The patient admitted to nibbling at the thickened mucosa (see second image below), which, in turn, made it thicker and easier to feel and, therefore, encouraged further nibbling. Included in the discussion are frictional keratoses, irritant contact stomatitis, and smokeless tobacco keratoses. Oral and Maxillofacial Pathology. Martinez Diaz-Canel AI, Garcia-Pola Vallejo MJ. Acta Bioeng Biomech. It can also lead to serious complications and timely diagnosis and treatment is necessary. The plaque had a slightly irregular surface, had no surrounding erythema, and was the only such plaque in the . Corresponding to the clinical presentation, the surface keratin can have a macerated appearance with fissures and clefting [6, 8]. The inflammation unlike oral lichen planus is composed of lymphocytes, plasma cells and scattered eosinophils. Classification schemes for lesions of the oral cavity typically have used the clinical appearance of lesions to determine which are premalignant. Frictional Keratosis. The .gov means its official. Share cases and questions with Physicians on Medscape consult. Flaitz CM. Leukoplakia, Frictional keratosis, Smokeless tobacco keratosis, Stomatitis, Leukoedema, Cinnamon. Int J Paediatr Dent. . Interface mucositis is identified, and the superficial connective tissue contains a predominately lymphocytic band-like inflammatory cell infiltrate which includes plasma cells, histiocytes and scattered eosinophils (Fig. The area is asymptomatic. HBID does not affect the anogenital region, esophagus or nasal mucosa. White, thickened plaques with irregular, rough surface change are noted on the gingiva of the right maxilla and mandible. 10(2):114-5. Courtesy of Catherine M. Flaitz, DDS and Alfredo Aguirre, DDS. 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]. Snuff-dippers lesion. The corresponding tooth can be slightly recontoured and polished. b When the cheek is everted and stretched the lesion diminishes. Bhattacharyya I. Of unknown etiology, PVL is associated with high recurrence and malignant transformation rates. MeSH terms Adolescent Adult Age Distribution Aged Aged, 80 and over Keeping the buccal cavity free from germs and bacteria can be achieved through having regular checkups with dentists and health professionals or simply by keeping the cavity clean. 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. The clinical effectiveness of reflectance optical spectroscopy for the in vivo diagnosis of oral lesions. 8d). Linea alba is thought to result from chronic cheek biting or sucking of these tissues (see images below). There is both clinical and histologic overlap in the features of benign keratosis and keratosis associated with proliferative verrucous leukoplakia (PVL) which is a recognized OPMD (Fig. Macdonald JB, Tobin CA, Hurley MY. Numerous papers have been published on the clinical and histologic features of oral leukoplakia and will not be repeated herein. 15(4):43-8. Cinnamon flavoring agents including cinnamic aldehyde, cinnamic acid and cinnamon oil, can cause a contact stomatitis [30]. Frictional keratosis is among the many different keratosis conditions. Dentrifice-related stomatitis, contact reactions to amalgam and cinnamon can cause keratotic lesions. 2010 May. [QxMD MEDLINE Link]. the keratinized epithelium is consist of 4 layers which are basal cell layer , prickle cell layer , granular cell layer and cornified celllayer , but non keratinized epithelium is consist of 3 layers only which are the . 1986 Apr. There is peeling of the superficial keratin without any underlying erythema or erosion. 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]. [QxMD MEDLINE Link]. The .gov means its official. They therefore do not need treatment as they often disappear after sometime unless the affected area is rubbed against repeatedly. Histologically, amalgam contact reactions can have tertiary lymphoid follicle formation composed of B-cells containing follicular dendritic cells surrounded by T-cells and macrophages similar to normal tonsils (Fig. The lesions usually present on the buccal mucosa or tongue where prolonged contact of the mucosa with the amalgam occur. On initial examination, the patient was asymptomatic and the oral mucosa had no abnormal findings, but on repeat examination when symptoms were present, the patient had shaggy white plaques on the bilateral buccal mucosa limited to the line of dental occlusion (Figure 1). Epidemiological study of oral mucosa pathology in patients of the Oviedo School of Stomatology. Dry skin. Microscopic examination of fragments of mucosa peeled away from the affected area revealed fragments ofparakeratotic cornified material colonized by numerous bacteria (Figure 3). Clefting of the superficial parakeratin is seen and often this superficial layer of keratin is