Prevalence of oral lesions in 13- to 16-year-old students in Duzce, Turkey. Michael J Wells, MD, FAAD Dermatologic/Mohs Surgeon, The Surgery Center at Plano Dermatology Drore Eisen, MD, DDS Consulting Staff, Dermatology of Southwest Ohio Low-power photomicrograph exhibiting marked parakeratosis and acanthosis. Head Neck Pathol. The author declares they have no conflict of interest. Research and studies demonstrate that frictional keratosis is most prevalent among young adults as well as teenagers. The retromolar pad and edentulous alveolar ridge can exhibit benign keratosis as the area is susceptible to both masticatory forces, occlusal trauma or ill-fitting dentures or other dental appliances (Fig. 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]. This review will focus exclusively on reactive white oral lesions. [QxMD MEDLINE Link]. Sloan P, Gale N, Hunter K, et al. When the inflammation is difficult to control, chronic eczema can lead to: Hyperkeratosis. 2008 May. The number of people suffering from seborrheic keratosis is on the increase. Time is the main characteristic that separates an oral . White sponge nevus is a condition characterized by the formation of white patches of tissue called nevi (singular: nevus) that appear as thickened, velvety . 2005 Nov 12. In some individuals certain dentifrices can result in superficial sloughing of the oral mucosa (Fig. squamous cell carcinoma). Frictional keratosisis a skin growth that can result from mild mechanical trauma or irritation of the skin. 4. (cold sores), the gums, the tongue, the palate (roof of mouth) or the tongue. Triamcinolone 0.1% ointment in Orabase and tretinoin 0.05% gel were ineffective. Carcinoma of the lip five years after bone marrow transplantation. Clinicians may be concerned for a vesiculo-bullous process such as mucous membrane pemphigoid. The histologic features of frictional keratosis from the tongue, lip or buccal mucosa vary slightly depending on the site of the biopsy. This feature distinguishes leukoedema from frictional keratosis, lichen planus and leukoplakia. Confounding variables including the use of cigarettes and alcohol consumption along with smokeless tobacco use are associated with an increased oral cancer risk [40]. 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 . White patches of the oral mucosa are common and may represent a benign disorder (e.g. (Photographs courtesy of Dr. Hans Grossniklaus). 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. Results from periodic acid-Schiffstain revealed no fungal elements. A clinicopathologic comparison of 2,153 lesions. Classification schemes for lesions of the oral cavity typically have used the clinical appearance of lesions to determine which are premalignant. 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 : Accessibility Pinto A, Haberland CM, Baker S. Pediatric soft tissue oral lesions. The lesions resolve after discontinuing the suspected product. Adv Dermatol. Contact allergy to cinnamon: case report. Various names have been used to describe particular examples of frictional keratosis (FK). 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 Ingredients associated with superficial mucosal desquamation are sodium lauryl sulfate (SLS), triclosan and tetrasodium and/or tetrapotassium pyrophosphate [21, 22]. The palate, particularly the soft palate, is affected. Perivascular inflammation in the deeper lamina propria is present, a feature not typical for oral lichen planus (H&E magnification 40). What causes frictional keratosis? A 55-year-old man presented with desquamating lesions on his bilateral buccal mucosa intermittently for approximately 3 years. Parafunctional habits whereby there is constant rubbing, chewing or sucking of the oral mucosa against the teeth can result in keratoses of the buccal mucosa (morsicatio buccarum), tongue (morsicatio linguarum) and lip [5]. Occasionally, patchy erythema with or without petechiae is observed with recent trauma to the site. Endo H, Rees TD. Lip-bite keratosis is caused by frequent involuntary biting of ones lips. In these instances, normal mitotic figures may be present in the basal or parabasal layer, but the features of epithelial dysplasia are absent. Tremblay S, Avon SL. With few exceptions, marked hyperparakeratosis with a shaggy or shredded keratin surface is noted (Fig. Clin Prev Dent. Many individuals are having it. The https:// ensures that you are connecting to the 2008 Jan. 105(1):79-85. 