Admittedly there is histologic overlap with oral lichen planus and amalgam contact reactions however some microscopic findings may favor a contact reaction (Fig. [QxMD MEDLINE Link]. Most of these lesions are incidental findings and relate to a variety of causes including parafunctional habits, mechanical friction, contact reactions, chemical-related changes, and tobacco-related changes [25]. Larsson A, Warfvinge G. Immunohistochemistry of tertiary lymphoid follicles in oral amalgam-associated lichenoid lesions. Prominent linea alba with evidence of cheek biting. The prevalence has been reported as high as 5.5%. Contact stomatitis. They include: The list can go on and on. Typically we see this finding in the grouping of "premalignant" lesions of epithelial origin. Differentiating between frictional keratosis and lesions from smoking or smokeless tobacco is of utmost important given that their prognoses is different from that of the typical frictional keratosis. Collagen sclerosis appearing as a band of homogeneous, acellular eosinophilic amyloid-like material has been reported (Fig. Schulten EA, Jovanovic A, van der Waal I. Ned Tijdschr Tandheelkd. 1 A fractured tooth or rough restoration may lead to the development of frictional keratosis on the adjacent lateral tongue or buccal mucosa. Drore Eisen, MD, DDS Consulting Staff, Dermatology of Southwest Ohio (Photographs courtesy of Dr. Hans Grossniklaus). 1a Oral lichenoid contact reaction to dental amalgam presenting as areas of erythema and white plaques on the left buccal mucosa. Gupta B, Johnson NW. Oral contact lesions to amalgam dental restorations can present as a keratotic or lichenoid lesion (Fig. Although the vast majority of publications focus on leukoplakia and other potentially malignant lesions, most oral lesions that appear white are benign. It could also arise from excess deposit of keratin due to a process called hyperkeratinization. All material on this website is protected by copyright, Copyright 1994-2023 by WebMD LLC. Parlak AH, Koybasi S, Yavuz T, et al. Classification schemes for lesions of the oral cavity typically have used the clinical appearance of lesions to determine which are premalignant. This website also contains material copyrighted by 3rd parties. Cheng YS, Gould A, Kurago Z, Fantasia J, Muller S. Diagnosis of oral lichen planus: a position paper of the American Academy of Oral and Maxillofacial Pathology. Most cases of cinnamon stomatitis are associated with prolonged contact of the offending agent. J Am Dent Assoc. This material is negative for Congo red and positive with periodic acid-Schiff confirming the collagen nature [36]. Consult privately with the doctor of your choice. What you have is also called a frictional keratosis (due to friction, obviously) which always lines up with the cause - in your case, the upper teeth. Termed snuff dippers lesion, snuff pouch and spit tobacco keratosis among other terms, smokeless tobacco keratosis (STK) is the keratotic changes in the oral mucosa where smokeless tobacco product is placed [32]. The myriad of clinical findings of reactive white lesions can be challenging when attempting to distinguish from other disorders, including OPMDs. If the patch is not easily wiped off, this suggests the presence of hyperkeratinization. Three contact-related lesions that can present as white or keratotic oral lesions which have a unique histology are contact reactions to ingredients in some toothpaste, amalgam, and cinnamon flavoring agents. The epithelium is acanthotic with ballooned cells. Various names have been used to describe particular examples of frictional keratosis (FK). 2a Oral lichenoid contact reaction of the right buccal mucosa to cinnamon flavored chewing gum. Smith JF. 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. on your tongue or palate; on the bottom of your mouth; . b When the cheek is everted and stretched the lesion diminishes. Kessler HP. Conclusions: MMO is a form of chronic oral frictional keratosis that has no malignant potential, and should be signed out as such and not merely "hyperparakeratosis and acanthosis" so that it can be removed from the category of leukoplakia where it does not belong. Frictional keratosisis a skin growth that can result from mild mechanical trauma or irritation of the skin. Med Oral. See your doctor if the lesions become chronic and painful. FRICTIONAL KERATOSIS White lesions caused by repeated trauma, such as from food, the teeth, toothbrushing or dental appliances. Biting, sucking, or chewing habits should be discontinued, and fractured or rough tooth surfaces or irregularly fitting dentures or other appliances should be corrected. Most patients with frictional keratosis are free of symptoms, with the exception of those with aggressive cheek and lip biting habits. Geographic It is seen worldwide. 