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Non-Infective Lesions - Coggle Diagram
Non-Infective Lesions
White Sponge Naevus
Aietology
autosomal dominat
Epidemology
Rare F>M
Signs and Symptoms
asymptomatic
patient may feel roughness/notice white patches
Clinical Features
White/greyish patches which merge with normal mucosa
firmly adherent
no associated source of trauma
surface is soft/spongy
can occur on any type of mucosa
Investigations
clinical grounds +/- biopsy
Management
explanation of condition - NOT a POMD
Oral Lichen Planus and Lichenoid Reactions
Diagnostic Criteria for Lichen Planus
lesions not localised exclusively to sites of smokeless tobacco
lesions not localised exclusively adjacent to restorations
lesions onset does not correlate with the start of medication
lesion once does not correlate with the use of cinnamon containing products
Aietology
Unkown 75% of cases
25% lichenoid reactions to dental materials
Epidemiology
F>M
Signs and Symptoms
asymptomatic
may feel rough patches
sensitive when eating - spicy, salty, acidic foods
pain on toothbrushing
Clinical Features
Bilateral if LICHEN PLANUS
tongue, cheeks and gingiva most commonly affected
TYPES
Reticular - white striae
Atropphic - areas of erythema surrounded by reticular pattern
Papular
Erosive (ulcerative)
Bullous
Plaque
ORAL POTENTIALLY MALIGNANT DISORDER
high risk factors
Tongue
atrophic or erosive
tobacco use
alcohol consumption
hep C infection
Investigations
Clinical Grounds + History
Biopsy and swab if candida infection suspected
FBC if suspicion of associated disease
Management
Explanation of diagnosis and POMD
Smoking cessation/alcohol reduction
Diet modification
SLS free toothpaste
Antifungal if superadded candidate infection
Topical Analgesics
Benzydamina hydrochloride 0.15% MW (Difflam)
CHX MW
Topical Steroids
Hydrocortisone oromucosal tablets 2.5mg
betamethasne tablets 500mg
Clean Modulite 50mg
Topical Calcineurin Inhibitor
More effective than topical corticosteroids
Systemic Management
Predinsolone
DMRADs
azathriopine
Regular review to assess pathological changes
Lichenoid Reactions to Medications
Antihypertensives
ACE inhibitors e.g. Catopril
Beta Blockers e.g. Propanolol
Calcium channel blockers
Oral Hypoglcaemics
Tolbutamide
NSAIDS
Ibuprofen
Naproxen
Lichenoid Reactions to Restorations
Type IV hypersensivity reaction
Must be contact between mucosa and restoration for reaction to occur
Diseases associated with Lichenoid Reactions
Graft vs Host Disease
occurs after allogenic haematopoetic cell transplant due to abnormal response of donor T lymphocutes to host antigens
donor T lymphocytes target host HLA antigens on keratinocytes causing OLP
Hep C
Hypertension
Diabetes
Thyroid Gland disease