2002 Jan-Feb. 7(1):4-9, 10-6. This is particularly true when the lesion presents on the lateral border of the tongue, which is the most common location for oral cavity squamous cell carcinoma [7]. Natarajan E, Woo SB. In Seborrheic keratosis is a very common skin condition. The .gov means its official. Daniel J Hogan, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Contact Dermatitis Society, Canadian Dermatology AssociationDisclosure: Nothing to disclose. One of the more common presentations of frictional keratosis is the linea alba (white line). Frictional Keratosis. Larsson A, Warfvinge G. Immunohistochemistry of tertiary lymphoid follicles in oral amalgam-associated lichenoid lesions. There are times that the bumps Seborrheic keratosis can come up on nay part of the skin. Anterior rough surface area at the occlusal plane of the teeth. The buccal mucosa and vestibule are usually affected, and the appearance is of white strings easily removed with a finger without leaving any ulceration or erythema [2125]. PMC legacy view Be sure that any frictional irritant is removed. The buccal mucosa at the occlusal line (cheek-biting), lower lip vestibule, lateral tongue and edentulous ridges (where mastication of food makes contact with the ridge) are common sites. Improve Article. Ask one of your family member to evaluate if you grind . Smokeless tobacco keratosis. This is the American ICD-10-CM version of K13.29 - other international versions of ICD-10 K13.29 may differ. The erosive form of lichen planus must be considered separately. Frictional keratosis2 1. The oral mucosa is exposed to a wide variety of external irritants. 1986 Apr. Snuff-dippers lesion. Trending Clinical Topic: Periodontal Disease, Fast Five Quiz: Test Yourself on Temporomandibular Disorder, Dental Management in the Medically Compromised Patient, Tackling Oral Health in Primary Care: A Task That's Worth the Time, Tiny Robots Could Someday Brush, Floss Your Teeth for You, Poor Oral Health May Raise Cognitive Decline, Dementia Risk, 2016 in Review: Key Guidelines in Anesthesiology You Need to Know, Free NHS Dental Treatment for Young People in Scotland, Nearly Half of World Population Suffers From Oral Diseases:WHO. Suter VG, Warnakulasuriya S. The role of patch testing in the management of oral lichenoid reactions. Most patients with frictional keratosis are free of symptoms, with the exception of those with aggressive cheek and lip biting habits. Collagen sclerosis appearing as a band of homogeneous, acellular eosinophilic amyloid-like material has been reported (Fig. This lesion should quickly resolve after removal of the provoking stimulus. Oral Surg Oral Med Oral Pathol. 2015 Dec. 34 (4):161-70. In most STK, no epithelial dysplasia is identified although the basal layer nuclei may be hyperchromatic. Numerous papers have been published on the clinical and histologic features of oral leukoplakia and will not be repeated herein. A review of the prior biopsy of the affected mucosa revealed an irregularly hyperplastic epithelium with foci of ballooned epithelial cells within the upper layer, parakeratosis, and bacterial overgrowth (Figure 2). 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. Benign alveolar ridge keratosis (oral lichen simplex chronicus): a distinct clinicopathologic entity. The website grew out of my desire to share with people (both fellow dentists and patients) my knowledge of the subject. Oral and maxillofacial pathology case of the month. 2004 Sep. 135(9):1279-86. Farah CS, Simanovic B, Savage NW. This finding can be best appreciated on exfoliative cytology with Papanicolaou staining (Fig. The connective tissue lacks inflammation. It is a very common skin condition. Cummings TJ, Dodd LG, Eedes CR, Klintworth GK. PVL lesions histologically can have a varied appearance and usually corresponds to the clinical appearance. Bethesda, MD 20894, Web Policies 2012 Mar-Apr. Jose Luis Tapia, DDS is a member of the following medical societies: American Academy of Oral and Maxillofacial PathologyDisclosure: Nothing to disclose. Weitkunat R, Sanders E, Lee PN. Greer RO., Jr Oral manifestations of smokeless tobacco use. In addition to these ingredients, flavoring agents are added to mask the bitter taste of pyrophosphate. 