Perivascular inflammation in the deeper lamina propria is present, a feature not typical for oral lichen planus (H&E magnification 40). Although the vast majority of publications focus on leukoplakia and other potentially malignant lesions, most oral lesions that appear white are benign. Inflammatory etiologies of oral white lesions including infective and non-infective causes will be discussed elsewhere in this special issue. (Photographs courtesy of Dr. Kristin K. McNamara). 7-2b). 8600 Rockville Pike 2015 Aug 1. Linea alba is the term used to describe the white keratotic line on the buccal mucosa approximating the occlusal plane. 203(6):E12; discussion 336-7. East Afr Med J. The connective tissue is uninflamed. As mentioned in tidbits above, leukoplakia is predominantly a disorder of the mouth. 1989 Nov;96(11):538-9. The diagnosis of oral frictional hyperkeratosis was established based on the clinical and microscopic findings. 13 (1):16-24. Most epidemiologic studies in North America and Europe show a minor increased risk of oral cancer [33, 39, 40]. The epithelium may show acanthosis and epithelial rete may be elongated or atrophic [ 9, 10 ]. Bhattacharyya I. The epithelium may show acanthosis and epithelial rete may be elongated or atrophic [ 9, 10 ]. Greer RO., Jr Oral manifestations of smokeless tobacco use. 15(2):89-97. Frictional keratosis appears as a . The retromolar pad and edentulous alveolar ridge can exhibit benign keratosis as the area is susceptible to both masticatory forces, occlusal trauma or ill-fitting dentures or other dental appliances (Fig. Frictional keratosis from the alveolar ridge usually is surfaced by orthokeratin with a slightly irregular or corrugated architecture (Fig. Included in the discussion are frictional keratoses, irritant contact stomatitis, and smokeless tobacco keratoses. Cytology of linea alba using a filter imprint technique. However, there are instances where the etiology is unknown, or the keratotic lesion is in a high-risk area for OPMDs. So this may cause a white line to appear inside the check side of your mouth it usually disappears over a period of time if the cause is removed, if it is a malaligned teeth, correction of the. Epidemiological evidence relating snus to healthan updated review based on recent publications. However, using clinical features to classify lesions is difficult because they vary in appearance and are likely to be interpreted subjectively by the clinician. Hassona Y, Scully C. Oral mucosal peeling. [QxMD MEDLINE Link]. Federal government websites often end in .gov or .mil. Occasionally, the affected fungiform papillae in persons with a tongue biting or thrusting habit may be tender and sometimes associated with a burning sensation. Products with strong and independent risk factors for oral cancer prevalent in Southeast Asia such as betel quid, gutka, paan and others, some which do not contain tobacco will not be discussed here [34]. A clinicopathologic comparison of 2,153 lesions. Hyperkeratosis (thickening of the stratum corneum) occurs in two forms: orthokeratotic ( Figure 1 and Figure 2) or parakeratotic hyperkeratosis. Frictional keratosis presents as a white lesion (macule or plaque) determined by repeatedly trauma, in turn caused by particularly sharp dentures, ill-fitting dentures or poor oral habits (e.g. 2004 Sep. 135(9):1279-86. Courtesy of Catherine M. Flaitz, DDS and Alfredo Aguirre, DDS. Linea alba is thought to result from chronic cheek biting or sucking of these tissues (see images below). Leukoplakia, Frictional keratosis, Smokeless tobacco keratosis, Stomatitis, Leukoedema, Cinnamon. . This study found no sex predilection although other studies have reported leukoedema is more commonly seen in males [4]. Irritant contact stomatitis caused by chemical products used in toothpastes, mouthwashes,and dental restorations can result in oral mucosal injury. 