detached from the epithelium (Fig. Leukoplakia of gingiva, lips, tongue. Mller S. Frictional keratosis, contact keratosis and smokeless tobacco keratosis: features of reactive white lesions of the oral mucosa. Here areas of erythema and ulceration develop secondary to vesicle formation within keratotic lesions, and patients complain of pain and burning. The epithelium is acanthotic and cellsin the spinous layer may show vacuolated cytoplasm. Steroids are administered to help with the symptoms of Oral Lichen Planus. These lesions can occasionally mimic dysplastic leukoplakia. They therefore do not need treatment as they often disappear after sometime unless the affected area is rubbed against repeatedly. The patient denied biting her tongue and the histology is not consistent with chronic tongue chewing/biting. It is possible to treat pigmentation yourself at home. Drore Eisen, MD, DDS is a member of the following medical societies: American Academy of Dermatology, American Academy of Oral Medicine, American Dental AssociationDisclosure: Nothing to disclose. a Typical clinical presentation of an early smokeless tobacco keratosis demonstrating an area of superficial keratosis with slight wrinkling, lacking any appreciative mucosal thickening. Perivascular inflammation composed of lymphocytes and plasma cells are observed in the deeper lamina propria. [QxMD MEDLINE Link]. [QxMD MEDLINE Link]. Intraepithelial linear clefting of the superficial parakeratin is seen. Woo SB, Grammer RL, Lerman MA. Tremblay S, Avon SL. 5 inset). Those Seborrheic keratosis is one of the most common skin conditions around today. Inflammatory etiologies of oral white lesions including infective and non-infective causes will be discussed elsewhere in this special issue. They include: The list can go on and on. In: el-Naggar AK, Chan JKC, Grandis JR, Takata T, Slootweg PJ, et al., editors. a Irregular, shaggy macerated appearance of the left buccal mucosa typical for cheek biting (morsicatio mucosae). Skaare A, Eide G, Herlofson B, Barkvoll P. The effect of toothpaste containing triclosan on oral mucosal desquamation. The epithelium has elongated anastomosing rete. If the cause of the white patches is a precancerous . Parlak AH, Koybasi S, Yavuz T, et al. Most epidemiologic studies in North America and Europe show a minor increased risk of oral cancer [33, 39, 40]. Lip-bite keratosis is caused by frequent involuntary biting of ones lips. Research and studies demonstrate that frictional keratosis is most prevalent among young adults as well as teenagers. Received 2018 Sep 21; Accepted 2018 Nov 2. . With few exceptions, marked hyperparakeratosis with a shaggy or shredded keratin surface is noted (Fig. Sloan P, Gale N, Hunter K, et al. Macigo FG, Mwaniki DL, Guthua SW. 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. 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. Oral and maxillofacial pathology case of the month. A prominent granular cell layer is noted. The whiteness is as a result of more cells being set by the body as it reacts to the irritation caused by friction. Histologic features of WSN are distinct with prominent parakeratosis and acanthosis and clearing of the spinous cell layer (Fig. or fever, they should speak to a doctor. Jose Luis Tapia, DDS is a member of the following medical societies: American Academy of Oral and Maxillofacial PathologyDisclosure: Nothing to disclose. Suter VG, Warnakulasuriya S. The role of patch testing in the management of oral lichenoid reactions. In addition, the affected fungiform papillae may be red and enlarged from the chronic irritation. White sponge nevus: report of a three-generation family. 2015 Dec. 34 (4):161-70. K13.29 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. Frictional keratosis must also be considered as it can affect the margins of the tongue. 16:39-78; discussion 79. 2b) [8, 12]. as frictional keratosis, which occurs ble cottage cheese or curdled milk.1,2 Although culture or cytopathologic tis- under a variety of diagnostic names Scraping the plaques with a tongue sue staining conrms the diagnosis, (Table 1). This condition derives its name from the act of friction (another object constantly rubbing itself against the skin) and this may lead to Frictional keratosispatches. We report the first example, to our knowledge, of a frictional keratosis from exuberant sucking in a breastfeeding infant. Prevalence of oral lesions in 13- to 16-year-old students in Duzce, Turkey. Normal variations of oral anatomy and common oral soft tissue lesions: evaluation and management. In addition to PVL there are benign conditions that can have clinical overlap with frictional keratosis. frictional keratosis), an oral potentially malignant disorder (e.g. In most cases, oral frictional keratosis appears as a thin line that is white in color across the cheek opposite the meeting point of the teeth. 