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    Non Keratotic Lesion and Normal Variations

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    hannyfaizah
    This document discusses several non-keratotic lesions and normal variations that can occur in the oral cavity. It describes cheek chewing, chemical burns, candidiasis including pseudomembranous candidiasis, denture stomatitis, angular cheilitis, median rhomboid glossitis, hyperplastic candidiasis, and Fordyce's granules. It also discusses normal variations like leukoedema, white sponge nevus, geographic tongue, fissured tongue, linea alba, and torus and exostoses. For each condition, it provides information on etiology, clinical features, location, treatment, and differential diagnosis.

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    Non Keratotic Lesion and Normal Variations

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    hannyfaizah
    518 views35 pages
    This document discusses several non-keratotic lesions and normal variations that can occur in the oral cavity. It describes cheek chewing, chemical burns, candidiasis including pseudomembranous candidiasis, denture stomatitis, angular cheilitis, median rhomboid glossitis, hyperplastic candidiasis, and Fordyce's granules. It also discusses normal variations like leukoedema, white sponge nevus, geographic tongue, fissured tongue, linea alba, and torus and exostoses. For each condition, it provides information on etiology, clinical features, location, treatment, and differential diagnosis.

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    This document discusses several non-keratotic lesions and normal variations that can occur in the oral cavity. It describes cheek chewing, chemical burns, candidiasis including pseudomembranous candidiasis, denture stomatitis, angular cheilitis, median rhomboid glossitis, hyperplastic candidiasis, and Fordyce's granules. It also discusses normal variations like leukoedema, white sponge nevus, geographic tongue, fissured tongue, linea alba, and torus and exostoses. For each condition, it provides information on etiology, clinical features, location, treatment, and differential diagnosis.

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    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    518 views35 pages

    Non Keratotic Lesion and Normal Variations

    Uploaded by

    hannyfaizah
    This document discusses several non-keratotic lesions and normal variations that can occur in the oral cavity. It describes cheek chewing, chemical burns, candidiasis including pseudomembranous candidiasis, denture stomatitis, angular cheilitis, median rhomboid glossitis, hyperplastic candidiasis, and Fordyce's granules. It also discusses normal variations like leukoedema, white sponge nevus, geographic tongue, fissured tongue, linea alba, and torus and exostoses. For each condition, it provides information on etiology, clinical features, location, treatment, and differential diagnosis.

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    NON KERATOTIC LESION

    AND NORMAL
    VARIATIONS
    Hafshah Samrotul Mahabbah 1206256610
    Hanny Faizah
    1206249214

    Non Keratotic Lesions

    Cheek chewing
    Also known as Morsicatio Buccarum

    Mostly located on the buccal mucosa and the lateral

    border of the tongue


    Mostly prevalence in people who under stress or
    exhibit psychologic conditions (stress can be a
    predisposing factor).
    Etiologi chronic iritation because of chewing

    procedures (repeated cheek sucking, nibbling,


    chewing)

    Clinical Features
    Lesion mostly found bilaterally or may be unilaterally on anterior
    buccal mucosa
    Thickened with shredded white areas, infrequently combined with

    erythema, erosions, or traumatic ulcerations


    Irregular ragged surface

    Cont
    Treatment
    No treatment required
    For patient who desire treatment : oral acrylic shield
    Several authors have suggested psychoteraphy as treatment of choice

    Chemical Burn
    Chemical injuries in the mouth can cause clinically

    significant damage
    Etiologi:
    Many chemicals and drugs :

    Aspirin
    Hydrogen Peroxide
    Sodium Hypoclhorite
    Formocresol
    Dental cavity varnishes
    Acid etch materials
    Eugenol
    Phenol , etc

    Clinical Features:
    Usually located on the mucobuccal fold area and gingiva.
    The injured area is irregular in shape, white, covered with a

    pseudomembrane, and very painful.