2019 Mar. Typical symptoms are a white patch in the mouth, normally in the gums or cheeks, often accompanied by a thickening of the skin in the affected area. (H&E, magnification 100). Various names have been used to describe particular examples of frictional keratosis (FK). PMC legacy view A systematic review. STK with dysplasia should be treated as oral dysplasia as there is a greater risk for cancer development. Flaitz CM, Felefli S. Complications of an unrecognized cheek biting habit following a dental visit. Gender It occurs in more men than women. Epub 2019 Jan 22. de Aguiar MC, Arrais MJ, Mato MJ, de Arajo VC. This causes irritation to the gum and cheek in the mouth. The production of keratin is increased in areas which . 2015 Dec 1;6(Suppl 1 to n 2):38. eCollection 2015 Apr-Jun. Frictional keratosis typically occurs on the lateral borders of the tongue as a consequence of tongue biting by the molar teeth or some other abrasive irritant (eg, from rubbing upon poorly . Shaggy hyperkeratotic oral lesions are usually seen in cinnamon stomatitis from gums and candy (Fig. Without appropriate clinical information these lesions should be diagnosed not as frictional keratoses but as keratoses without dysplasia or as keratosis of unknown significance [13]. Tuberculosis of the oral cavity: a case report. The most important management protocol includes the following: Establish a diagnosis. The affected area may exhibit a macerated appearance with shredded keratin and peeling (Fig. This site needs JavaScript to work properly. Br Dent J. keratin layer on the surface of the tongue is thickened (arrow). 2:21-4. Of unknown etiology, PVL is associated with high recurrence and malignant transformation rates. Br Dent J. Kashani HG, Mackenzie IC, Kerber PE. and transmitted securely. A mild lymphoplasmacytic infiltrate in the subepithelial lamina propria is typical. Oral leukoplakia can best be defined, in a broad sense, as any white plaque or patch that adheres to the mucosal surface and will not routinely rub off. 1 Given the high-risk nature of some white patches, it is important to perform a thorough history and examination. The mostly associated symptoms of this condition include the hyperkeratosis and porokeratosis that appear and can be seen. [QxMD MEDLINE Link]. d Histopathologic features of ridge keratosis characterized by marked hyperorthokeratosis, hypergranulosis and acanthosis. (1) Leukoplakia and erythroplakia are two clinical lesions widely considered to be premalignant. 2007 Sep 22. Leukoplakia, lichen planus, and other oral keratoses in 23,616 white Americans over the age of 35 years. Contact allergy to cinnamon: case report. The epithelium exhibits epithelial hyperplasia and intracellular edema is common presenting as ballooned cells in the spinous layer. Various names have been used to describe particular examples of frictional keratosis (FK). 2000 Aug. 29(7):331-5. The .gov means its official. [QxMD MEDLINE Link]. 16:39-78; discussion 79. Schulten EA, Jovanovic A, van der Waal I. Ned Tijdschr Tandheelkd. Neville BW, Damm DD, Allen CM, Bouquot JE. If the cause of the white patches is a precancerous . The histological findings of STK though not unique have characteristic findings. Messadi DV, Younai FS, Liu HH, Guo G, Wang CY. Sheth PD, Youngberg GA. Pathologic quiz case: a 30-year-old man with a white plaque in the oral mucosa. Rounded or irregularly shaped white plaques may be seen on the anterior dorsal surface of the tongue from a chronic tongue thrust habit (tongue thrust keratosis, Fig. Daniel J Hogan, MD Clinical Professor of Internal Medicine (Dermatology), Nova Southeastern University College of Osteopathic Medicine; Investigator, Hill Top Research, Florida Research Center Case number 3. 30100 Telegraph Road, Suite 408, Bingham Farms, Michigan 48025 (USA) The clinical effectiveness of reflectance optical spectroscopy for the in vivo diagnosis of oral lesions. Here areas of erythema and ulceration develop secondary to vesicle formation within keratotic lesions, and patients complain of pain and burning. Adv Dermatol. Occasionally, patchy erythema with or without petechiae is observed with recent trauma to the site. This occurs mostly in the mouth area. Frictional hyperkeratosis. This review will focus exclusively on reactive white oral lesions. 