recognizing white lesions part i: reactive, idiopathic, hereditary david e. wojtowicz, dds, mba
TRANSCRIPT
![Page 1: RECOGNIZING WHITE LESIONS PART I: Reactive, Idiopathic, Hereditary David E. Wojtowicz, DDS, MBA](https://reader035.vdocuments.net/reader035/viewer/2022081401/56649c9b5503460f94959398/html5/thumbnails/1.jpg)
RECOGNIZING WHITE RECOGNIZING WHITE LESIONS LESIONS
PART I: Reactive, Idiopathic, PART I: Reactive, Idiopathic, Hereditary Hereditary
RECOGNIZING WHITE RECOGNIZING WHITE LESIONS LESIONS
PART I: Reactive, Idiopathic, PART I: Reactive, Idiopathic, Hereditary Hereditary
David E. Wojtowicz, DDS, MBADavid E. Wojtowicz, DDS, MBA
![Page 2: RECOGNIZING WHITE LESIONS PART I: Reactive, Idiopathic, Hereditary David E. Wojtowicz, DDS, MBA](https://reader035.vdocuments.net/reader035/viewer/2022081401/56649c9b5503460f94959398/html5/thumbnails/2.jpg)
White Lesions White Lesions White Lesions White Lesions
A Lesion Appears WHITE Because Some Material Is Obscuring the Normal PINK or Racial Color.
Is the WHITE Material Directly on the Surface?
A Lesion Appears WHITE Because Some Material Is Obscuring the Normal PINK or Racial Color.
Is the WHITE Material Directly on the Surface?
![Page 3: RECOGNIZING WHITE LESIONS PART I: Reactive, Idiopathic, Hereditary David E. Wojtowicz, DDS, MBA](https://reader035.vdocuments.net/reader035/viewer/2022081401/56649c9b5503460f94959398/html5/thumbnails/3.jpg)
3 Mechanisms3 Mechanismsto Achieve White Appearance to Achieve White Appearance
3 Mechanisms3 Mechanismsto Achieve White Appearance to Achieve White Appearance
Epithelial Thickening– Rough / Does NOT Rub Off
Surface Material– Rough / Does Rub Off
Subepithelial Change– Smooth / Does NOT Rub Off
Epithelial Thickening– Rough / Does NOT Rub Off
Surface Material– Rough / Does Rub Off
Subepithelial Change– Smooth / Does NOT Rub Off
![Page 4: RECOGNIZING WHITE LESIONS PART I: Reactive, Idiopathic, Hereditary David E. Wojtowicz, DDS, MBA](https://reader035.vdocuments.net/reader035/viewer/2022081401/56649c9b5503460f94959398/html5/thumbnails/4.jpg)
SixSix Common Etiologies for Common Etiologies for White LesionsWhite Lesions
SixSix Common Etiologies for Common Etiologies for White LesionsWhite Lesions
Reactive (Snuff) Idiopathic (Hairy Tongue)Hereditary (Leukoedema)Auto-Immune (Lichen Planus) Infectious (Candidiasis)Neoplastic (SCC)
Reactive (Snuff) Idiopathic (Hairy Tongue)Hereditary (Leukoedema)Auto-Immune (Lichen Planus) Infectious (Candidiasis)Neoplastic (SCC)
![Page 5: RECOGNIZING WHITE LESIONS PART I: Reactive, Idiopathic, Hereditary David E. Wojtowicz, DDS, MBA](https://reader035.vdocuments.net/reader035/viewer/2022081401/56649c9b5503460f94959398/html5/thumbnails/5.jpg)
1. 1. SixSix Reactive White Reactive White Hyperkeratotic LesionsHyperkeratotic Lesions
(These are (These are HYPERKERATOTICHYPERKERATOTIC. They Do . They Do NOTNOT Rub Off.) Rub Off.)
1. 1. SixSix Reactive White Reactive White Hyperkeratotic LesionsHyperkeratotic Lesions
(These are (These are HYPERKERATOTICHYPERKERATOTIC. They Do . They Do NOTNOT Rub Off.) Rub Off.)
a. Snuff Dipper’s Lesion
b. Nicotinic Stomatitis
c. Chemical Burn
d. Linea Alba
e. Actinic Cheilitis
f. Denture Acanthosis
a. Snuff Dipper’s Lesion
b. Nicotinic Stomatitis
c. Chemical Burn
d. Linea Alba
e. Actinic Cheilitis
f. Denture Acanthosis
![Page 6: RECOGNIZING WHITE LESIONS PART I: Reactive, Idiopathic, Hereditary David E. Wojtowicz, DDS, MBA](https://reader035.vdocuments.net/reader035/viewer/2022081401/56649c9b5503460f94959398/html5/thumbnails/6.jpg)
1. 1. SixSix Reactive White Reactive White Hyperkeratotic LesionsHyperkeratotic Lesions
(Do They Rub Off?)(Do They Rub Off?)
a.a. Snuff Dipper’s LesionSnuff Dipper’s Lesion
1. 1. SixSix Reactive White Reactive White Hyperkeratotic LesionsHyperkeratotic Lesions
(Do They Rub Off?)(Do They Rub Off?)
