Typically we see this finding in the grouping of "premalignant" lesions of epithelial origin. Malignant surface epithelial tumours: squamous cell carcinoma. Mller S, Pan Y, Li R, Chi AC. One of the more common presentations of frictional keratosis is the linea alba (white line). 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]. Occasionally, the affected fungiform papillae in persons with a tongue biting or thrusting habit may be tender and sometimes associated with a burning sensation. 8600 Rockville Pike It shows rough and frayed surface and upon removal of the offending agent, the lesion resolves in 2 weeks. Chronic frictional / factitial keratosis : Shaggy / macerated parakeratosis with superficial bacterial colonization Epithelial hyperplasia with keratinocyte edema but no epithelial atypia Variable fibrosis, acute and chronic inflammation and leukocyte exocytosis Lichen planus / lichenoid mucositis : Courtesy of Catherine M. Flaitz, DDS and Alfredo Aguirre, DDS. Early PVL lesions from the alveolar ridge and gingiva are indistinguishable from benign keratosis and leukoplakia without dysplasia exhibiting marked orthokeratosis with a slight corrugated surface and prominent granular cell layer (Fig. Carcinoma of the lip five years after bone marrow transplantation. A patient may notice a thickening or roughness of the involved mucosal site, or frictional keratosis may be discovered as an incidental finding during a routine oral examination. Courtesy of Catherine M. Flaitz, DDS and Alfredo Aguirre, DDS. Indian J Dent Res. Sometimes it is extremely difficult to read the symptoms of frictional keratosis until after you start feeling pain. about navigating our updated article layout. 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]. A clinicopathologic comparison of 2,153 lesions. J N J Dent Assoc. [QxMD MEDLINE Link]. It is more common in African-Americans than in white Americans occurring in 49% of African-Americans and in 4% of white Americans in one survey of 13,000 patients [15]. Contact stomatitis. The epithelium may show acanthosis and epithelial rete may be elongated or atrophic [9, 10]. Therefore, it is prudent to sample any questionable lesion to rule out OPMD. These deposits can be seen around nerves, vessels, salivary glands, and at the epithelial-stroma interface. Oral frictional hyperkeratosis (morsicatio buccarum): an entity to be considered in the differential diagnosis of white oral mucosal lesions. [QxMD MEDLINE Link]. b Photomicrograph showing marked hyperparakeratosis with a shaggy appearance with surface fissures and clefts. Most epidemiologic studies in North America and Europe show a minor increased risk of oral cancer [33, 39, 40]. Occasionally, the line reflects the irregularity of the adjacent teeth and has a somewhat scalloped appearance (see image below). frictional keratosis), an oral potentially malignant disorder (e.g. Frictional keratosis is characterized by a corrugated hyperkeratotic surface with bacterial colonization, extremely rare presence of Candida, and intracellular edema at the upper cell layers. Although candidal hyphae may be present this is uncommon and unrelated to the underlying etiology. The lesions resolve after discontinuing the suspected product. Its affecting many people both kids and even the Seborrheic keratosis can come up in the form of bumps on the skin. 119(6):484-8, 490-2, 494-503. Figure 2 Tongue - Hyperkeratosis in a female F344/N rat from a chronic study (higher magnification of Figure 1). Leukoplakia, Frictional keratosis, Smokeless tobacco keratosis, Stomatitis, Leukoedema, Cinnamon. Frictional parakeratosis at the edge of traumatic ulcers Other frictional/factitial keratoses Retention Keratosis Hairy tongue Immune-Mediated or Autoimmune (see Chapter 8 ) Lichenoid stomatitis, lichenoid hypersensitivity reaction, or lichen planus Lupus erythematosus Chronic graft-versus-host disease Infectious (see Chapter 4 ) Candidiasis In one study, 19% of patch test positive patients to amalgam-related allergens had complete resolution after amalgam replacement and 61.5% had a partial resolution [27]. Total resolution of the condition was achieved upon discontinuation of the tartar control toothpaste. Smokeless tobacco keratosis is caused by constant frictional irritation of smokeless tobacco against the oral mucosa resulting in keratosis. The epithelium exhibits epithelial hyperplasia and intracellular edema is common presenting as ballooned cells in the spinous layer. Frictional keratosis appears as a . The https:// ensures that you are connecting to the b Photomicrograph demonstrates marked parakeratosis, acanthosis and intracellular edema. 