    Short exposures : superficial white, wrinkled appereance
    Long exposures : epithelium becomes separated from underlying

    tissue and can be descuamated easily -> red, bleeding

    Cont

    Treatments:
    The best treatment is prevention : potentially caustic drugs

    -> instruct the patient to swallow not allow it to remain in


    oral cavity
    Local symptomatic therapy aimed at keeping the mouth
    clean, such as sodium bicarbonate mouth rinses with or
    without the use of systemic analgesics, is appropriate.
    Alcohol-based commercial mouth rinses should be
    discouraged because of their drying effect on the oral
    mucosa.
    Temporary pain relief : Topical dyclonine HCL
    Large area of necrosis : surgical debridement & antibiotics

    Candidiasis
    Definition : Most prevalent opportunistic infection

    affecting oral mucosa.


    Etiology : Fungal infections (Candida albicans and
    other Candida species: C.tropicalis, C.glabrata)
    Candidiasis : Acute and Chronic Lesions
    Predisposing Factor : Local and General

    Cont

    Acute Candidiasis

    Pseudomembranous
    Candidiasis/Thrush
    An acute form of candidiasis and recognized as classic
    Candida infection
    Predisposing factors: immunodeficiency condition,
    predominantly patient medicated with antibiotics,
    immunosuppresant drugs, or a disease that suppresses
    the immune system
    Clinical Features:
    presence of adherent white plaques that resemble cottage

    cheese or curdled milk.


    Easily wiped off leave inflamed area : erythematous,
    atrophic, or ulcerated mucosa

    Cont
    Histopathological features : inflammatory response,

    and ulceration covered by fibrin


    Location : buccal mucosa, palatum, dorsal tongue
    Differential diagnosis : Lichen Planus, hairy
    leukoplakia, leukoplakia, fordyce granules
    Management:
    Control of any local cause thrush to resolve
    If not, a course of nystatin or amphotericin should allow

    the oral microflora to turn to normal


    Failure of response to topical antifungals suggest immune
    deficiency. In such patients, candidiasis may respond to
    fluconazole or itraconazole.

    Erythematous candidiasis
    Patient complain burning sensation because of diffuse loss of

    the filliform papillae of the dorsal tongue.


    Clinical features : red macules, Reddened bald appereance
    of the tongue, diffused border, no white flecks, Erythematous
    surface reflects atrophy and increased vascularization
    Location : Posterior hard palate, buccal mucosa, dorsal
    tongue
    Predisposing factors : smoking, treatment with broadspectrum antibiotic, iron deficiency anemia, inhalation steroids
    DD: erythroleukoplakia
    Treatment:
    Treat any predisposing cause
    Antifungals such as nystatin oral suspension, pastilles, amphotericin

    lozenges, miconazole gel, tablets or fluconazole tablets

    Chronic Candidiasis

    Denture Stomatitis
    Is a varying degrees of erythema, sometimes

    accompanied by petechial hemorrage, localized to


    the denture-bearing areas of maxillary removable
    prothesis
    Usually caused by microorganism living beneath
    the denture of improper design of the denture,
    allergy to denture base.
    Clinical features: red and asymptomatic
    Location: Confined to palatal denture which face
    to mucosa
    DD: Erythematous candidiasis
    Treatments:

    CIE : Improve denture hygene, not to use denture while

    sleeping,, store the denture in antimicrobial solutions


    Antifungal treatment

    Angular Cheilitis
    Lesion on fissures of the commissures of the mouth,

    usually surrounded by erythema.


    Clinical features:
    As a roughly triangular area of erythema and oedema at

    the commonly at both angles of the mouth


    Linear furrows or fissures radiating from the angle of the
    mouth

    Predisposing factors:
    Dry skin
    Candidia or staphylococcus aureus
    Vit. B12, phosphate andiron deficinecy

    DD: Exfoliative cheilitis, Actinic cheilitis


    Treatments: Antifungal cream (usually miconazole) or
    other antifungal therapy, application of moisturizing cream, a
    course of oral iron or vit B supplements may be helpful

    Median Rhomboid Glossitis


    Clinically characterized by an erythematous lesion

    in the center of posterior part of the dorsum of the


    tongue
    The area of erythema resulting from atrophy of the
    filiform papillae
    Etiology: C. albicans and much less commonly by
    other species of Candida
    Predisposing factors: Smokers, denture weares,
    and patient who use inhalation steroids
    Location: Involve the posterior dorsum of the
    tongue