a.a. Snuff Dipper’s LesionSnuff Dipper’s Lesion
Wrinkled, Velvety US & Canada, Lower Carcinogenic Rate Asia Higher Rate Due to Added Carcinogens Treatment = Quit Habit, Switch Site
Wrinkled, Velvety US & Canada, Lower Carcinogenic Rate Asia Higher Rate Due to Added Carcinogens Treatment = Quit Habit, Switch Site
![Page 7: RECOGNIZING WHITE LESIONS PART I: Reactive, Idiopathic, Hereditary David E. Wojtowicz, DDS, MBA](https://reader035.vdocuments.net/reader035/viewer/2022081401/56649c9b5503460f94959398/html5/thumbnails/7.jpg)
1. 1. SixSix Reactive White Lesions Reactive White Lesions
b.b. Nicotinic StomatitisNicotinic Stomatitis
1. 1. SixSix Reactive White Lesions Reactive White Lesions
b.b. Nicotinic StomatitisNicotinic Stomatitis
Grey, White and Red on Hard Palate Pipe and Tobacco Smoking (Heat) Red Spots, Inflamed Minor Salivary Gland
Orifices Treatment = Quit Smoking
Grey, White and Red on Hard Palate Pipe and Tobacco Smoking (Heat) Red Spots, Inflamed Minor Salivary Gland
Orifices Treatment = Quit Smoking
![Page 8: RECOGNIZING WHITE LESIONS PART I: Reactive, Idiopathic, Hereditary David E. Wojtowicz, DDS, MBA](https://reader035.vdocuments.net/reader035/viewer/2022081401/56649c9b5503460f94959398/html5/thumbnails/8.jpg)
1. 1. Six Six Reactive White Reactive White Hyperkeratotic LesionsHyperkeratotic Lesions
c.c. Chemical BurnChemical Burn
1. 1. Six Six Reactive White Reactive White Hyperkeratotic LesionsHyperkeratotic Lesions
c.c. Chemical BurnChemical Burn Caused by Aspirin Painful Usually in Molar Region Treatment = Discontinue Aspirin Use
Caused by Aspirin Painful Usually in Molar Region Treatment = Discontinue Aspirin Use
![Page 9: RECOGNIZING WHITE LESIONS PART I: Reactive, Idiopathic, Hereditary David E. Wojtowicz, DDS, MBA](https://reader035.vdocuments.net/reader035/viewer/2022081401/56649c9b5503460f94959398/html5/thumbnails/9.jpg)
1. 1. Six Six Reactive White Reactive White Hyperkeratotic LesionsHyperkeratotic Lesions
dd.. Linea AlbaLinea Alba
1. 1. Six Six Reactive White Reactive White Hyperkeratotic LesionsHyperkeratotic Lesions
dd.. Linea AlbaLinea Alba Most Common White Lesion White Line @ Occlusal Plane Bilateral on the Buccal Mucosa No Treatment Needed
Most Common White Lesion White Line @ Occlusal Plane Bilateral on the Buccal Mucosa No Treatment Needed
![Page 10: RECOGNIZING WHITE LESIONS PART I: Reactive, Idiopathic, Hereditary David E. Wojtowicz, DDS, MBA](https://reader035.vdocuments.net/reader035/viewer/2022081401/56649c9b5503460f94959398/html5/thumbnails/10.jpg)
1. 1. Six Six Reactive White Reactive White Hyperkeratotic LesionsHyperkeratotic Lesions
ee.. Actinic CheilitisActinic Cheilitis
1. 1. Six Six Reactive White Reactive White Hyperkeratotic LesionsHyperkeratotic Lesions
ee.. Actinic CheilitisActinic Cheilitis Sun Damage Lower Lip Obliteration of Border Treatment = Avoid Sun, Use Sunblock
Sun Damage Lower Lip Obliteration of Border Treatment = Avoid Sun, Use Sunblock
![Page 11: RECOGNIZING WHITE LESIONS PART I: Reactive, Idiopathic, Hereditary David E. Wojtowicz, DDS, MBA](https://reader035.vdocuments.net/reader035/viewer/2022081401/56649c9b5503460f94959398/html5/thumbnails/11.jpg)
1. 1. Six Six Reactive White Reactive White Hyperkeratotic LesionsHyperkeratotic Lesions
ff.. Denture AcanthosisDenture Acanthosis
1. 1. Six Six Reactive White Reactive White Hyperkeratotic LesionsHyperkeratotic Lesions
ff.. Denture AcanthosisDenture Acanthosis Caused by Irritants Clinical Appearance is Similar to Hyperkeratosis Thickened Intermediate Cell layer Elongation of Rete Pegs Treatment = Avoid Irritants, ie. Ill-fitting Dentures
Caused by Irritants Clinical Appearance is Similar to Hyperkeratosis Thickened Intermediate Cell layer Elongation of Rete Pegs Treatment = Avoid Irritants, ie. Ill-fitting Dentures
![Page 12: RECOGNIZING WHITE LESIONS PART I: Reactive, Idiopathic, Hereditary David E. Wojtowicz, DDS, MBA](https://reader035.vdocuments.net/reader035/viewer/2022081401/56649c9b5503460f94959398/html5/thumbnails/12.jpg)
2. 2. TwoTwo Idiopathic White Idiopathic White Hyperkeratotic LesionsHyperkeratotic Lesions2. 2. TwoTwo Idiopathic White Idiopathic White Hyperkeratotic LesionsHyperkeratotic Lesions
Geographic TongueHairy Tongue
Geographic TongueHairy Tongue
![Page 13: RECOGNIZING WHITE LESIONS PART I: Reactive, Idiopathic, Hereditary David E. Wojtowicz, DDS, MBA](https://reader035.vdocuments.net/reader035/viewer/2022081401/56649c9b5503460f94959398/html5/thumbnails/13.jpg)
Geographic TongueGeographic Tongue(Benign Migratory Glossitis)(Benign Migratory Glossitis)
Geographic TongueGeographic Tongue(Benign Migratory Glossitis)(Benign Migratory Glossitis) White Borders (+/-Hyperkeratotic) Red Patches of Denuded Filiform Papillae Common Disorder (1 - 2%), Females,