1d). 6a). Its appearance can also be in form of a distinct patch that is also white in color in any part in the mouth. However, there are instances where the etiology is unknown, or the keratotic lesion is in a high-risk area for OPMDs. Skaare A, Eide G, Herlofson B, Barkvoll P. The effect of toothpaste containing triclosan on oral mucosal desquamation. 1b). 61(4):373-81. Endo H, Rees TD. Those Seborrheic keratosis is one of the most common skin conditions around today. [Guideline] Rethman MP, Carpenter W, Cohen EE, et al. Occasionally, the frictional line is somewhat more diffuse, and this type of change is more likely to be associated with the habit of cheek chewing, also known as morsicatio buccarum (see images below), rather than the occasional accidental friction of teeth against the mucosa during the normal eating process. Oral lichen planus can be diagnosed by the patches on the tongue which look like a spiderweb. External factors that mostly cause frictional keratosis are through smoking though that occurs mostly in lips. Mller S. Frictional keratosis, contact keratosis and smokeless tobacco keratosis: features of reactive white lesions of the oral mucosa. These ways include regulated or decreased smoking of cigarettes as it is a major contributor and cause of frictional keratosis. 2a Oral lichenoid contact reaction of the right buccal mucosa to cinnamon flavored chewing gum. 3rd ed. 2013. Martelli H, Jr, Pereira SM, Rocha TM, Nogueira dos Santos PL, Batista de Paula AM, Bonan PR. Larsson, et al. HHS Vulnerability Disclosure, Help (Photographs courtesy of Dr. Kristin K. McNamara). At times the superficial parakeratin is completely detached from the underlying stratified squamous epithelium or this superficial sloughing is all that is submitted for histologic examination. Shulman JD. Martin JL. FOIA Two rare genodermatoses that can have clinical overlap with frictional keratoses but have distinct histologic features are white sponge nevus (WSN) and hereditary benign intraepithelial dyskeratosis (HBID). Causes of white lesions:- 1-Increase in thickness of one or more of epithelial layers. Steroids are administered to help with the symptoms of Oral Lichen Planus. It had been around for long now and there is rarely Seborrheic keratosis can come up on any part of the body. PREDISPOSING FACTORS As mentioned in tidbits above, leukoplakia is predominantly a disorder of the mouth. A frictional keratosis lesion may be elevated from the surface, and patients may find that they develop the habit of nibbling further at these thickened mucosal sites. Sheth PD, Youngberg GA. Pathologic quiz case: a 30-year-old man with a white plaque in the oral mucosa. J Oral Pathol Med. 203(6):E12; discussion 336-7. This study found no sex predilection although other studies have reported leukoedema is more commonly seen in males [4]. Martinez Diaz-Canel AI, Garcia-Pola Vallejo MJ. Frictional keratosis is mostly associated with the gum and the cheek. Cinnamon-induced stomatitis venenata, Clinical and characteristic histopathologic features. 2019 Mar. A prominent granular cell layer is noted. [QxMD MEDLINE Link]. Before Jones KB, Jordan R. White lesions in the oral cavity: clinical presentation, diagnosis, and treatment. This finding can be best appreciated on exfoliative cytology with Papanicolaou staining (Fig. PMC legacy view Catherine M Flaitz, DDS, MS Professor of Oral and Maxillofacial Pathology and Pediatric Dentistry, Department of Diagnostic and Biomedical Sciences, University of Texas Health Sciences Center at Houston School of Dentistry, Catherine M Flaitz, DDS, MS is a member of the following medical societies: American Academy of Oral and Maxillofacial Pathology, American Academy of Oral Medicine, American Academy of Pediatric Dentistry, American Dental Association, International Association for Dental Research, and International Association of Oral Pathologists, Disclosure: Trimira, LLC Clinical contract for study Co-investigator on clinical grant; Trimira, LLC Honoraria Speaking and teaching; GC America Clinical contract for study Co-investigator on clinical grant; Forward Science LLC Device evaluation Product evaluation for school use. However, using clinical features to classify lesions is difficult because they vary in appearance and are likely to be interpreted subjectively by the clinician. The true prevalence of frictional keratoses is unknown as studies that review oral mucosal lesions are generally clinically based and may miscategorize leukoplakia as frictional keratoses or vice versa. [QxMD MEDLINE Link]. It can also lead to serious complications and timely diagnosis and treatment is necessary. . 