1 Given the high-risk nature of some white patches, it is important to perform a thorough history and examination. Mathew AL, Pai KM, Sholapurkar AA, Vengal M. The prevalence of oral mucosal lesions in patients visiting a dental school in Southern India. The affected area may exhibit a macerated appearance with shredded keratin and peeling (Fig. keratin layer on the surface of the tongue is thickened (arrow). The erosive form of lichen planus must be considered separately. c Photomicrograph of smokeless tobacco keratosis shows a corrugated parakeratotic surface and epithelial acanthosis. Cytology of linea alba using a filter imprint technique. (cold sores), the gums, the tongue, the palate (roof of mouth) or the tongue. The prevalence has been reported as high as 5.5%. An example of a common lesion that has a frictional component is cheek chewing or morsicatio buccarum. All material on this website is protected by copyright, Copyright 1994-2023 by WebMD LLC. 1b). Accessibility 7 The characteristic white appearance of oral frictional keratosis is due to generation of keratin filaments from chronic irritation. [QxMD MEDLINE Link]. The connective tissue lacks inflammation. 73(6):708-16. Triamcinolone 0.1% ointment in Orabase and tretinoin 0.05% gel were ineffective. Madani FM, Kuperstein AS. 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]. Sucking on the cheeks, lips, or sides of the tongue may be a habit to relieve the discomfort from temporomandibular disorder or burning mouth syndrome. Anterior rough surface area at the occlusal plane of the teeth. Gupta B, Johnson NW. Geographic It is seen worldwide. WSN is inherited as an autosomal dominant trait that presents as asymptomatic thickened soft white plaques most commonly on the buccal mucosa (Fig. Hereditary benign intraepithelial dyskeratosis. Kashani HG, Mackenzie IC, Kerber PE. Many individuals are having it. [QxMD MEDLINE Link]. Biopsies should be performed on these lesions that do not heal to rule out a Toothbrush keratosis can develop when a person uses excessive force while brushing teeth and causes inflammations in ones mouth. When the inflammation is difficult to control, chronic eczema can lead to: Hyperkeratosis. 2019 Mar. Frictional keratosis Frictional keratoses occur in oral cavity subsites that are subjected to chronic low-grade trauma. As the name suggests these patches occur due to friction or . 2009 Jan;67(1):140-6. doi: 10.1016/j.joms.2008.08.040. Endo H, Rees TD. will also be available for a limited time. However, chronic frictional or chemical assault on the tissue over time can also cause dysplastic changes. In rare examples, individuals may give a history of picking the oral mucosa with long fingernails or some other external object. The epithelium is acanthotic with ballooned cells. PMC 7-2c) [10, 31]. (H&E magnification 400). The surface can feel rough with irregular tags which initiates a cycle of a patient removing the rough tags with their teeth only to produce more tags. Federal government websites often end in .gov or .mil. HHS Vulnerability Disclosure, Help Schulten EA, Jovanovic A, van der Waal I. Ned Tijdschr Tandheelkd. 1980. Morsicatio mucosae oris--a chronic oral frictional keratosis, not a leukoplakia. 2007 Sep 22. such as dorsum of the tongue, hard palate, and attached gingiva, sometimes . In one study evaluating benign alveolar ridge keratosis with lesions exhibiting dysplasia, lesional size was not a predictor [10]. Various names have been used to describe particular examples of frictional keratosis (FK). Frictional keratosis. Admittedly there is histologic overlap with oral lichen planus and amalgam contact reactions however some microscopic findings may favor a contact reaction (Fig. 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 fitting dental work), as shown in the image below. Changing trends in oral squamous cell carcinoma with particular reference to young patients: 19712006. 2b The microscopic features of oral lichenoid contact reaction to cinnamon show marked epithelial acanthosis and intracellular edema. Frictional keratosis from the alveolar ridge usually is surfaced by orthokeratin with a slightly irregular or corrugated architecture (Fig. The Although the clinical presentation of irritant contact stomatitis share similarities with allergic contact stomatitis, patch testing is negative [20]. The use of oral tobacco products used in North American and Europe can result in clinical changes at the site of tobacco placement. Lesions associated with infections such as oral hairy leukoplakia and hyperplastic candidiasis can have a clinical presentation similar to frictional keratoses. Scaling. Although candidal hyphae may be present this is uncommon and unrelated to the underlying etiology. 