Young Adults Painfree or . . . Painful if inflamation is present Treatment = None, or Topical Anesthetic
White Borders (+/-Hyperkeratotic) Red Patches of Denuded Filiform Papillae Common Disorder (1 - 2%), Females,
Young Adults Painfree or . . . Painful if inflamation is present Treatment = None, or Topical Anesthetic
![Page 14: RECOGNIZING WHITE LESIONS PART I: Reactive, Idiopathic, Hereditary David E. Wojtowicz, DDS, MBA](https://reader035.vdocuments.net/reader035/viewer/2022081401/56649c9b5503460f94959398/html5/thumbnails/14.jpg)
Hairy TongueHairy TongueHairy TongueHairy Tongue
Shaggy Matte of Filliform Papillae Candidiasis Stimulates the Hyperplasia Coffee, Tea, Tobacco = Black Treatment = Brush Tongue, Improve Oral
Hygiene
Shaggy Matte of Filliform Papillae Candidiasis Stimulates the Hyperplasia Coffee, Tea, Tobacco = Black Treatment = Brush Tongue, Improve Oral
Hygiene
![Page 15: RECOGNIZING WHITE LESIONS PART I: Reactive, Idiopathic, Hereditary David E. Wojtowicz, DDS, MBA](https://reader035.vdocuments.net/reader035/viewer/2022081401/56649c9b5503460f94959398/html5/thumbnails/15.jpg)
3. 3. TwoTwo Hereditary White Hereditary White Hyperkeratotic LesionsHyperkeratotic Lesions3. 3. TwoTwo Hereditary White Hereditary White Hyperkeratotic LesionsHyperkeratotic Lesions
LeukoedemaWhite Sponge Nevus
LeukoedemaWhite Sponge Nevus
![Page 16: RECOGNIZING WHITE LESIONS PART I: Reactive, Idiopathic, Hereditary David E. Wojtowicz, DDS, MBA](https://reader035.vdocuments.net/reader035/viewer/2022081401/56649c9b5503460f94959398/html5/thumbnails/16.jpg)
LeukoedemaLeukoedemaLeukoedemaLeukoedema
Milky Grey Film Bilateral Buccal Mucosa, Non-progressive Disappears When Stretched More Common in Black Population Treatment = None Needed
Milky Grey Film Bilateral Buccal Mucosa, Non-progressive Disappears When Stretched More Common in Black Population Treatment = None Needed
![Page 17: RECOGNIZING WHITE LESIONS PART I: Reactive, Idiopathic, Hereditary David E. Wojtowicz, DDS, MBA](https://reader035.vdocuments.net/reader035/viewer/2022081401/56649c9b5503460f94959398/html5/thumbnails/17.jpg)
White Sponge NevusWhite Sponge NevusWhite Sponge NevusWhite Sponge Nevus
Rough, Fissured Texture Symetric, Bilateral Buccal Mucosa Appears During Childhood, Non-
progressive Autosomal Dominant Transmission
Rough, Fissured Texture Symetric, Bilateral Buccal Mucosa Appears During Childhood, Non-
progressive Autosomal Dominant Transmission
![Page 18: RECOGNIZING WHITE LESIONS PART I: Reactive, Idiopathic, Hereditary David E. Wojtowicz, DDS, MBA](https://reader035.vdocuments.net/reader035/viewer/2022081401/56649c9b5503460f94959398/html5/thumbnails/18.jpg)
RECOGNIZING WHITE RECOGNIZING WHITE LESIONS II:LESIONS II:
Auto-Immune, Infectious, Auto-Immune, Infectious, Neoplastic Neoplastic
RECOGNIZING WHITE RECOGNIZING WHITE LESIONS II:LESIONS II:
Auto-Immune, Infectious, Auto-Immune, Infectious, Neoplastic Neoplastic
David E. Wojtowicz, DDS, MBADavid E. Wojtowicz, DDS, MBA
![Page 19: RECOGNIZING WHITE LESIONS PART I: Reactive, Idiopathic, Hereditary David E. Wojtowicz, DDS, MBA](https://reader035.vdocuments.net/reader035/viewer/2022081401/56649c9b5503460f94959398/html5/thumbnails/19.jpg)
4. 4. Two Two Auto-Immune White Auto-Immune White Hyperkeratotic LesionsHyperkeratotic Lesions
4. 4. Two Two Auto-Immune White Auto-Immune White Hyperkeratotic LesionsHyperkeratotic Lesions
Lichen PlanusLupus Erythematosus
Lichen PlanusLupus Erythematosus
![Page 20: RECOGNIZING WHITE LESIONS PART I: Reactive, Idiopathic, Hereditary David E. Wojtowicz, DDS, MBA](https://reader035.vdocuments.net/reader035/viewer/2022081401/56649c9b5503460f94959398/html5/thumbnails/20.jpg)
Lichen PlanusLichen PlanusLichen PlanusLichen Planus
Auto-immune Degeneration of Connective Tissue / Mucosa (Skin) Interface
Middle Age (Rare Before 30) M = F, Skin Lesions (33%)
Auto-immune Degeneration of Connective Tissue / Mucosa (Skin) Interface
Middle Age (Rare Before 30) M = F, Skin Lesions (33%)
![Page 21: RECOGNIZING WHITE LESIONS PART I: Reactive, Idiopathic, Hereditary David E. Wojtowicz, DDS, MBA](https://reader035.vdocuments.net/reader035/viewer/2022081401/56649c9b5503460f94959398/html5/thumbnails/21.jpg)
Lichen PlanusLichen PlanusLichen PlanusLichen Planus
Reticular (Wickham’s Striae)AnnularErosive Atrophic, Bullous
Reticular (Wickham’s Striae)AnnularErosive Atrophic, Bullous
![Page 22: RECOGNIZING WHITE LESIONS PART I: Reactive, Idiopathic, Hereditary David E. Wojtowicz, DDS, MBA](https://reader035.vdocuments.net/reader035/viewer/2022081401/56649c9b5503460f94959398/html5/thumbnails/22.jpg)
Lichen PlanusLichen PlanusLichen PlanusLichen Planus
Stress & Thiazide Drugs are Possible Triggers
Differential: Snuff (Stretch) White Sponge (Youth)
Treatment = None if Asymptomatic . . .