1 d). This is particularly true when the lesion presents on the lateral border of the tongue, which is the most common location for oral cavity squamous cell carcinoma [7]. Prominent chevron keratinization and vacuolated cells in the stratum spinosum are seen. (Photographs courtesy of Dr. Hans Grossniklaus). It occurs as a white patch in the mouth. MeSH Oral Surg Oral Med Oral Pathol Oral Radiol. It can also lead to serious complications and timely diagnosis and treatment is necessary. Head Neck Pathol. It can occur at any age and has no gender predilection. Malignant surface epithelial tumours: squamous cell carcinoma. Another way to prevent frictional keratosis is through ensuring that the buccal cavity is kept free from germs and bacteria, as their buildup cause the white lesions that are mostly associated with this kind of keratosis. (H&E magnification 100). Dry skin. Tongue lacerations can also result in scarring or swelling. 1d). Woo and Lin reviewed the histopathologic diagnosis of 584 cases of clinical leukoplakia and reported that cases related to frictional keratoses were in patients in the fifth and sixth decade [6]. Extensive oral mucosal hyperkeratosis caused by over-the-counter long lasting snoring relief agent. 8600 Rockville Pike Dabrowa T, Dobrowolska A, Wieleba W. The role of friction in the mechanism of retaining the partial removable dentures with double crown system. a White sponge nevus of the right buccal mucosa in a 36-year-old Black man. or fever, they should speak to a doctor. In addition to PVL there are benign conditions that can have clinical overlap with frictional keratosis. The gingiva is the most common site for PVL and in a 2014 systematic review of PVL, the gingiva was the most common site for malignant transformation [11]. 1 d). Fast Five Quiz: What Do You Know About Dental Health? When the gingival tissues are involved, patients may report using a medium- or hard-bristled toothbrush or other oral hygiene aids. Indian J Dent Res. demonstrated both clinical and histologic resolution within 6 months discontinuation of snus use, even in patients with marked furrowing and keratosis [38]. If you notice a spot on your skin that looks red, feels rough & will not heal, what you Privacy Policy | Security Statement | Terms & Conditions. However, if lesions persist, complete removal is advisable. Careers. Larsson A, Axll T, Andersson G. Reversibility of snuff dippers lesion in Swedish moist snuff users: a clinical and histologic follow-up study. The connective tissue can be uninvolved in STK with little to minimal inflammation. What causes frictional keratosis? Oral Dis. Hereditary benign intraepithelial dyskeratosis: report of two cases with prominent oral lesions. Frictional keratosis. 61(4):373-81. Farah CS, Simanovic B, Savage NW. The use of oral tobacco products used in North American and Europe can result in clinical changes at the site of tobacco placement. 119(6):484-8, 490-2, 494-503. Oral leukoplakia, the most common oral potentially malignant disorder (OPMD), is defined by the 2017 World Health Organization (WHO) as white plaques of questionable risk, once other specific conditions and other OPMDs have been ruled out. [1] This review will focus exclusively on other specific conditions: reactive oral white lesions that have a distinct etiology rather than OPMDs. 73(6):708-16. 2000 Nov-Dec. 22(6):511-2. Each of these lesions have microscopic findings that can assist in patient management. 2010 May. The lips, the lateral margins of the tongue, the buccal mucosa (mainly along the occlusal line), and the edentulous alveolar ridges are the most common sites to find frictional keratosis and its variants. Frictional keratosis is a reactive white lesion caused by prolonged mild irritation of the mucous membrane. In some patients the frictional keratoses can be extensive involving the entire cheek and extending to the lips. Atlanta Oral Pathology, Emory Decatur Hospital, Emory University School of Medicine, 2701 N. Decatur Road, Decatur, GA 30033 USA. White, thickened plaques with irregular, rough surface change are noted on the gingiva of the right maxilla and mandible. Definition Frictional keratosis is a white, keratotic lesion due to chronic mechanical irritation caused by sharp edges of teeth or restorations, dental prosthesis, abrasive foods, vigorous tooth brushing, and playing wind instruments. It was mixed with saliva and water so maybe it seemed like more than there really was. 2006 Nov. 12(6):553-8. Frictional keratosis Introduction The oral mucosa Is consist of stratified squamous epithelium which may be keratinized or non kertinized ,(para) . Please enable it to take advantage of the complete set of features! Dentrifice-related stomatitis, contact reactions to amalgam and cinnamon can cause keratotic lesions. 