    Cont
    Clinical features:
    erythematous lesion in the center of posterior part of

    the dorsum of the tongue or


    Flat or nodular, red, or red and white
    Lesion -> oval configuration
    Asymptomatic
    DD:
    Geographic tongue
    White lesions chemical burns, traumatic
    ulcerations, and white keratotic lesions.
    Red lesions drug reactions, erosive lichen planus
    Treatments:
    Elimination of predisposing factors
    Antifungal therapy (Nystatin oral suspension, cream)

    Hyperplastic Candidiasis
    Clinical features:
    White plaques that are not removable, irregular
    Asymtomatic
    Histopathologic epithelial hiperplasia

    Location: Anterior buccal mucosa, but also can be

    found at dorsum of the tongue, palate, labial


    commisures
    Predisposing factors:

    Smoking
    Nutrition deficiency
    Immunodeficiency
    Denture-wearers
    HIV patient
    Chronic iritations

    Cont
    DD:
    Leukoplakia
    Candidiasis

    pseudomembranous
    Lichen planus
    Treatments:
    Elimination of predisposing

    factors
    Consumption of vegetable
    and fruits
    Vitamin A
    Antifungal therapy

    Fordyces granule
    Manifestations of ectopic

    sebaceous glands
    Clinical finding : appear white
    to yellow in color, either
    discreetly separated/forming
    plaques, may be slightly
    raised, size 1-2mm
    Location : commonly noted
    within buccal mucose and
    labial mucose altough can be
    found on any mucosal oral site

    Leukoedema
    Clinical findings :
    white veil-like, diffuse, and filmy

    apperance.
    Leukoedema is less clinically evident
    after streching the mucosa and cant
    be scrapped off
    Location :
    bilaterally in the buccal mucosa
    (frequent site),
    border of the tongue, soft palate &
    floor of the mouth (rare site)
    Differential diagnosis : Lichen
    planus, white sponge nevus, cheek
    biting

    White sponge nevus


    Clinical findings : white lesion

    with an elevated and irreguler


    surface comprising fissures or
    plaque formations
    Ethiology : autosomal
    dominant developmental
    anatomaly link with genes
    mutation
    Location :
    buccal mucosa,
    other sites: parakeratinezed
    or nonkeratinized ephitelium
    in oral cavity,
    may involve extraoral sites ->
    esophagus and anogenital
    mucosa

    Geographic Tongue/Benign Migratory


    Glossitis/Erythema Migrans
    Clinical findings : Irregularly shaped

    erythemathous macules with


    surronding elevated white borders.
    (map like apparence)
    Location :
    Dorsum of the tongue,

    Fissured tongue
    Clinical findings :
    presence of fissured and grooves

    along the dorsal surface 2-6 mm,


    severe case : numerous fissures cover
    entire dorsal surface and divide the
    tongue papilae into multiple islands
    Location : anterior dorsum of the
    tongue

    Linea Alba
    Common alteration of the

    buccal mucosa that is most


    likely associated with pressure,
    fricitional irritattion, or sucking
    trauma
    Clinical findings : irreguler,
    shaggy, white line running
    along the inside of the cheek
    bilaterally.
    Location : buccal mucosa
    Treatment : elimination of
    predisposing factor
    Diferential diagnosis :
    1.Frictional keratosis
    2.Cheek biting

    Torus and Exostoses


    Clinical findings : Benign,

    developmental bony growth.


    Covered by
    keratinized/nonkeratinezed mucosa
    Location :
    Maxillary tori occur in the midline of
    hard palate
    Mandibular tori decelop along the
    lingual aspect
    Exostoses appear clinnicaly identical
    to mandibular tori on the buccal
    surface of the mandible or maxilla
    Treatment : No treatment needed. If
    denture fabrication is required, tori
    can be surgically removed

    Bruch, Jean M and Nathaniel S Treister. Clinical Oral Medicine And

    Pathology. New York: Humana Press, 2010. Print.


    Burket, Lester W et al. Burket's Oral Medicine. Hamilton, Ont.: BC
    Decker, 2008. Print.
    Kim, June Woo et al. "Leukoedema Of The Oral Mucosa". Annals of
    Dermatology 18.1 (2006): 21. Web.

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