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White Lesions, Source of Information - Coggle Diagram
White Lesions
Fordyce Granules
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Fordyce is granules affect most of the adult population, as much as 80%. They are rarely found in children.
Intraoral: Fordyce granules are appears as superficial yellowish to yellowish white, slightly elevated spots/ they are found mainly on lower lip, buccal mucosa, and often bilaterally symmetrical.
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Leukoedema
Leukoedema is sufficiently common that most authorities consider it a variant of normal rather than pathologic condition.
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It shows a predilection for black and other darker skinned individuals, but also occur in white individuals. It affects male and females equally. Leukoedema is a common mucosal anomaly characterized by intracellular edema and whiteness.
Intraoral: Produces a white opaqueness, sometime with fine wrinkles, of the mucosa. It is often found on the buccal mucosa and often seen as bilaterally symmetrical. It does not rub off and characteristic disappear when the mucosa is stretched.
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Treatment and prognosis: No treatment is indicated. The healthcare practitioner can teach the patient about the oral cancer self exam and point out variation from normal such as leukoedema.
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Frictional Keratoma
Physical irritation of the oral mucosa may produce whitish plaque know as Frictional keratosis (FK).Adaptive response is a callus (over production of keratin) against physical injury.
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Intraoral: FK presents as a variably sized, whitish plaque that does not rub off.
Dental implication: The cause of these lesions should be identified and eliminated. Factitious injuries are sometimes associated with psychiatrics disorders. Lesions that do not resolve may be confused with other pathologic conditions such as leukoplakia.
Treatment and prognosis: Because FK is an adaptive response, the hyperkeratosis will resolve once irritant is identifies and removed.
Linea alba
Linea alba is a localized form of frictional keratosis due to irritation of the cheek during friction. This may indicate bruxism or clenching
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Intraoral: Linea alba a linear white line along the occlusal plane of the buccal mucosa. Lesions are often bilateral, variably raised and occasionally scalloped, corresponding with embrasure of the teeth.
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Nicotine Stomatitis
Heavy smokers often develop keratotic changes of their palatal mucosa.This often happens most frequently in pipe smokers. Heat may play a greater role than irritation from the combustion of tobacco products burnt.
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The keratotic changes are a reaction of the palatal mucosa to irritation and heat from smoked tobacco.
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Dental implication: The lesion itself is not considered premalignant (except in the case the lesion is associated with reverse smoking), its presence can alert the clinician to an increased risk of developing oral carcinoma in the patient. the clinician can use the presence of the patient's visible lesion as visual consequences of smoking tobacco habits. The patient should be offered tobacco cessation counseling
Treatment and Prognosis: Nicotine stomatitis is diagnosed by its clinical features with confirmation of the patient's smoking habit. Palatal changes will resolve with smoking cessation. The lesion is not considered premalignant, except in the case of reverse smoking. Patient should be encourage to stop smoking because the habit increases their overall risk of oral cancer
Cheek Chewing (Morsicatio Buccarium, Morsicatio labiorum)
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Lesion are associated with overproduction of keratin and damage to the epithelium as a reaction to physical injury.
Intraoral: Chronic cheek induces hyperkeratosis and continued chewing abrades the tissue, leaning white, irregular surface. lesion are often bilateral and acute injury can produce areas of redness.
Dental implication: Disruptive oral habits, such as cheek biting, should be discouraged. Long term inflammation is detrimental to any mucosal tissue
Treatment and prognosis. The diagnosis can be made from clinical features and confirmed by a patient history of cheek biting. The clinical tissue changes are not considered premalignant; therefore no treatment is indicated. The patient should be educated about the lesion and encourage to stop the habit.
Hairy Tongue
Unknown etiolofy but theie is several factors associated with its development: Antibiotics, radiation therapy, smoking, oxygenated mouth rinses/peroxide, and overgrowth of oral flora
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Hairy tongue represent elongation of the filiform papillae of the dorsal of the tongue to the extent it looks like hair. The reason for the elongation is unknown.
Intraoral: The hair like projections can be whitish or, more commonly, brown or black, representing pigments produced by the oral flora or exogenous staining due to tobacco. The elongated papillae provides and area from increase growth of the oral flora.
Treatment and prognosis: Predisposing factors for condition should be corrected if possible. Gentle debridement with a brush or tongue scarper is helpful. Often antimicrobial mouth wash is recommended such as chlorohexidine. If candida infection is present, antifungal therapy should be given.
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Infections Acute Pseudomembranous Candidiasis (Candidiasis, Moniliasis,Thrush)
Cause by species candida, usually albicans. Predisposing factors of infected individuals: Systemic board spectrum antibiotic therapy, smoking, xerostomia, immune system disorders, diabetes and corticosteroid use.
Candidiasis is an infection, it is not highly transmissible. It is considered an opportunistic infection
Candidiasis has a worldwide distribution and is commonly found in immunocompromised individuals and the elderly who have predisposing factors. Also, called thrush which is the clinical characteristic form of yeast infection.
Extraoral: Candidiasis can occur in any epithelial surface of the body but more commonly In areas that are warm and moist such as the feet, where hair overlaps, where fat tissues overlap each other commonly for over weight individuals. Intraoral: Acute pseudomembranous candidiasis manifest as multiple, raised, whitish, cordlike plaque with variable surrounding erythema. The plaque is always multiple and it is not uncommon for large areas of the oral mucosa to be infected.
Dental implication: Candidiasis is a infection that need to be diagnosed and treated. The tendency for the infection to favor immunocompromised individuals should prompt the clinician to review the medical history for signs of undiagnosed systematic problems.
Treatment and prognosis: Once the diagnosis is establish a variety of antifungal medication are used for treatment. Many clinician treat the infection with topical medication such as nystatin oral suspension or clotrimazole troche. Effective systemic medication is also available, such as fluconazole.
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Source of Information
Delong, L & Burkhart, N. (2019). General and Oral Pathology for the Dental Hygienist. Third Edition. Philadelphia: Wolter Kluwer.