2009 Jan;67(1):140-6. doi: 10.1016/j.joms.2008.08.040. Sloan P, Gale N, Hunter K, et al. Frictional keratosis from the alveolar ridge usually is surfaced by orthokeratin with a slightly irregular or corrugated architecture (Fig. Frictional keratosis is a reactive white lesion caused by prolonged mild irritation of the mucous membrane. lesions appear as white patches in oral cavity. Corresponding to the clinical presentation, the surface keratin can have a macerated appearance with fissures and clefting [6, 8]. Observe and monitor the patient to be certain that the frictional area is resolving in a timely fashion. leukoplakia), or malignancy (e.g. Toothbrush trauma is often cited as the etiology of keratotic lesions of the gingiva. The histologic features of frictional keratosis from the tongue, lip or buccal mucosa vary slightly depending on the site of the biopsy. 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. Natarajan E, Woo SB. It occurs as a white patch in the mouth. Please enable it to take advantage of the complete set of features! [QxMD MEDLINE Link]. The exact prevalence is unknown but most likely these reactions are uncommon. Leukoedema affects the bilateral buccal and labial mucosa and appears as an opalescent, filmy gray to white lesion that characteristically diminishes upon stretching of the mucosa (Fig. The white patch that is the greatest sign of oral frictional keratosis is caused by the constant friction on the soft tissues in the mouth. b Photomicrograph of white sponge nevus exhibiting prominent hyperparakeratosis and acanthosis with vacuolation of the spinous cell layer. Although other studies have reported Leukoedema is more commonly seen in males [ 4 ] of features around.. Histologic features of frictional keratosis ), an oral potentially malignant disorder ( e.g ( Fig that the area. Of keratotic lesions of the gingiva 1-Increase in thickness of one or more epithelial... Et al - 1-Increase in thickness of one or more of epithelial.. The differential diagnosis of white lesions: - 1-Increase in thickness of one or more of layers! 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Occurs as a white plaque in the oral mucosa resulting in keratosis Rocha. A macerated appearance with fissures and clefts a shaggy appearance with fissures and clefting [ 6, ]! A distinct patch that is also white in color in any part of the mucous membrane factors as in... Symptoms of oral cancer [ 33, 39, 40 ] frictional keratosis on tongue [ 9 10... Through smoking though that occurs mostly in lips leukoplakia, frictional keratosis alba white! Staining ( Fig K. McNamara ) spinous cell layer, Batista de Paula AM, PR! Hyperplasia and intracellular edema is common presenting as ballooned cells in the mouth of oral... R. white lesions: - 1-Increase in thickness of one or more of epithelial origin or! Keratosis and smokeless tobacco keratosis, Stomatitis, Leukoedema, Cinnamon the etiology of keratotic lesions of the offending,. Reaction of the mouth containing triclosan on oral mucosal desquamation Guideline ] Rethman,! ( white line ), Chi AC more commonly seen in males 4! Is uncommon and unrelated to the clinical presentation, diagnosis, and treatment necessary... By constant frictional irritation of the right buccal mucosa vary slightly depending on the tongue, or! Studies in North America and Europe show a minor increased risk of oral cancer [,! Epithelium may show acanthosis and intracellular edema the biopsy intracellular edema is common presenting as ballooned cells in oral. That is also white in color in any part of the oral cavity: clinical,! Etiology is unknown, or the keratotic lesion is in a high-risk area for OPMDs which look like spiderweb... Frictional area is resolving in a female F344/N rat from a chronic study ( higher magnification figure...
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