Oral Lesions: Red and White Variations

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Questions and Answers

Which characteristic differentiates plaque-type oral lichen planus (OLP) from homogeneous oral leukoplakia?

  • Existence of reticular or papular structures (correct)
  • Surrounding erythematous zone
  • Presence of a desquamative gingivitis
  • Homogeneous red area surrounding the lesions

What is the primary clinical feature of ulcerative lesions in oral lichen planus?

  • Well-demarcated white plaques without inflammation
  • Increased keratinization and sharp demarcation
  • Fibrin-coated ulcers with surrounding erythema (correct)
  • Smooth, red patches with no striae

In which form of oral lichen planus might striae frequently be seen at the periphery of lesions?

  • Plaque-type OLP only
  • Discoid lupus erythematosus
  • Erythematous (atrophic) OLP (correct)
  • Ulcerative type OLP exclusively

Which disorder is characterized by easily detached epithelium due to Nikolsky’s phenomenon?

<p>Mucous membrane pemphigoid (D)</p> Signup and view all the answers

What is the current approach to the management of oral lichen planus?

<p>Reducing or eliminating symptoms (D)</p> Signup and view all the answers

What is the etiology of linea alba?

<p>Pressure and frictional irritation (A)</p> Signup and view all the answers

Fordyce's granules are most commonly found in which population percentage?

<p>80 to 90% (B)</p> Signup and view all the answers

Which condition is characterized by a bilateral faint white diffuse appearance on the buccal mucosa?

<p>Leukoedema (B)</p> Signup and view all the answers

Which of the following conditions does NOT require treatment?

<p>Linea alba (C)</p> Signup and view all the answers

Which of the following is a common cause of thermal burns in the oral cavity?

<p>Hot dental instruments (A)</p> Signup and view all the answers

Which of the following lesions is more common in men and generally appears at puberty?

<p>Fordyce's granules (A)</p> Signup and view all the answers

What is the appearance of habitual cheek biting lesions?

<p>Paler than surrounding tissue (D)</p> Signup and view all the answers

Which of the following is a differential diagnosis for leukoplakia?

<p>Cheek biting lesion (D)</p> Signup and view all the answers

What is the initial treatment recommended for reverse smokers with a lesion that does not disappear after 3-4 weeks?

<p>Stoppage of smoking habit (B)</p> Signup and view all the answers

Which of the following is NOT a clinical feature of traumatic keratosis?

<p>Presence of swelling (C)</p> Signup and view all the answers

What is the appropriate action if a traumatic keratosis lesion does not disappear after 2-3 weeks?

<p>Histological examination (B)</p> Signup and view all the answers

Which condition has clinical features that include bilaterally symmetrical white spongy thick plaques?

<p>White spongy nevus (D)</p> Signup and view all the answers

What is the common treatment for denture sore mouth (DSM)?

<p>Good oral and denture hygiene (B)</p> Signup and view all the answers

In which demographic is white spongy nevus typically present?

<p>Present at birth or young age (A)</p> Signup and view all the answers

Which of the following is considered a major differential diagnosis for papillary hyperplasia?

<p>Chronic candidiasis (B)</p> Signup and view all the answers

What is the histological finding utilized to determine treatment for lesions in reverse smokers?

<p>Dysplastic changes (C)</p> Signup and view all the answers

What common treatment is suggested for radiation mucositis?

<p>Topical anesthetics mouth rinse (D)</p> Signup and view all the answers

Which of the following lesions is most closely associated with heavy tobacco smoking?

<p>Stomatitis nicotina palati (A)</p> Signup and view all the answers

What is a characteristic feature of Koplik’s spots?

<p>Small discrete white lesions (A)</p> Signup and view all the answers

Which demographic is most frequently affected by stomatitis nicotina palati?

<p>Adults, primarily males (C)</p> Signup and view all the answers

How does reverse smoking impact the palatal mucosa compared to conventional smoking?

