White Lesions of the Oral Mucosa
CHAPTER 8
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A B
Fig. 8-5. Linea alba. A, Prominent example in the classic location. B, Unusual location and appearance of linea alba on the mucosal surface of the lower lip. The patient habitually sucked the tissue in against his anterior teeth.
ETIOLOGIC FACTORS OF LEUKOPLAKIA • • • • • • • • • •
Tobacco products Ethanol Hot, cold, spicy, and acidic foods and beverages Alcoholic mouthrinse (Fig. 8-6) Occlusal trauma Sharp edges of prostheses or teeth Actinic radiation Syphilis Presence of Candida aLbicans Presence of viruses
Leukoplakia then likely commences as a protective reaction against a chronic initant. This reaction produces a dense layer of keratin, which is retained to insulate the deeper epithelial components from the deleterious effects of the irritant. When clinical leukoplakic lesions are studied microscopically, they can be seen to embrace a spectrum of histologic changes that shows only increased keratosis to invasive (Fig. 8-7). These differences cannot be identified clinically, so to establish the specific diagnosis the lesion needs to be examined microscopically.
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Features Leukoplakic lesions are characteristically asymptomatic and are most often discovered during a routine oral examination. Leukoplakia is a common lesion. It represents 6.2% of all oral biopsy specimens 6 and occurs in approximately 3% of white Americans over 35 years of age. 7 Most lesions occur between 40 and 70 years of age and more commonly in men. Frequent sites are the lip vermilion, buccal mucosa, mandibular gingiva, tongue, oral floor, hard palate, maxillary gingiva, lip mucosa, and soft palate. The lesions may vary greatly in size, shape, and
Fig.8-6. Keratotic condition of the oral mucosa produced by holding Listerine mouthwash in the mouth for 15 minutes once a day. (From Bernstein ML: Oral mucosal white lesions associated with excessive use of Listerine mouthwash: report of two cases. Oral Surg 46(6):781-785, 1978.)
distribution. The borders may be distinct or indistinct and smoothly contoured or ragged. The lesions may be solitary, or multiple plaques may be scattered through the mouth.
Classifications Clinical appearance Lesions may be divided into four basic clinical appearances (see box on p. 100): I. Homogeneous white plaques have no red component but have a fine, white, grainy texture or a more mottled, rough appearance (Fig. 8-8 and Plate G, I). 2. Speckled leukoplakias are composed of white and red flecks of fine or coarse variety (see Figs. 8-8, B. and 5-12 and Plates G, 7 to G, 9). 3. Combination white and red patches demonstrate segregation of the red and white components and