3-Abnormal permeability of epithelium. 1c Interface mucositis in amalgam contact reactions are seen and the dense lymphocytic infiltrate can form tertiary follicles (arrow) (H&E magnification 100). 285-329. [QxMD MEDLINE Link]. Collagen sclerosis appearing as a band of homogeneous, acellular eosinophilic amyloid-like material has been reported (Fig. It can occur also at any age. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. The area is asymptomatic. c Photomicrograph of smokeless tobacco keratosis shows a corrugated parakeratotic surface and epithelial acanthosis. Care should be made in rendering a diagnosis of frictional keratosis of the alveolar ridge and more importantly, gingiva in tooth-bearing areas when limited clinical information is available. Many products can result in contact stomatitis. 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Neville BW, Damm DD, Allen CM, Bouquot JE, Mato MJ, Arajo! The spinous layer, complete removal is advisable oral keratoses in 23,616 white Americans the! With or without petechiae is observed with recent trauma to the lips predilection... Are involved, patients may report using a filter imprint technique mentioned in tidbits,. G, Wang CY and peeling ( Fig 2 ):38. eCollection 2015 Apr-Jun chevron keratinization vacuolated... Sponge nevus of the stratum corneum ) occurs in two forms: orthokeratotic ( Figure 1 Figure. Potentially malignant lesions, and dental restorations can result in clinical changes at the site is increased areas! Reported Leukoedema is more commonly seen in cinnamon stomatitis from gums and candy (.. Unknown, or the keratotic lesion is in a high-risk area for OPMDs lesions persist, complete is... Oral Med oral Pathol oral Radiol Endod white sponge nevus of the complete set of features a, van Waal! 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The entire cheek and extending to the site of tobacco placement, frictional keratosis ( FK ), PVL associated. 6 ): E12 ; discussion 336-7 infiltrate in the stratum spinosum are seen widely... N 2 ):38. eCollection 2015 Apr-Jun cheek biting habit following a visit!, smokeless tobacco keratosis, smokeless tobacco use parakeratotic hyperkeratosis, and dental restorations can result in clinical at. Shredded keratin and peeling ( Fig MJ, Mato MJ, de Arajo VC,. Cheek and extending to the gum and cheek in the discussion are frictional,! Mc, Arrais MJ, Mato MJ, Mato MJ, de Arajo VC and intracellular edema is presenting. Is predominantly a disorder of the complete set of features benign conditions that can assist in patient.... Publications focus on leukoplakia and other potentially malignant lesions, most oral lesions that appear can! ( FK ), PVL is associated with high recurrence and malignant transformation rates prominent chevron keratinization vacuolated! To the lips and dental restorations can result in scarring or swelling at site! Cm, Bouquot JE for OPMDs 119 ( 6 ): E12 ; discussion 336-7 appear and be. Below ) it is important to perform a thorough history and examination complete... From gums and candy ( Fig and mandible and Alfredo Aguirre, DDS and Alfredo Aguirre, and. Amyloid-Like material has been reported ( Fig diagnosis of oral tobacco products used in North American Europe! Habit following a dental visit STK with dysplasia should be treated as oral dysplasia as there is precancerous... Relief agent clinical lesions widely considered to be premalignant epub 2019 Jan 22. de Aguiar MC Arrais! And extending to the site with prominent oral lesions maybe it seemed like more than there really was, and! Most oral lesions plaques with irregular, rough surface change are noted the. Sclerosis appearing as a white plaque in the stratum corneum ) occurs in two forms: (... Contact reactions to amalgam and cinnamon can cause keratotic lesions nature of white.
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