<p>It produces more pronounced alterations that are considered pre-malignant (D)</p> Signup and view all the answers

What is the primary sign in the initial stages of stomatitis nicotina palati?

<p>Burn-like red lesions (A)</p> Signup and view all the answers

Which of the following is NOT considered a differential diagnosis for Koplik’s spots?

<p>Chickenpox vesicles (B)</p> Signup and view all the answers

What is a common characteristic of red lesions of the oral mucosa?

<p>Increased vascularization (C)</p> Signup and view all the answers

Which of the following treatments is recommended for smokers with stomatitis nicotina palati?

<p>Stoppage of smoking habit (D)</p> Signup and view all the answers

Which of the following describes a papule?

<p>A raised lesion up to 1 cm in diameter (B)</p> Signup and view all the answers

Which condition is NOT classified as a keratotic white lesion?

<p>Oral candidiasis (D)</p> Signup and view all the answers

What is one possible etiology of a white lesion in the oral mucosa?

<p>Necrosis due to toxic chemicals (A)</p> Signup and view all the answers

Which term describes a localized area of disease or injury in the oral cavity?

<p>Lesion (B)</p> Signup and view all the answers

Which of the following is NOT considered a non-keratotic white lesion?

<p>Chronic atrophic candidiasis (C)</p> Signup and view all the answers

Which type of oral candidiasis is characterized by a white pseudomembrane?

<p>Acute pseudomembranous candidiasis (C)</p> Signup and view all the answers

Which of the following is a benign thickening of the stratum spinosum that may cause white lesions?

<p>Leukoedema (C)</p> Signup and view all the answers

What is a common characteristic of lesions caused by chemical burns?

<p>Lesions are painful and develop with erythema. (B)</p> Signup and view all the answers

Which treatment is recommended for chemical burns in the mouth?

<p>Topical anesthetic mouth rinse diphenhydramine hydrochloride (A)</p> Signup and view all the answers

Which condition is associated with uremic stomatitis in chronic renal failure patients?

<p>Type I - Erythemopultaceous lesions (B)</p> Signup and view all the answers

What unique aspect characterizes the reticular form of Oral Lichen Planus (OLP)?

<p>Fine white lines or striae that may form a network (B)</p> Signup and view all the answers

Which of the following best describes the papular type of Oral Lichen Planus (OLP)?

<p>Composed of small white dots that often intermingle with the reticular form (B)</p> Signup and view all the answers

Which lesion type is NOT part of the classification for oral lichenoid reactions?

<p>Type I Erythemopultaceous lesions (A)</p> Signup and view all the answers

What feature is NOT typically observed in lesions of oral lichen planus?

<p>Formation of large ulcers from the outset (D)</p> Signup and view all the answers

What is a common treatment approach for secondary infections associated with chemical burns?

<p>Antibiotics (C)</p> Signup and view all the answers

Flashcards

What is a lesion?

A localized area of disease or injury in any organ or tissue of the body.

What is a papule?

A well circumscribed, solid, raised lesion up to 1 cm in diameter.

What is a plaque?

A well circumscribed solid raised lesion more than 1 cm in diameter.

What is hyperkeratosis?

A white appearance of the oral mucosa caused by increased keratin production.

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What is acanthosis?

A white appearance of the oral mucosa caused by abnormal thickening of the stratum spinosum.

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What causes white lesions from fluid buildup in the epithelium?

A white appearance of the oral mucosa caused by fluid accumulation in the epithelium.

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What causes white lesions from necrosis of the oral epithelium?

A white lesion caused by necrosis of the oral epithelium.

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What causes the white appearance of oral candidiasis?

A white lesion caused by microbes producing pseudomembranes.

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Linea alba

A horizontal white streak on the buccal mucosa at the level of the occlusal plane, extending from the commissure to posterior teeth. Caused by pressure, friction, or sucking trauma.

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Fordyce's granules/spots

Ectopic sebaceous glands found within normal oral mucosa.

