Red and White Lesions in Oral Mucosa

Questions and Answers

Why does the mucosa appear white in color?

Increased production of keratin, abnormal but benign thickening of stratum spinosum, intra and extracellular accumulation of fluid in the epithelium, or fungi producing white pseudomembranes.

Why does the mucosa appear red in color?

Atrophy of the epithelium, reduction in the number of epithelial cells.

What is the common lesion associated with frictional irritation, pressure, or sucking trauma from facial surfaces of the teeth?

Linea alba (correct)

Morsicatio mucosae oris

Thermal burn

Chemical burn

What is the common site of Thermal burn?

Palate or posterior buccal mucosa. Signup and view all the answers

What is Morsicatio mucosae oris?

Chronic chewing of buccal mucosa, labial mucosa, or lateral border of the tongue, leading to thick, shredded, white areas with irregular, ragged surface. Signup and view all the answers

What is the treatment for Thermal burn?

Corticosteroids and antibiotics are used when there is involvement of the upper airway with breathing difficulties. Signup and view all the answers

What is the risk associated with the use of electronic cigarettes?

Both thermal and chemical burns Signup and view all the answers

What is the treatment for Electronic cigarette burns?

The burn area should be tested for pH, and if alkaline, covered with mineral oil, and if acidic, irrigated with water. Signup and view all the answers

What is the recommended treatment regimen for oral candidiasis using Nystatin oral suspension?

Swish and spit out (or swallow) 10 ml five times a day for 7-14 days Signup and view all the answers

Which medication for angular cheilitis requires to be applied to the corners of the mouth three times a day?

Nystatin and triamcinolone acetonide ointment Signup and view all the answers

Submucosal hemorrhage is commonly characterized by blanching lesions.

False Signup and view all the answers

What is the best treatment for chemical burns according to the text?

prevention of exposure to caustic materials Signup and view all the answers

What are some common factors associated with hairy tongue? Select all that apply.

General debilitation Signup and view all the answers

Angular cheilitis is commonly seen in younger patients.

False Signup and view all the answers

What can coated tongue be mistaken for? It may be mistaken for __________.

candidiasis Signup and view all the answers

Match the drug with its application method according to the text:

Clotrimazole 1% cream = Apply thin film to inner surface of denture and/or angles of mouth four times a day (after each meal and at bedtime) Clotrimazole troches 10 mg = Dissolve, in mouth, 1 troche as a lozenge five times daily for 14 consecutive days Signup and view all the answers

Study Notes

Red and White Lesions

Causes of white mucosa:
- Hyperkeratosis (increased keratin production)
- Acanthosis (abnormal thickening of stratum spinosum)
- Intra- and extracellular fluid accumulation in epithelium
- Fungal pseudomembranes
Causes of red mucosa:
- Atrophy of epithelium (decrease in cell size)
- Reduction in number of epithelial cells

Developmental, Hereditary, and Congenital Lesions

White lesions:
- White sponge nevus
- Leukoedema
- Hereditary benign intraepithelial dyskeratosis
Red lesions:
- Hemangioma
Red and white lesions:
- Oral lichen planus
- Erythema migrans/geographic tongue

Linea Alba

Common lesion
Caused by frictional irritation, pressure or sucking trauma
Presents as a linear white lesion, usually bilateral on buccal mucosa along occlusal plane
No need for biopsy or treatment, may show spontaneous regression

Morsicatio Mucosae Oris

Caused by chronic chewing
Presents as thick, shredded, white areas with irregular surface
May have zones of erythema, erosion, or focal traumatic ulceration
Common in females, affecting anterior buccal mucosa, lips, and tongue
No treatment needed, resolves upon habit cessation

Thermal Burn

Caused by ingestion of hot foods or beverages
Presents as sloughing white lesion, red-white lesion, or red lesion
May show zones of erythema and ulceration
Commonly affects palate or posterior buccal mucosa
Most cases resolve without treatment, corticosteroids and antibiotics used in severe cases

Chemical Burn

Caused by:
- Aspirin-tablets, powder
- Bisphosphonates
- Psychoactive drugs
- Hydrogen peroxide
- Recreational drugs
Presents as white, wrinkled plaque or necrotic red, bleeding connective tissue
May affect any oral mucosal site
Treatment involves prevention of exposure, sodium hypochlorite irrigation, and debridement