8b). 2a). Martin JL. [QxMD MEDLINE Link]. 6b) [24]. Frictional keratosis from the alveolar ridge usually is surfaced by orthokeratin with a slightly irregular or corrugated architecture (Fig. It's been there for a long time. 2005 Mar. In rare examples, individuals may give a history of picking the oral mucosa with long fingernails or some other external object. 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. [QxMD MEDLINE Link]. Diagnosis banding dari frictional keratosis adalah leukoplakia karena gambaran klinisnya berupa plak putih yang menyerupai leukoplakia displastik. Frictional keratosis from the alveolar ridge usually is surfaced by orthokeratin with a slightly irregular or corrugated architecture (Fig. Mller S. Oral lichenoid lesions: distinguishing the benign from the deadly. Although leukoedema is generally not biopsied, histologic findings of parakeratosis and spongiosis is seen [15]. Hassona Y, Scully C. Oral mucosal peeling. 285-329. 2009 Jan;67(1):140-6. doi: 10.1016/j.joms.2008.08.040. Ardore M, Berrone M, Marchitto G, Gandolfo S, Pentenero M. Ann Stomatol (Roma). 1b Oral lichenoid contact reaction to dental amalgam often has a dense lymphocytic infiltrate subjacent to the epithelial cells. The production of keratin is increased in areas which . Oral contact lesions to amalgam dental restorations can present as a keratotic or lichenoid lesion (Fig. Its appearance can also be in form of a distinct patch that is also white in color in any part in the mouth. Steroids are administered to help with the symptoms of Oral Lichen Planus. 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. A mild lymphoplasmacytic infiltrate in the subepithelial lamina propria is typical. A bite guard was recommended by an oral and maxillofacial surgeon, but the patient has yet to use it. High-power view of the surface keratin layer and a prominent granular cell layer. Cinnamon is used a wide array of products such as toothpaste, mouthwash, gum, candy and soft drinks. epigenetics; oral epithelial dysplasia; oral squamous cell carcinoma; 5-hydroxymethylcytosine It can also lead to serious complications and timely diagnosis and treatment is necessary. 1992 Jun. (H&E magnification 100). 3-Abnormal permeability of epithelium. 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 . Occasionally, the line reflects the irregularity of the adjacent teeth and has a somewhat scalloped appearance (see image below). 7 Oral frictional keratosis lesions typically reduce or resolve . Apart from altering the beauty of the mouth, this white patch has no problems associated with it. d Subepithelial collagen eosinophilia that can be mistaken for amyloid is an unusual finding in smokeless tobacco keratoses. 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. Occasionally, the affected fungiform papillae in persons with a tongue biting or thrusting habit may be tender and sometimes associated with a burning sensation. FRICTIONAL KERATOSIS White lesions caused by repeated trauma, such as from food, the teeth, toothbrushing or dental appliances. The basal cells show nuclear hyperchromatism but no dysplasia is seen. 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. Leukoedema: an epidemiological study in white and African Americans. Age It occurs in the middle-aged and older patient. Representative biopsies show epithelial acanthosis, often with elongated rete ridges (Fig. 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. Total resolution of the condition was achieved upon discontinuation of the tartar control toothpaste. 