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Leukoedema

A common mucosal alteration seen on the buccal mucosa. It appears as a faint white, diffuse, and filmy appearance with many surface folds, resulting in surface wrinkling. It cannot be scraped off and disappears on stretching.

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Habitual cheek/lip biting

A white plaque with a rough surface on the buccal mucosa or lips. It appears paler than the surrounding tissue and is caused by habitual biting of the cheeks or lips due to stress.

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Burns - thermal

Oral lesions caused by hot beverages or foods, commonly seen on the lips and commissures.

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Red and white lesions with unknown or increased malignant potential

White lesions with unknown or increased malignant potential. They are associated with potential oral cancer.

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Leukoplakia

A white lesion that appears as a thick, white plaque on the mucous membrane of the mouth. It can be caused by various factors, including smoking, alcohol abuse, and chronic irritation.

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Erythroplakia

A red, velvety patch on the mucous membrane of the mouth. It is considered a precancerous lesion and requires careful monitoring.

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Chemical Burn

A type of burn caused by contact with chemicals like aspirin, hydrogen peroxide, or sodium hypochlorite.

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Chemical Burn Lesion Characteristics

A white, pseudomembrane covered lesion that has an irregular shape and is often painful.

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Chemical Burn Lesion Response to Pressure

The white material on a chemical burn lesion can slide off with gentle pressure, leaving an ulcer.

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Erythema and Chemical Burns

Redness that develops around a chemical burn lesion.

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Candidiasis (Oral Thrush)

A fungal infection of the oral mucosa that resembles a chemical burn, but is often less painful and can have a cottage cheese-like appearance.

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Uremic Stomatitis

A condition that occurs in patients with severe, untreated kidney failure (chronic), characterized by different types of lesions.

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Type I Uremic Stomatitis

A type of uremic stomatitis characterized by red and inflamed lesions.

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Type II Uremic Stomatitis

A type of uremic stomatitis characterized by ulcers in the mouth.

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Plaque-type Oral Lichen Planus

A distinct, well-defined white lesion on the oral mucosa often surrounded by lines (striae) and may resemble oral leukoplakia.

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Erythematous (Atrophic) Oral Lichen Planus

A red, well-defined area on the oral mucosa, often with lines (striae) at the edges. May appear as desquamative gingivitis.

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Ulcerative Oral Lichen Planus

The most severe type of oral lichen planus, characterized by sores (ulcers) surrounded by a red zone and white radiating lines.

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Discoid Lupus Erythematosus (DLE)

A condition that is characterized by prominent white lines with a sharp edge, which resembles oral lichen planus but is distinguished by pronounced hyperkeratinization and abrupt termination of the lines.

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What is Stomatitis Nicotina Palati?

A specific white lesion that develops on the hard and soft palate of heavy cigarette, pipe, and cigar smokers. The lesions are restricted to areas exposed to hot smoke during inhalation. It's not considered premalignant and associated closely with tobacco smoking.

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What is reverse smoking?

A rare form of smoking where the lit end of the cigarette is held in the mouth, leading to more pronounced palatal alterations considered premalignant.

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What is uremic stomatitis?

A condition that occurs in patients with severe, untreated kidney failure. It presents with different types of lesions, including red and inflamed lesions, ulcers, and white lesions.

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What is leukoedema?

Common mucosal alteration seen on the buccal mucosa. It appears as a faint white, diffuse, and filmy appearance with many surface folds, resulting in surface wrinkling. It cannot be scraped off and disappears on stretching.

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What is type I uremic stomatitis?

A type of uremic stomatitis characterized by red and inflamed lesions in the mouth.

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What is type II uremic stomatitis?

A type of uremic stomatitis characterized by ulcers in the mouth.

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What are Koplik's spots?

A white lesion caused by the measles virus, appearing as small, discrete, white lesions on the buccal mucosa or gingiva. It is common in children and usually less than 1cm in size.

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What is leukoplakia?

A common oral condition that can be caused by different factors, including smoking, alcohol abuse, and chronic irritation. It appears as a thick, white plaque on the mucous membrane of the mouth.