Leukoedema

Common oral mucosal condition
Seen in 70-90% of black adults and 50% of black children
Presents as diffuse gray-white, milky, or opalescent lesion
Unknown cause, may be developmental in nature
No treatment required

Candidiasis

Most common oral fungal infection
Caused by:
- Local factors (denture wearing, smoking, inhalation steroids)
- General factors (immunosuppressive diseases, impaired health status)
Presents as:
- Pseudomembranous candidiasis (adherent white plaques)
- Coated tongue (accumulation of bacteria and desquamated epithelial cells)
- Hairy tongue (marked accumulation of keratin on filiform papillae)

Hairy Tongue

Seen in 0.5-11.3% of adults
Caused by increase in keratin production or decrease in normal keratin desquamation
Presents as elongated, yellowish-white or brown filiform papillae on dorsal tongue
Asymptomatic, eliminate predisposing factors, encourage excellent oral hygiene

Median Rhomboid Glossitis

Presents as well-demarcated erythematous zone on midline of posterior dorsal tongue
Erythema due to loss of filiform papillae, often asymmetric and smooth or lobulated
Often asymptomatic### Denture Stomatitis/Chronic Atrophic Candidiasis
Most common form of candidiasis in denture patients, usually asymptomatic
Localized to denture-bearing areas of maxillary removable denture
Seen when patient wears denture continuously, but must rule out other causes such as improper denture design, allergy to denture base, or inadequate curing of denture acrylic
Presents with varying degrees of erythema, sometimes accompanied by petechial hemorrhage
Can be associated with concomitant inflammatory papillary hyperplasia, often secondary to poorly fitting dentures

Angular Cheilitis

Presents with erythema, fissuring, and scaling of the angles of the mouth
Commonly seen in older patients with decreased vertical dimension of occlusion and accentuated folds at the corners of the mouth, with pooling of saliva in the corners of the mouth
The severity of the lesions waxes and wanes
Caused by 20% Candida albicans, 60% Candida albicans & Staphylococcus aureus, and 20% Staphylococcus aureus

Oral Candidiasis

Diagnosis involves clinical signs in conjunction with exfoliative cytology
Cytological findings should demonstrate hyphal phase of the organism
Cytology is simple, non-invasive, and cost-effective
Treatment options include:
- Imidazole agents (clotrimazole 1% cream, clotrimazole troches 10 mg)
- Polyene agents (nystatin oral suspension 100,000 units/ml, nystatin pastilles 200,000 units/pastille, nystatin ointment)
- Triazoles (fluconazole)
- Other agents (iodoquinol)

Geographic Tongue (Erythema Migrans, Benign Migratory Glossitis)

Seen in 1-3% of the population, with unknown etiopathogenesis and female predilection
Presents as multiple, well-demarcated zones of erythema (atrophy of filiform papillae) surrounded by slightly raised yellow-white serpentine or scalloped border on the dorsal tongue (anterior 2/3rd) and ventrolateral tongue
Lesions develop quickly, heal in days to weeks, and then develop in a different area; continually changing pattern
Often associated with fissured tongue (1/3rd of patients)
May demonstrate burning sensation or sensitivity to hot or spicy foods
Treatment is not usually indicated, but topical steroids may be used for symptomatic patients

Submucosal Hemorrhage

Seen when a traumatic event results in hemorrhage and entrapment of blood within tissues
Terminology depends on the size of hemorrhage:
- Petechiae: minute hemorrhages into skin, mucosa, or serosa
- Purpura: slightly larger area affected (5 mm – 2 cm)
- Ecchymosis: any accumulation greater than 2 cm
- Hematoma: accumulation of blood within tissue producing a mass
Causes include:
- Trauma (blunt trauma, oral trauma from sexual practices)
- Increased intrathoracic pressure (repeated or prolonged coughing, vomiting, convulsion, or giving birth)
- Non-traumatic causes (anticoagulation therapy, thrombocytopenia, disseminated intravascular coagulation, viral infections)
Presents as non-blanching lesion, usually flat, except for hematoma (elevated lesion)
Commonly seen on labial mucosa or buccal mucosa
No treatment if not associated with morbidity or related to systemic disease, as areas resolve spontaneously

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Description

This quiz deals with the composition and characteristics of red and white lesions in oral mucosa, including hyperkeratosis and abnormal thickening of stratum spinosum. Test your knowledge of oral pathology and histology!