6b) [24]. Smokeless tobacco keratosis is caused by constant frictional irritation of smokeless tobacco against the oral mucosa resulting in keratosis. 2a Oral lichenoid contact reaction of the right buccal mucosa to cinnamon flavored chewing gum. Hereditary benign intraepithelial dyskeratosis: report of two cases with prominent oral lesions. Please confirm that you would like to log out of Medscape. Disclaimer, National Library of Medicine However, these microscopic findings are relatively non-specific (H&E, magnification 200). The alteration in texture within his mouth created an uncomfortable sensation and, at times, the lesions spontaneously peeled away requiring him to spit repeatedly. lesions appear as white patches in oral cavity. 2006 Nov. 12(6):553-8. Occasionally, the affected fungiform papillae in persons with a tongue biting or thrusting habit may be tender and sometimes associated with a burning sensation. This material is negative for Congo red and positive with periodic acid-Schiff confirming the collagen nature [36]. These plaques are moveable over the underlying tissue. The connective tissue is uninflamed. https://profreg.medscape.com/px/getpracticeprofile.do?method=getProfessionalProfile&urlCache=aHR0cHM6Ly9lbWVkaWNpbmUubWVkc2NhcGUuY29tL2FydGljbGUvMTA3NjA4OS1jbGluaWNhbA==. 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. Epibulbar blood vessels can be hyperemic resulting in a bloodshot appearance. Frictional keratosis from the alveolar ridge usually is surfaced by orthokeratin with a slightly irregular or corrugated architecture (Fig. Malignant surface epithelial tumours: squamous cell carcinoma. [QxMD MEDLINE Link]. (1) Leukoplakia and erythroplakia are two clinical lesions widely considered to be premalignant. 5) Frictional Keratosis. The first step in the identification of white patches suspected of being associated with physical trauma is to use a 2 X 2-inch sterile gauze to wipe off the lesion or lesions. There are different types of frictional keratoses whose classification is based on the area that suffers friction and develops patches. The mostly associated symptoms of this condition include the hyperkeratosis and porokeratosis that appear and can be seen. J Am Dent Assoc. It occurs as a white patch in the mouth. 7-1a) [8, 12, 26]. d Histopathologic features of ridge keratosis characterized by marked hyperorthokeratosis, hypergranulosis and acanthosis. Tex Dent J. The first image below shows a frictional keratosis lesion that displays marked keratinization. Martin JL. These ways include regulated or decreased smoking of cigarettes as it is a major contributor and cause of frictional keratosis. Frictional keratosis can also be avoided in a number of ways. Jose Luis Tapia, DDS Assistant Professor, Department of Oral Diagnostic Sciences, State University of New York at Buffalo This site needs JavaScript to work properly. 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. Benign alveolar ridge keratosis (oral lichen simplex chronicus): A distinct clinicopathologic entity. The clinical presentation can vary. The white patches or thickening associated with constant friction or bites that gradually damage the lining of ones moth, tongue, the gums, palate, lips, teeth and so on. 2015 Aug 1. Other mucosal sites of involvement include nasal, esophageal and anogenital. 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. HBID is characterized histopathologically by hyperplastic stratified squamous epithelium with marked parakeratosis and acanthosis (Fig. This area is exactly level with the occlusal plane and was being chewed constantly by the patient. Axll T. Occurrence of leukoplakia and some other oral white lesions among 20,333 adult Swedish people. 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Marked epithelial acanthosis vacuolated cytoplasm other oral white lesions among 20,333 adult Swedish people stratified squamous epithelium with parakeratosis... Surface of the teeth the right maxilla and mandible and burning School of Stomatology steroids administered... And examination epibulbar blood vessels can be seen: 10.1016/j.joms.2008.08.040 the inflammation is difficult to control chronic... Of pain and burning hyperorthokeratosis, hypergranulosis and acanthosis irregular surface, had no erythema. With the symptoms of this condition include the Hyperkeratosis and porokeratosis that appear and be! Library of Medicine however, chronic frictional or chemical assault on the clinical appearance of oral lichenoid reaction. Erosive form of lichen planus is composed of lymphocytes, plasma cells are observed in the mouth filter technique... This is uncommon and unrelated to the clinical effectiveness of reflectance optical for...
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