Stress & Thiazide Drugs are Possible Triggers
Differential: Snuff (Stretch) White Sponge (Youth)
Treatment = None if Asymptomatic . . .
![Page 23: RECOGNIZING WHITE LESIONS PART I: Reactive, Idiopathic, Hereditary David E. Wojtowicz, DDS, MBA](https://reader035.vdocuments.net/reader035/viewer/2022081401/56649c9b5503460f94959398/html5/thumbnails/23.jpg)
Erosive Lichen PlanusErosive Lichen PlanusErosive Lichen PlanusErosive Lichen Planus
PainfulRisk Factor for SCCTreatment = Biopsy, Steroids,
Retinoic Acid
PainfulRisk Factor for SCCTreatment = Biopsy, Steroids,
Retinoic Acid
![Page 24: RECOGNIZING WHITE LESIONS PART I: Reactive, Idiopathic, Hereditary David E. Wojtowicz, DDS, MBA](https://reader035.vdocuments.net/reader035/viewer/2022081401/56649c9b5503460f94959398/html5/thumbnails/24.jpg)
Lupus ErythematosusLupus ErythematosusLupus ErythematosusLupus Erythematosus
Skin Lesions: Butterfly Rash (Sun Exposed Area)
Mucosal Lesions: Rough White Patch
Bordered by Striae, Ulcers, Erythema
Skin Lesions: Butterfly Rash (Sun Exposed Area)
Mucosal Lesions: Rough White Patch
Bordered by Striae, Ulcers, Erythema
![Page 25: RECOGNIZING WHITE LESIONS PART I: Reactive, Idiopathic, Hereditary David E. Wojtowicz, DDS, MBA](https://reader035.vdocuments.net/reader035/viewer/2022081401/56649c9b5503460f94959398/html5/thumbnails/25.jpg)
Lupus ErythematosusLupus ErythematosusLupus ErythematosusLupus Erythematosus
Systemic: Arthritis, Vasculitis (Renal Failure)
Antinuclear Antibodies (ANA) Differential: Lichen Planus (Symmetrical
& Cutaneous), Leukoedema (Stretch) White Sponge (Youth)
Treatment = Corticosteroids
Systemic: Arthritis, Vasculitis (Renal Failure)
Antinuclear Antibodies (ANA) Differential: Lichen Planus (Symmetrical
& Cutaneous), Leukoedema (Stretch) White Sponge (Youth)
Treatment = Corticosteroids
![Page 26: RECOGNIZING WHITE LESIONS PART I: Reactive, Idiopathic, Hereditary David E. Wojtowicz, DDS, MBA](https://reader035.vdocuments.net/reader035/viewer/2022081401/56649c9b5503460f94959398/html5/thumbnails/26.jpg)
5. 5. Three Three Infectious White Infectious White LesionsLesions
5. 5. Three Three Infectious White Infectious White LesionsLesions
Candidiasis (DOES & Does NOT Scrape Off) - FIVE Clinical Lesions
Oral Hairy Leukoplakia (Does NOT Scrape Off)
Syphilitic Mucous Patch (Does NOT Scrape Off)
Candidiasis (DOES & Does NOT Scrape Off) - FIVE Clinical Lesions
Oral Hairy Leukoplakia (Does NOT Scrape Off)
Syphilitic Mucous Patch (Does NOT Scrape Off)
![Page 27: RECOGNIZING WHITE LESIONS PART I: Reactive, Idiopathic, Hereditary David E. Wojtowicz, DDS, MBA](https://reader035.vdocuments.net/reader035/viewer/2022081401/56649c9b5503460f94959398/html5/thumbnails/27.jpg)
Candidiasis (Moniliasis)Candidiasis (Moniliasis)Candidiasis (Moniliasis)Candidiasis (Moniliasis)
Acute– Pseudomembraneous (“Thrush”) - White
DOES Scrape Off
– Atrophic (“Erythematous”) - Red (Does NOT Scrape Off)
Chronic– Hyperplastic (“Candidal Leukoplakia”) - White
(Does NOT Scrape Off)
Acute– Pseudomembraneous (“Thrush”) - White
DOES Scrape Off
– Atrophic (“Erythematous”) - Red (Does NOT Scrape Off)
Chronic– Hyperplastic (“Candidal Leukoplakia”) - White
(Does NOT Scrape Off)
![Page 28: RECOGNIZING WHITE LESIONS PART I: Reactive, Idiopathic, Hereditary David E. Wojtowicz, DDS, MBA](https://reader035.vdocuments.net/reader035/viewer/2022081401/56649c9b5503460f94959398/html5/thumbnails/28.jpg)
CandidiasisCandidiasisCandidiasisCandidiasis
Commensal Organism - Normal Oral Flora Capable of Opportunistic Infections
(Hyphae) Early Sign of Host Defense Breakdown
(Neutropenia) Risk Factors: Antibiotics, Imunosupression,
Diabetes, HIV, Steroids, Nutritional Deficiency, Radiation/Chemo
Commensal Organism - Normal Oral Flora Capable of Opportunistic Infections
(Hyphae) Early Sign of Host Defense Breakdown
(Neutropenia) Risk Factors: Antibiotics, Imunosupression,
Diabetes, HIV, Steroids, Nutritional Deficiency, Radiation/Chemo
![Page 29: RECOGNIZING WHITE LESIONS PART I: Reactive, Idiopathic, Hereditary David E. Wojtowicz, DDS, MBA](https://reader035.vdocuments.net/reader035/viewer/2022081401/56649c9b5503460f94959398/html5/thumbnails/29.jpg)
Candidiasis: Acute Candidiasis: Acute PseudomembraneousPseudomembraneous