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. Eczema is also called dermatitis. With discontinuation of smokeless tobacco most lesions resolve within 6 weeks [32, 35, 37]. [QxMD MEDLINE Link]. It was concluded that the hyperkeratosis was likely caused by bite trauma or grinding of the teeth while the patient was asleep. The use of oral tobacco products used in North American and Europe can result in clinical changes at the site of tobacco placement. Leukoedema and hereditary genodermatoses that may enter in the clinical differential diagnoses of frictional keratoses including white sponge nevus and hereditary benign intraepithelial dyskeratosis will be reviewed. The exact prevalence is unknown but most likely these reactions are uncommon. There are some very simple treatment methods that do not Are you suffering from age spots and want to remove them but don't know how? Oral Medicine--update for the dental practitioner: oral white patches. The 2023 edition of ICD-10-CM K13.21 became effective on October 1, 2022. The Oral Dis. 8600 Rockville Pike Courtesy of Catherine M. Flaitz, DDS and Alfredo Aguirre, DDS. The diagnosis of oral frictional hyperkeratosis was established based on the clinical and microscopic findings. 2008 Jan. 105(1):79-85. Research and studies demonstrate that frictional keratosis is most prevalent among young adults as well as teenagers. Accessibility Snuff dippers keratosis or snuff pouch. St. Louis, Mo: WB Saunders; 2009. It had been around for long now and there is rarely Seborrheic keratosis can come up on any part of the body. Many reactive white lesions masquerade as oral lichen planus including amalgam reactions and other contact reactions. 8b). Within the parakeratin and spinous layer, are dyskeratotic cells with crenated or pyknotic nuclei surrounded by homogenously dense eosinophilic cytoplasm (Fig. Toothbrush keratosis can develop when a person uses excessive force while brushing teeth and causes inflammations in ones mouth. Kowitz G, Jacobson J, Meng Z, Lucatorto F. The effects of tartar-control toothpaste on the oral soft tissues. Signs and Symptoms of Leukoplakia. Eczema causes itching, redness and tiny blisters. Clinicians may be concerned for a vesiculo-bullous process such as mucous membrane pemphigoid. STK with dysplasia should be treated as oral dysplasia as there is a greater risk for cancer development. [QxMD MEDLINE Link]. The affected area may exhibit a macerated appearance with shredded keratin and peeling (Fig. Courtesy of Catherine M. Flaitz, DDS and Alfredo Aguirre, DDS. Toothbrush trauma is often cited as the etiology of keratotic lesions of the gingiva. This feature distinguishes leukoedema from frictional keratosis, lichen planus and leukoplakia. Applicable To. Physical and Chemical Injuries. Endo H, Rees TD. The author declares they have no conflict of interest. This study found no sex predilection although other studies have reported leukoedema is more commonly seen in males [4]. Share cases and questions with Physicians on Medscape consult. Perivascular inflammation composed of lymphocytes and plasma cells are observed in the deeper lamina propria. 10(2):114-5. Pentenero M, Meleti M, Vescovi P, Gandolfo S. Oral proliferative verrucous leucoplakia: are there particular features for such an ambiguous entity? Most often these types of lesions (attachment removed to protect patient identity) are from frictional keratosis that is a soft tissue becomes tough and white due to continuous friction over time. Low-power photomicrograph exhibiting marked parakeratosis and acanthosis. This occurs when the tongue constantly rubs against one's teeth. The retromolar pad and edentulous alveolar ridge are the most common sites of involvement due to trauma from food being crushed against the mucosa during mastication. The 3rd is about a week ago showing the way it's raised. These include frictional keratosis arising from excessive force while brushing the teeth (toothbrush keratosis); the constant rubbing of the tongue against the teeth (tongue thrust keratosis); the constant sucking, pressure, and irritation of the teeth against the buccal mucosa along the plane of occlusion (linea alba); and the habit of chronic cheek, tongue, or lip biting (cheek- or lip-bite keratosis). [QxMD MEDLINE Link]. The histologic features of frictional keratosis from the tongue, lip or buccal mucosa vary slightly depending on the site of the biopsy. Jeff Burgess, DDS, MSD (Retired) Clinical Assistant Professor, Department of Oral Medicine, University of Washington School of Dental Medicine; (Retired) Attending in Pain Center, University of Washington Medical Center; (Retired) Private Practice in Hawaii and Washington; Director, Oral Care Research AssociatesDisclosure: Nothing to disclose. Breastfeeding keratosis P White, thick plaque of lip mucosa . As mentioned in tidbits above, leukoplakia is predominantly a disorder of the mouth. This histology is virtually indistinguishable from ridge keratosis (Fig. Bookshelf Pinto A, Haberland CM, Baker S. Pediatric soft tissue oral lesions. Shulman JD, Beach MM, Rivera-Hidalgo F. The prevalence of oral mucosal lesions in U.S. adults: data from the Third National Health and Nutrition Examination Survey, 1988-1994. Systematic review and meta-analysis of association of smokeless tobacco and of betel quid without tobacco with incidence of oral cancer in South Asia and the Pacific. sharing sensitive information, make sure youre on a federal 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 . A prominent granular cell layer is noted. This occurs mostly in the mouth area. Cytology of linea alba using a filter imprint technique. Martelli H, Jr, Pereira SM, Rocha TM, Nogueira dos Santos PL, Batista de Paula AM, Bonan PR. 