis depends on severity; supplements such as alpha lipoic acid, lycopene, curcumin can help
- - - - Widespread keratinization/white plaques on buccaland labial mucosa; lesions do not rub off
    - - Occasionally present cosmetic problems
    - - Autosomal dominant inheritance
    - - No treatment is needed for WSN; prognosis excellent
    - - Inherited; mutation of certain keratin genes; usually aparent in childhood
- - - - Outside of mouth skin lesion or purpleish, raised papules; May be itchy; affect legs and forearms; inside mouth on buccal mucosa/possibly gingiva -keratotic white surface pattern - very fine interlacing lines called Wickham striae.
    - - Often confused with other pathology's. Pre-malignant nature of LP is controversial.
    - - Not applicable
    - - Chronic immune mediated mucocutaneous disorder; T lymphocytes are recruited to skin or oral mucosa where they produce damage