Candidiasis: Acute Candidiasis: Acute PseudomembraneousPseudomembraneous
White, Scrapes Off Underlying Tissue: Erythematous,
Hemorrhagic, Pruritic Newborns & RF (See Previous Item) Treatment = a. Correct the Predisposing
Factorb. Prescribe: Nystatin Vaginal Tablets– Disp: 70– Use: One Tablet as a Lozenge 5 Times a Day
White, Scrapes Off Underlying Tissue: Erythematous,
Hemorrhagic, Pruritic Newborns & RF (See Previous Item) Treatment = a. Correct the Predisposing
Factorb. Prescribe: Nystatin Vaginal Tablets– Disp: 70– Use: One Tablet as a Lozenge 5 Times a Day
![Page 30: RECOGNIZING WHITE LESIONS PART I: Reactive, Idiopathic, Hereditary David E. Wojtowicz, DDS, MBA](https://reader035.vdocuments.net/reader035/viewer/2022081401/56649c9b5503460f94959398/html5/thumbnails/30.jpg)
Candidiasis: Chronic HyperplasticCandidiasis: Chronic Hyperplastic-Candidal Leukoplakia-Candidal Leukoplakia
Candidiasis: Chronic HyperplasticCandidiasis: Chronic Hyperplastic-Candidal Leukoplakia-Candidal Leukoplakia
Keratotic Plaques or Papules (?Scrape Off?) Against Erythematous Background With Acanthosis
Sites: Labial Commissure, Labial & Buccal Vestibule
Risk Factors: Smoking, Poor Oral Hygiene (Dentures), Xerostomia - These Are Essentially All Chronic Irritants
Keratotic Plaques or Papules (?Scrape Off?) Against Erythematous Background With Acanthosis
Sites: Labial Commissure, Labial & Buccal Vestibule
Risk Factors: Smoking, Poor Oral Hygiene (Dentures), Xerostomia - These Are Essentially All Chronic Irritants
![Page 31: RECOGNIZING WHITE LESIONS PART I: Reactive, Idiopathic, Hereditary David E. Wojtowicz, DDS, MBA](https://reader035.vdocuments.net/reader035/viewer/2022081401/56649c9b5503460f94959398/html5/thumbnails/31.jpg)
Candidiasis: Chronic HyperplasticCandidiasis: Chronic Hyperplastic
-Candidal Leukoplakia-Candidal LeukoplakiaCandidiasis: Chronic HyperplasticCandidiasis: Chronic Hyperplastic
-Candidal Leukoplakia-Candidal Leukoplakia Cancer Risk: Biopsy is Mandatory of All
Speckled Erythroplakia or Erythroleuko-plakia Because of Increased SCC Risk
Treatment = a. Correct the Predisposing Factorb. Biopsy Lesionc. Prescribe: Nystatin Vaginal Tablets– Disp: 70– Use: One Tablet as a Lozenge 5 Times a Day
Cancer Risk: Biopsy is Mandatory of All Speckled Erythroplakia or Erythroleuko-plakia Because of Increased SCC Risk
Treatment = a. Correct the Predisposing Factorb. Biopsy Lesionc. Prescribe: Nystatin Vaginal Tablets– Disp: 70– Use: One Tablet as a Lozenge 5 Times a Day
![Page 32: RECOGNIZING WHITE LESIONS PART I: Reactive, Idiopathic, Hereditary David E. Wojtowicz, DDS, MBA](https://reader035.vdocuments.net/reader035/viewer/2022081401/56649c9b5503460f94959398/html5/thumbnails/32.jpg)
Candidiasis: Candidiasis: Three Three RedRed Chronic Oral LesionsChronic Oral Lesions
Candidiasis: Candidiasis: Three Three RedRed Chronic Oral LesionsChronic Oral Lesions
Angular Cheilitis = Perleche (Red) Median Rhomboid Glossitis (Red) Denture Sore Mouth = Atrophic
Candidiasis (Red)
Angular Cheilitis = Perleche (Red) Median Rhomboid Glossitis (Red) Denture Sore Mouth = Atrophic
Candidiasis (Red)
![Page 33: RECOGNIZING WHITE LESIONS PART I: Reactive, Idiopathic, Hereditary David E. Wojtowicz, DDS, MBA](https://reader035.vdocuments.net/reader035/viewer/2022081401/56649c9b5503460f94959398/html5/thumbnails/33.jpg)
Oral Hairy LeukoplakiaOral Hairy LeukoplakiaOral Hairy LeukoplakiaOral Hairy Leukoplakia
Rough, Hyperkeratotic, Patch Opportunistic E-B Virus HIV & Immunocompromised Bilateral, Lateral Borders of the Tongue Treatment: None or Acylovir
– Disp: 60 Capsules– One Cap q.4h. for 5 to 10 days
Rough, Hyperkeratotic, Patch Opportunistic E-B Virus HIV & Immunocompromised Bilateral, Lateral Borders of the Tongue Treatment: None or Acylovir
– Disp: 60 Capsules– One Cap q.4h. for 5 to 10 days
![Page 34: RECOGNIZING WHITE LESIONS PART I: Reactive, Idiopathic, Hereditary David E. Wojtowicz, DDS, MBA](https://reader035.vdocuments.net/reader035/viewer/2022081401/56649c9b5503460f94959398/html5/thumbnails/34.jpg)
Syphilitic Mucous PatchSyphilitic Mucous PatchSyphilitic Mucous PatchSyphilitic Mucous Patch
Painless, White, Mucosal UlcersWith . . .