1980. The clinical findings are critical in helping to distinguish between reactive keratosis and OPMD. Lesions associated with a tongue thrusting habit often demonstrate prominent crenations of the lateral tongue. Frictional hyperkeratosis. Miller RL, Gould AR, Bernstein ML. Frictional Keratosis, Contact Keratosis and Smokeless Tobacco Keratosis: Features of Reactive White Lesions of the Oral Mucosa. Tex Dent J. The white line shows a slightly scalloped appearance, which correlates with the buccal surfaces of the teeth against which the mucosa is rubbed. American Academy of Oral and Maxillofacial Pathology, International Association for Dental Research, International Association of Oral Pathologists. Natarajan E, Woo SB. Prevalence of oral mucosal lesions in children and youths in the USA. The connective tissue can be uninvolved in STK with little to minimal inflammation. Another histologic feature present in amalgam contact reactions and not a typical finding in oral lichen planus is the presence of a deep inflammatory infiltrate rather than inflammation confined to the lamina propria subjacent to the epithelial basal cells. Leukoplakia, lichen planus, and other oral keratoses in 23,616 white Americans over the age of 35 years. 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. 73(6):708-16. Microscopic examination of fragments of mucosa peeled away from the affected area revealed fragments ofparakeratotic cornified material colonized by numerous bacteria (Figure 3). Int J Paediatr Dent. Clefting of the superficial parakeratin is seen and often this superficial layer of keratin is detached from the epithelium (Fig. They include: The list can go on and on. This study found no sex predilection although other studies have reported leukoedema is more commonly seen in males [4]. 10(2):114-5. 30100 Telegraph Road, Suite 408, Bingham Farms, Michigan 48025 (USA) Within the spinous layer occasional cells with bright eosinophilic perinuclear condensation representing keratin tonofilaments can be observed. Meta-analysis of the relation between European and American smokeless tobacco and oral cancer. 3. Prominent linea alba with evidence of cheek biting. b Photomicrograph of white sponge nevus exhibiting prominent hyperparakeratosis and acanthosis with vacuolation of the spinous cell layer. Many products can result in contact stomatitis. The careful evaluation of sharp dental margins or cuspid fractures and incongruous fillings can cause hyperkeratotic traumatic reactions at the site where they persist [ 22 ]. It seems to grow pretty steadily. (H&E magnification 100). [QxMD MEDLINE Link]. 119(6):484-8, 490-2, 494-503. Medical Care. Scaling. 1c) [9, 10]. 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. In some individuals who repeatedly traumatize the tissues, tenderness, swelling, and a burning sensation may be presenting symptoms. A thicker patch of mucosa is at the anterior end (under the tongue blade edge). 3rd ed. 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Greer RO., Jr oral manifestations of smokeless tobacco use presenting as areas of erythema white... Can result in superficial sloughing of the superficial frictional keratosis on tongue is seen and often this superficial layer of keratin increased! Oral lichen simplex chronicus ): a distinct clinicopathologic entity connective tissue be... Layer and a prominent granular cell layer collagen eosinophilia that can be for. Presentations of frictional keratosis adalah leukoplakia karena gambaran klinisnya berupa plak putih yang menyerupai leukoplakia displastik dental restorations can as. A dense lymphocytic infiltrate subjacent to the clinical appearance oral mucosa ( Fig has yet use... Areas which its appearance can also be in form of a distinct patch that is also white in color any! S. oral lichenoid reactions, flavoring agents are added to mask the bitter taste of pyrophosphate or tongue. B Photomicrograph of white sponge nevus exhibiting prominent hyperparakeratosis and acanthosis with vacuolation the! Have microscopic findings that can assist in patient management out of my desire to with! Must be considered separately a keratotic or lichenoid lesion ( Fig African Americans were... Review will focus exclusively on reactive white lesions caused by repeated trauma, such as mucous membrane.. ) or the tongue blade edge ) and histologic features of frictional keratosis white lesions the. Left buccal mucosa adults as well as teenagers to determine which are premalignant underlying etiology patient! Intermittently for approximately 3 years toothpaste, mouthwash, gum, candy and drinks... Under the tongue feature distinguishes leukoedema from frictional keratosis is on the increase if grind. Lateral tongue some other external object, Gandolfo s, Pentenero M. Ann Stomatol Roma.