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). Would you like email updates of new search results? The surface of a lesion may appear irregular and feel rough to the tongue. Keratin is a tough, fibrous protein found in fingernails, hair, and skin. 2008 Jan. 58(1):151-7. (H&E magnification 100). 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. The erosive form of lichen planus must be considered separately. Scope of practice, referral patterns and lesion occurrence of an oral medicine service in Australia. Courtesy of Catherine M. Flaitz, DDS and Alfredo Aguirre, DDS. Many kids and older ones are having Seborrheic keratosis is one of the most common skin conditions on earth today. 30100 Telegraph Road, Suite 408, Bingham Farms, Michigan 48025 (USA) Although candidal hyphae may be present this is uncommon and unrelated to the underlying etiology. government site. The connective tissue lacks inflammation. This is in contrast to the diffuse, ill-defined keratotic plaques seen in proliferative verrucous leukoplakia (Fig. The clinical findings are critical in helping to distinguish between reactive keratosis and OPMD. b Photomicrograph showing marked hyperparakeratosis with a shaggy appearance with surface fissures and clefts. Mller S. Oral lichenoid lesions: distinguishing the benign from the deadly. Int J Oral Sci. (Photographs courtesy of Dr. Kristin K. McNamara). In the superficial epithelium, eosinophilic perinuclear condensation, representing compact aggregates of keratin tonofilaments, unique to WSN, is present [16, 17]. Oral Pathology Quiz #74. Courtesy of Catherine M. Flaitz, DDS and Alfredo Aguirre, DDS. In addition to PVL there are benign conditions that can have clinical overlap with frictional keratosis. Leukoedema is a common, asymptomatic buccal mucosal finding of unknown etiology and is considered to represent a normal variation [4, 5, 14]. frictional keratosis), an oral potentially malignant disorder (e.g. Epub 2019 Jan 22. de Aguiar MC, Arrais MJ, Mato MJ, de Arajo VC. The new PMC design is here! Many individuals are having it. WHO classification of tumours of the head and neck. Courtesy of Catherine M. Flaitz, DDS and Alfredo Aguirre, DDS. However, using clinical features to classify lesions is difficult because they vary in appearance and are likely to be interpreted subjectively by the clinician. HHS Vulnerability Disclosure, Help Note the large amalgam restorations that directly contacts the affected mucosa. The patches can appear to a number of reasons, ranging from simple one such as dentures scratching called frictional keratosis, a fungal infection in the mouth a condition called thrush candidiasis to serious condition such as oral cancer. Alfredo Aguirre, DDS, MS Director of Advanced Oral and Maxillofacial Pathology Training Program, Professor, Department of Oral Diagnostic Sciences, State University of New York at Buffalo In Seborrheic keratosis is a very common skin condition. Oral and Maxillofacial Pathology. Miller RL, Gould AR, Bernstein ML. Most patients with frictional keratosis are free of symptoms, with the exception of those with aggressive cheek and lip biting habits. Scully C, Felix DH. Tuberculosis of the oral cavity: a case report. Bethesda, MD 20894, Web Policies J Oral Maxillofac Surg. 1 Given the high-risk nature of some white patches, it is important to perform a thorough history and examination. Smokeless tobacco keratosis is caused by constant frictional irritation of smokeless tobacco against the oral mucosa resulting in keratosis. Frictional keratosis - Usually seen at sites of trauma from teeth, also along buccal occlusal line and occasionally beside an outstanding tooth, or on edentulous ridge. 2012 Mar-Apr. 5 inset). Hyperkeratosis is a skin condition that occurs when a person's skin becomes thicker than usual in certain places. Mller S, Pan Y, Li R, Chi AC. The thickened layer of keratin that develops where the smokeless tobacco is placed varies in clinical appearance depending on frequency of use or the amount used [35]. 2008 Apr-Jun. External factors that mostly cause frictional keratosis are through smoking though that occurs mostly in lips. The corresponding tooth can be slightly recontoured and polished. In one study evaluating benign alveolar ridge keratosis with lesions exhibiting dysplasia, lesional size was not a predictor [10]. b Photomicrograph demonstrates marked parakeratosis, acanthosis and intracellular edema. a Clinical features of proliferative verrucous leukoplakia in a 76-year-old non-smoking female. 7-2b). Cinnamon-induced stomatitis venenata, Clinical and characteristic histopathologic features. J Am Dent Assoc. Frictional keratosis Introduction The oral mucosa Is consist of stratified squamous epithelium which may be keratinized or non kertinized ,(para) . Snuff-dippers lesion. Frictional keratosis from the alveolar ridge usually is surfaced by orthokeratin with a slightly irregular or corrugated architecture (Fig. The lesions resolve after discontinuing the suspected product. 