Nonpruritic Skin Rash,Lymphadenopathy
Signs of Secondary Syphilis (T. pallidum)
Painless, White, Mucosal UlcersWith . . .
Nonpruritic Skin Rash,Lymphadenopathy
Signs of Secondary Syphilis (T. pallidum)
![Page 35: RECOGNIZING WHITE LESIONS PART I: Reactive, Idiopathic, Hereditary David E. Wojtowicz, DDS, MBA](https://reader035.vdocuments.net/reader035/viewer/2022081401/56649c9b5503460f94959398/html5/thumbnails/35.jpg)
6. 6. Four Four Neoplastic White Neoplastic White LesionsLesions
6. 6. Four Four Neoplastic White Neoplastic White LesionsLesions
Squamous Cell CarcinomaVerrucous CarcinomaEpithelial DysplasiaCarcinoma in Situ
Squamous Cell CarcinomaVerrucous CarcinomaEpithelial DysplasiaCarcinoma in Situ
![Page 36: RECOGNIZING WHITE LESIONS PART I: Reactive, Idiopathic, Hereditary David E. Wojtowicz, DDS, MBA](https://reader035.vdocuments.net/reader035/viewer/2022081401/56649c9b5503460f94959398/html5/thumbnails/36.jpg)
Squamous Cell Carcinoma Squamous Cell Carcinoma (SCC)(SCC)
Squamous Cell Carcinoma Squamous Cell Carcinoma (SCC)(SCC)
90% of All Oral Malignancies = SCC Mixed Red & White is
Most Likely Presentation Age: Elderly (40+)
Gender: Males (2:1) Location: Lower Lip, Floor of Mouth,
Lateral & Ventral Tongue, Soft Palate
90% of All Oral Malignancies = SCC Mixed Red & White is
Most Likely Presentation Age: Elderly (40+)
Gender: Males (2:1) Location: Lower Lip, Floor of Mouth,
Lateral & Ventral Tongue, Soft Palate
![Page 37: RECOGNIZING WHITE LESIONS PART I: Reactive, Idiopathic, Hereditary David E. Wojtowicz, DDS, MBA](https://reader035.vdocuments.net/reader035/viewer/2022081401/56649c9b5503460f94959398/html5/thumbnails/37.jpg)
Squamous Cell Carcinoma Squamous Cell Carcinoma (SCC)(SCC)
Squamous Cell Carcinoma Squamous Cell Carcinoma (SCC)(SCC)
Uncontrolled Growth“Up Regulation” of Oncogenes
– Kinases & Cyclines Become Overactive
Deactivation of Suppresser Genes (Antioncogenes)
Uncontrolled Growth“Up Regulation” of Oncogenes
– Kinases & Cyclines Become Overactive
Deactivation of Suppresser Genes (Antioncogenes)
![Page 38: RECOGNIZING WHITE LESIONS PART I: Reactive, Idiopathic, Hereditary David E. Wojtowicz, DDS, MBA](https://reader035.vdocuments.net/reader035/viewer/2022081401/56649c9b5503460f94959398/html5/thumbnails/38.jpg)
Verrucous CarcinomaVerrucous CarcinomaVerrucous CarcinomaVerrucous Carcinoma
Hyperkeratotic, Exophytic,Papillary
Age: Elderly (60+)Gender: Males (2:1)
Location: Gingiva, Alveolar Ridge,Buccal Mucosa
Hyperkeratotic, Exophytic,Papillary
Age: Elderly (60+)Gender: Males (2:1)
Location: Gingiva, Alveolar Ridge,Buccal Mucosa
![Page 39: RECOGNIZING WHITE LESIONS PART I: Reactive, Idiopathic, Hereditary David E. Wojtowicz, DDS, MBA](https://reader035.vdocuments.net/reader035/viewer/2022081401/56649c9b5503460f94959398/html5/thumbnails/39.jpg)
Epithelial DysplasiaEpithelial DysplasiaEpithelial DysplasiaEpithelial Dysplasia
Premalignanat Changes ofCell & Architecture
Mixed Red & White is Most Likely Presentation
Cell Alterations: Nuclear Changes Architecture Alterations:
Bulbous Rete Pegs
Premalignanat Changes ofCell & Architecture
Mixed Red & White is Most Likely Presentation
Cell Alterations: Nuclear Changes Architecture Alterations:
Bulbous Rete Pegs
![Page 40: RECOGNIZING WHITE LESIONS PART I: Reactive, Idiopathic, Hereditary David E. Wojtowicz, DDS, MBA](https://reader035.vdocuments.net/reader035/viewer/2022081401/56649c9b5503460f94959398/html5/thumbnails/40.jpg)
Carcinoma in Situ (CIS)Carcinoma in Situ (CIS)Carcinoma in Situ (CIS)Carcinoma in Situ (CIS)
Entire Thickness (Top to Bottom Change)
Basement Membrane IntactNo Invasion or Change of
Connective Tissue
Entire Thickness (Top to Bottom Change)
Basement Membrane IntactNo Invasion or Change of
Connective Tissue
![Page 41: RECOGNIZING WHITE LESIONS PART I: Reactive, Idiopathic, Hereditary David E. Wojtowicz, DDS, MBA](https://reader035.vdocuments.net/reader035/viewer/2022081401/56649c9b5503460f94959398/html5/thumbnails/41.jpg)
GeriatricsGeriatricsGeriatricsGeriatrics
Proliferative Verrucous Leukoplakia (PVL)
– Hyperkeratotic Lesions Mixed Smooth and Warty
– Mainly on Edentulous Alveoloar RidgeCancer Risk: May Progress to
SCC or VC
Proliferative Verrucous Leukoplakia (PVL)
– Hyperkeratotic Lesions Mixed Smooth and Warty
– Mainly on Edentulous Alveoloar RidgeCancer Risk: May Progress to
SCC or VC
