Keratosis and-related-disorder-of-the-oral-mucosa

By:
Dr. Mo’ad A. Albdour

1. Keratosis and related disorder of the oral mucosa By: Dr. Mo’ad A. Albdour

2. Hereditary conditions: Oral epithelial naevus (white spnge naevus ): - autosomal-dominant condition that is due to point mutations for genes coding for keratin 4 and/or 13. - Asymptomatic - Bilateral shaggy white buccal mucosal change - appears early in life - Does not disappear when cheek is stretched - No treatment, no malignant potential - histologically; marked spongiosis , acanthosis , and parakeratosis .

3. Lukoedema : - a generalized mild opacification of the buccal mucosa that is regarded as a variation of normal . - the cause has not been established. Factors such as smoking, chewing tobacco, alcohol ingestion, bacterial infection, salivary conditions, electrochemical interactions play a significant rule. - asymptomatic and symmetrically distributed in the buccal mucosa, and to a lesser extent over the labial mucosa. - It appears as a gray-white, diffuse, filmy, or milky surface alteration . - With stretching of the buccal mucosa, the opaque changes dissipate . - Histologically; the epithelium is parakeratotic and acanthotic , - no treatment required.

4. Reactive conditions: Frictional (focal) hyperkeratosis: - white lesion that is related to chronic rubbing or friction against an oral mucosal surface. - occur in areas that are commonly traumatized, such as the lips, lateral margins of the tongue, buccal mucosa along the occlusal line. - hyperkeratosis is noted without dysplastic change. - If cause is removed, lesion should subside. When in doubt, perform a biopsy. chronic rubbing of the lip against teeth cheek chewing

5. Nicotine Stomatitis: - Caused by pipe, cigar, and cigarette smoking “ reverse smoke ”. - Opacification of the palate caused by heat. - Generalized hyperkeratosis seen in hard palate with Red dots in the palate represent inflamed minor salivary duct orifices. Reverse smoker’s palate

6. Hairy Leukoplakia: - unusual asymptomatic white lesion along the lateral margins of the tongue . - Associated with immunosuppression (esp. AIDS and organ transplantation). - Most commonly seen on lateral tongue, often bilateral. - Papillary , filiform , or plaquelike architecture. - May occur before or after the diagnosis of AIDS.

7. HAIRY TONGUE: - condition of filiform papillary overgrowth on the dorsal surface of the tongue of variable color . - believed to be related to alterations in oral flora (by Use of broad-spectrum antibiotics, systemic corticosteroids, hydrogen peroxide). - usually asymptomatic. - treatment; identify and eliminate the initiating factor, brush the tongue with baking soda.

8. Other white lesions Lichen planus : - chronic mucocutaneous disease of unknown cause, with oral lesions occurring most commonly in women between 30 and 60 years of age. - affects women more frequently. - types of lichen planus ; 1) reticular form : most common type characterized by numerous interlacing white keratotic striae (Wickham’s striae ) that produce lacy pattern, The buccal mucosa bilaterally is the site most commonly involved.

9. 2) plaque form: resemble leukoplakia clinically but has a multifocal distribution. range from slightly elevated to smooth and flat,The primary sites are the dorsum of the tongue and the buccal mucosa . 3) erythematous (atrophic) form: red patches with very fine white striae . may be seen in conjunction with reticular or erosive form. The attached gingiva commonly involved. Patients may complain of burning, sensitivity, and generalized discomfort . 4) erosive form: central area of the lesion is ulcerated, pseudomembrane covers the ulcer. - corticosteroid successfully controlled but not cure lichen planus . erosive form reticular form