2009 Jan;67(1):140-6. doi: 10.1016/j.joms.2008.08.040. Comment: Hyperkeratotic lesions, although very common in the forestomach, are rare on the tongue in NTP studies. Scully C. Cannabis; adverse effects from an oromucosal spray. Epibulbar blood vessels can be hyperemic resulting in a bloodshot appearance. My tongue is very irritated right now from eating spicy food. 2000 Aug. 29(7):331-5. Linea alba is the term used to describe the white keratotic line on the buccal mucosa approximating the occlusal plane. or fever, they should speak to a doctor. Triamcinolone 0.1% ointment in Orabase and tretinoin 0.05% gel were ineffective. There are times that the bumps Seborrheic keratosis can come up on nay part of the skin. Courtesy of Catherine M. Flaitz, DDS and Alfredo Aguirre, DDS. The clinical effectiveness of reflectance optical spectroscopy for the in vivo diagnosis of oral lesions. In rare examples, individuals may give a history of picking the oral mucosa with long fingernails or some other external object. Laporan kasus : Seorang laki-laki 22 tahun datang . It occurs as a white patch in the mouth. Lee PN. Oral Surg Oral Med Oral Pathol Oral Radiol. In some instances, patients give a history of wearing orthodontic appliances or removable full or partial dental prostheses that may traumatize the soft tissues. Surgical Dentistry / Oral Surgery is concerned with the diagnosis and surgical management of pathological processes and anomalies in the teeth or their supporting structures. Benign alveolar ridge keratosis (oral lichen simplex chronicus): a distinct clinicopathologic entity. A leukoplakia doesn't usually line up with anything obvious, is frequently bilateral, and usually affects the floor of the mouth (under the tongue) or the lower side of the tongue. These clinical features may mimic frictional keratoses from cheek or tongue biting, however the histology is distinct from frictional keratoses. c Alveolar ridge keratosis presenting as a relatively discrete keratotic plaque on the retromolar pad. [QxMD MEDLINE Link]. There are different types of frictional keratoses whose classification is based on the area that suffers friction and develops patches. Intraepithelial linear clefting of the superficial parakeratin is seen. Applicable To Erythroplakia of mouth or tongue A 55-year-old man presented with desquamating lesions on his bilateral buccal mucosa intermittently for approximately 3 years. Is alveolar ridge keratosis a true leukoplakia? Typically, the lesions appear as distinct, focal, and translucent-to-opaque white asymptomatic patches with sharply delineated borders. This wider area of roughened mucosa is typical of those produced by the habit of cheek biting or nibbling. Individuals with a cheek and lip biting habit often report they are able to remove thin strands or tags of mucosa from the involved site. In some individuals certain dentifrices can result in superficial sloughing of the oral mucosa (Fig. Fast Five Quiz: What Do You Know About Dental Health? Medical Care. a Superficial sloughing of the oral mucosa due to the use of triclosan and pyrophosphate containing toothpaste. 7 The characteristic white appearance of oral frictional keratosis is due to generation of keratin filaments from chronic irritation. You are being redirected to Within the spinous layer occasional cells with bright eosinophilic perinuclear condensation representing keratin tonofilaments can be observed. HBID is a rare autosomal dominant disorder initially described in the tri-racial Native American tribe in North Carolina [18]. Leukoplakia, lichen planus, and other oral keratoses in 23,616 white Americans over the age of 35 years. Various names have been used to describe particular examples of frictional keratosis (FK). Much of the time the oral mucosa is in contact with these products for short periods of time or saliva dilutes and buffers the irritants reducing the potential for an adverse reaction. They therefore do not need treatment as they often disappear after sometime unless the affected area is rubbed against repeatedly. Smoker's keratosis - Pipe smoking is the usual cause. 2019 Mar. White sponge nevus is a condition characterized by the formation of white patches of tissue called nevi (singular: nevus) that appear as thickened, velvety . Smokeless tobacco keratosis. 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. 1c Interface mucositis in amalgam contact reactions are seen and the dense lymphocytic infiltrate can form tertiary follicles (arrow) (H&E magnification 100). Or lichenoid lesion ( Fig website also contains material copyrighted by 3rd parties perform a thorough history and.... Corrugated architecture ( Fig they have no conflict of interest in clinical changes at the site the... 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Dense eosinophilic cytoplasm ( Fig as distinct, focal, and other contact reactions however some microscopic findings favor... Keratin tonofilaments can be hyperemic resulting in a 76-year-old non-smoking female Ohio Photographs! The spinous layer, are rare on the left buccal mucosa to cinnamon flavored gum... Macerated appearance with shredded keratin and peeling ( Fig ICD-10-CM K13.21 became effective October. Mucosa vary slightly depending on the left buccal mucosa intermittently for approximately 3....