![Page 42: RECOGNIZING WHITE LESIONS PART I: Reactive, Idiopathic, Hereditary David E. Wojtowicz, DDS, MBA](https://reader035.vdocuments.net/reader035/viewer/2022081401/56649c9b5503460f94959398/html5/thumbnails/42.jpg)
Risk Factors / Predisposing Risk Factors / Predisposing FactorsFactors
Risk Factors / Predisposing Risk Factors / Predisposing FactorsFactors
Demographic (Age,Gender,Race) Social (Alcohol, Tobacco,
Oral Habits) Recent History (*Trauma, *Infection,
Surgery) (*Especially Chronic)
Medical History (Chronic Disease, Acute Illness, Medications,Treatments) (Especially: Diabetes, Organ Cancer, Antibiotics, Chemo)
Demographic (Age,Gender,Race) Social (Alcohol, Tobacco,
Oral Habits) Recent History (*Trauma, *Infection,
Surgery) (*Especially Chronic)
Medical History (Chronic Disease, Acute Illness, Medications,Treatments) (Especially: Diabetes, Organ Cancer, Antibiotics, Chemo)
![Page 43: RECOGNIZING WHITE LESIONS PART I: Reactive, Idiopathic, Hereditary David E. Wojtowicz, DDS, MBA](https://reader035.vdocuments.net/reader035/viewer/2022081401/56649c9b5503460f94959398/html5/thumbnails/43.jpg)
3 Mechanisms:3 Mechanisms:3 Mechanisms:3 Mechanisms: Surface Material
– Rough / Does Rub Off Epithelial Thickening
– Rough / Does NOT Rub Off
Subepithelial Change– Smooth / Does NOT Rub Off
– Two Examples: Fordyce Granules = Ectopic Sebaceous
Glands Scar: Surgical, Traumatic
Surface Material– Rough / Does Rub Off
Epithelial Thickening– Rough / Does NOT Rub Off
Subepithelial Change– Smooth / Does NOT Rub Off
– Two Examples: Fordyce Granules = Ectopic Sebaceous
Glands Scar: Surgical, Traumatic
![Page 44: RECOGNIZING WHITE LESIONS PART I: Reactive, Idiopathic, Hereditary David E. Wojtowicz, DDS, MBA](https://reader035.vdocuments.net/reader035/viewer/2022081401/56649c9b5503460f94959398/html5/thumbnails/44.jpg)
Clues to NormalClues to NormalClues to NormalClues to Normal
Bilateral Symmetry Predictable Locations Asymptomatic Independent Finding (no Secondary
Features such as redness, swelling) Increase with Age Remains Unchanged w/ Treatment
Bilateral Symmetry Predictable Locations Asymptomatic Independent Finding (no Secondary
Features such as redness, swelling) Increase with Age Remains Unchanged w/ Treatment
![Page 45: RECOGNIZING WHITE LESIONS PART I: Reactive, Idiopathic, Hereditary David E. Wojtowicz, DDS, MBA](https://reader035.vdocuments.net/reader035/viewer/2022081401/56649c9b5503460f94959398/html5/thumbnails/45.jpg)
Glossary of TermsGlossary of TermsGlossary of TermsGlossary of Terms
Acanthosis: excessively thickened intermediate cell layer with broad and long rete pegs
Hyperkeratosis: excessively thickened keratin in stratum corneum
Leukoplakia: a white patch on the oral mucosa that cannot be scraped off and cannot be classified as any other disease
Acanthosis: excessively thickened intermediate cell layer with broad and long rete pegs
Hyperkeratosis: excessively thickened keratin in stratum corneum
Leukoplakia: a white patch on the oral mucosa that cannot be scraped off and cannot be classified as any other disease
![Page 46: RECOGNIZING WHITE LESIONS PART I: Reactive, Idiopathic, Hereditary David E. Wojtowicz, DDS, MBA](https://reader035.vdocuments.net/reader035/viewer/2022081401/56649c9b5503460f94959398/html5/thumbnails/46.jpg)
Review: Which of the Following Review: Which of the Following Choices Demonstrate Concepts Choices Demonstrate Concepts
of Differential Diagnosis:of Differential Diagnosis:
Review: Which of the Following Review: Which of the Following Choices Demonstrate Concepts Choices Demonstrate Concepts
of Differential Diagnosis:of Differential Diagnosis:
a List of Diseases With Similar Manifestations (Yes)b Oral Ulcer (No, monomorphic presentation)c Zinc Deficiency, Trauma, Herpes, Aphthous Lesion as
Potential Etiologies for a Single Monomorphic Presentation. (Yes)
d Rely Primarily on the Clinical Appearance (No, must include history, risk factors, visual inspection)
a List of Diseases With Similar Manifestations (Yes)b Oral Ulcer (No, monomorphic presentation)c Zinc Deficiency, Trauma, Herpes, Aphthous Lesion as
Potential Etiologies for a Single Monomorphic Presentation. (Yes)
d Rely Primarily on the Clinical Appearance (No, must include history, risk factors, visual inspection)
![Page 47: RECOGNIZING WHITE LESIONS PART I: Reactive, Idiopathic, Hereditary David E. Wojtowicz, DDS, MBA](https://reader035.vdocuments.net/reader035/viewer/2022081401/56649c9b5503460f94959398/html5/thumbnails/47.jpg)