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Traumatic Keratosis

A white lesion on the buccal mucosa, gingiva, or lateral tongue, often asymptomatic, appearing as a well-defined, non-scrapable white plaque. It may be associated with trauma or irritation.

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White Spongy Nevus

A rare genetic disease appearing as bilaterally symmetrical white spongy thick plaques on the buccal mucosa, often present at birth and asymptomatic.

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Denture Sore Mouth (DSM)

An oral condition associated with denture wear, ranging from small, localized, asymptomatic red spots on the posterior palate to large, confluent crimson red areas, and later progressing to pebbly appearances due to palatal mucosa hyperplasia.

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Papillary Hyperplasia (PH)

A more severe form of Denture Sore Mouth (DSM), characterized by the development of pebbly appearances on the palate due to hyperplasia of palatal mucosa.

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Reverse Smoker's Lesion

A condition affecting reverse smokers (those who inhale smoke from the non-burning end of a cigarette) characterized by a white lesion that often disappears after stopping smoking.

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Treatment for Reverse Smoker's Lesion

Treatment for a Reverse Smoker's Lesion typically involves stopping smoking, patient education, and periodic observation. If the lesion persists after 3-4 weeks, surgical excision and histological examination may be indicated if dysplasia is present.

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Study Notes

Red and White Oral Lesions

  • Oral mucosa can appear white due to various factors, including increased keratin production (hyperkeratosis), abnormal thickening of the stratum spinosum (acanthosis), fluid accumulation, toxic chemical exposure, or microbial infections (fungal pseudomembranes).
  • Red lesions can result from epithelial atrophy (reduced epithelial cells) or increased vascularization.

Differential Diagnosis

  • Various conditions can cause red and white variations in oral mucosa.
  • These include common issues like linea alba, Fordyce granules, leukoedema, as well as more serious conditions potentially linked to cancer, including leukoplakia, erythroplakia, oral submucous fibrosis, lichen planus, and various types of candidiasis.

Oral Lesions and Conditions

  • Oral Candidiasis: Different forms exist (acute pseudomembranous, acute atrophic, chronic atrophic, chronic hypertrophic)
  • Keratotic White Lesions: Conditions like stomatitis nicotina palati (smokers' palate).
  • Red and White Lesions with Possible Malignant Potential: Conditions like Leukoplakia, Erythroplakia, oral submucous fibrosis, including specific examples.

Specific Lesions

  • Linea alba: White line on buccal mucosa due to pressure or friction.
  • Fordyce's granules: Small yellowish-white spots due to ectopic sebaceous glands.
  • Leukoedema: Diffuse, filmy, white appearance on buccal mucosa, disappears when stretched.
  • Lichen planus: Oral lesions with different textures (reticular, papular, plaque-type, erythematous, and ulcerative), frequently with white and red elements.
  • Epithelial Hyperplasia: Increased cell proliferation on the oral mucosa, usually in response to chronic irritation. This appears as white and/or red papules or plaques.
  • Burns (chemical, thermal): Characterized by an irregular shape with white pseudomembrane or erythema, depending on the burn type.
  • Radiation mucositis/Mucositis: Secondary to radiation therapy for head and neck cancers, there's redness, followed by pseudomembrane covering. Often with greyish, white slough.
  • Koplik's spots: Small white spots, frequently seen in measles.
  • Denture Sore Mouth (DSM) and Papillary Hyperplasia (PH): Linked to denture use, with varying levels of severity, from red spots to hyperplastic red palate.
  • White spongy nevus: Rare genetic condition with bilaterally symmetrical thick plaques on buccal mucosa, often asymptomatic.

Treatment and Management

  • Treatment options vary based on the specific condition and severity. They often involve managing underlying causes (like smoking cessation), providing topical treatments (like anti-fungal medication), and in some cases surgical intervention.
  • Observation, supportive measures, and palliative treatments are also crucial aspects of management.

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