List the List the Seven Seven Primary Primary Clinical Manifestations of Clinical Manifestations of
Non-dental LesionsNon-dental Lesions
List the List the Seven Seven Primary Primary Clinical Manifestations of Clinical Manifestations of
Non-dental LesionsNon-dental Lesions
– Normal Variation– White– Red (Pigmented or Dark)– Ulceration– Exophytic– Radiographic– Syndrome
– Normal Variation– White– Red (Pigmented or Dark)– Ulceration– Exophytic– Radiographic– Syndrome
![Page 48: RECOGNIZING WHITE LESIONS PART I: Reactive, Idiopathic, Hereditary David E. Wojtowicz, DDS, MBA](https://reader035.vdocuments.net/reader035/viewer/2022081401/56649c9b5503460f94959398/html5/thumbnails/48.jpg)
•List List Four Four Techniques Techniques Employed to Investigate the Employed to Investigate the Secondary Clinical Features Secondary Clinical Features
of Oral Lesions:of Oral Lesions:
•List List Four Four Techniques Techniques Employed to Investigate the Employed to Investigate the Secondary Clinical Features Secondary Clinical Features
of Oral Lesions:of Oral Lesions: Visual Inspection Palpation Probing Patient Awareness
Visual Inspection Palpation Probing Patient Awareness
![Page 49: RECOGNIZING WHITE LESIONS PART I: Reactive, Idiopathic, Hereditary David E. Wojtowicz, DDS, MBA](https://reader035.vdocuments.net/reader035/viewer/2022081401/56649c9b5503460f94959398/html5/thumbnails/49.jpg)
Name at Least Name at Least Four Four Visual Visual Features to Inspect for When Features to Inspect for When
Examining an Oral Lesion:Examining an Oral Lesion:
Name at Least Name at Least Four Four Visual Visual Features to Inspect for When Features to Inspect for When
Examining an Oral Lesion:Examining an Oral Lesion: Location Shape & Contours Size Solitary/Multiple Borders Homogenous/Heterogeneous Surface Color/Texture Displacement (of Teeth?)
Location Shape & Contours Size Solitary/Multiple Borders Homogenous/Heterogeneous Surface Color/Texture Displacement (of Teeth?)
![Page 50: RECOGNIZING WHITE LESIONS PART I: Reactive, Idiopathic, Hereditary David E. Wojtowicz, DDS, MBA](https://reader035.vdocuments.net/reader035/viewer/2022081401/56649c9b5503460f94959398/html5/thumbnails/50.jpg)
During Palpation One Can During Palpation One Can Check For:Check For:
During Palpation One Can During Palpation One Can Check For:Check For:
Compressible Tender Color Change (Blanching) Mobile / Bound Down Induration Probing, Exudate
Compressible Tender Color Change (Blanching) Mobile / Bound Down Induration Probing, Exudate
![Page 51: RECOGNIZING WHITE LESIONS PART I: Reactive, Idiopathic, Hereditary David E. Wojtowicz, DDS, MBA](https://reader035.vdocuments.net/reader035/viewer/2022081401/56649c9b5503460f94959398/html5/thumbnails/51.jpg)
During the Interview, Inquire During the Interview, Inquire if Patient is Aware of:if Patient is Aware of:
During the Interview, Inquire During the Interview, Inquire if Patient is Aware of:if Patient is Aware of:
Pain or Altered Function Duration (Acute, Chronic) Progressive Course or Remission Response to Stress/ Foods
Pain or Altered Function Duration (Acute, Chronic) Progressive Course or Remission Response to Stress/ Foods
![Page 52: RECOGNIZING WHITE LESIONS PART I: Reactive, Idiopathic, Hereditary David E. Wojtowicz, DDS, MBA](https://reader035.vdocuments.net/reader035/viewer/2022081401/56649c9b5503460f94959398/html5/thumbnails/52.jpg)
List List Four Four Risk or Risk or Contributory Factors:Contributory Factors:
List List Four Four Risk or Risk or Contributory Factors:Contributory Factors:
Demographic (Age,Gender,Race) Social (Alcohol, Tobacco, Oral Habits) Recent History (Trauma, Infection,
Surgery) Medical History (Chronic Disease,
Acute Illness, Medications,Treatments)
Demographic (Age,Gender,Race) Social (Alcohol, Tobacco, Oral Habits) Recent History (Trauma, Infection,
Surgery) Medical History (Chronic Disease,
Acute Illness, Medications,Treatments)
![Page 53: RECOGNIZING WHITE LESIONS PART I: Reactive, Idiopathic, Hereditary David E. Wojtowicz, DDS, MBA](https://reader035.vdocuments.net/reader035/viewer/2022081401/56649c9b5503460f94959398/html5/thumbnails/53.jpg)
Differential DiagnosisDifferential DiagnosisDifferential DiagnosisDifferential Diagnosis
List of Diseases With Similar Manifestations
Rule Out (R/O) on the Basis of Contradictions
Example: Oral Ulcer
List of Diseases With Similar Manifestations
Rule Out (R/O) on the Basis of Contradictions
Example: Oral Ulcer