2005 Mar. Careers. Martin JL. Parlak AH, Koybasi S, Yavuz T, et al. 1a). The lesions usually present on the buccal mucosa or tongue where prolonged contact of the mucosa with the amalgam occur. Frictional Keratosis, Contact Keratosis and Smokeless Tobacco Keratosis: Features of Reactive White Lesions of the Oral Mucosa. 3-Abnormal permeability of epithelium. [QxMD MEDLINE Link]. 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. 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]. Prominent chevron keratinization and vacuolated cells in the stratum spinosum are seen. It was concluded that the hyperkeratosis was likely caused by bite trauma or grinding of the teeth while the patient was asleep. 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. A prominent granular cell layer is noted. 2007 Sep 22. In the superficial epithelium, eosinophilic perinuclear condensation, representing compact aggregates of keratin tonofilaments, unique to WSN, is present [16, 17]. 2a) [8, 10]. 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. J Oral Maxillofac Surg. In one study evaluating benign alveolar ridge keratosis with lesions exhibiting dysplasia, lesional size was not a predictor [10]. J Am Dent Assoc. The myriad of clinical findings of reactive white lesions can be challenging when attempting to distinguish from other disorders, including OPMDs. Triamcinolone 0.1% ointment in Orabase and tretinoin 0.05% gel were ineffective. Microscopic examination of fragments of mucosa peeled away from the affected area revealed fragments ofparakeratotic cornified material colonized by numerous bacteria (Figure 3). Hyperkeratosis (thickening of the stratum corneum) occurs in two forms: orthokeratotic ( Figure 1 and Figure 2) or parakeratotic hyperkeratosis. A thicker patch of mucosa is at the anterior end (under the tongue blade edge). 2014 Sep. 6 (3):162-7. Get it evaluated in a Dental office. White lesions of the oral cavity are quite common and can have a variety of etiologies, both benign and malignant. J Oral Pathol Med. The connective tissue lacks inflammation. It can occur also at any age. 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. 2015 Dec. 34 (4):161-70. Frictional hyperkeratosis. Another way to prevent frictional keratosis is through ensuring that the buccal cavity is kept free from germs and bacteria, as their buildup cause the white lesions that are mostly associated with this kind of keratosis. Erythema and ulceration may be present. Gabri D, Vrdoljak DV, Boras VV. 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. [QxMD MEDLINE Link]. Frictional keratosis, contact keratosis and smokeless tobacco keratosis: . (H&E, magnification 100). Madani FM, Kuperstein AS. It can also lead to serious complications and timely diagnosis and treatment is necessary. White sponge nevus: report of a three-generation family. Eczema causes itching, redness and tiny blisters. Patients with persistent cheek and lip biting habits tend to have increased stress and psychologic disorders. A 55-year-old man presented with desquamating lesions on his bilateral buccal mucosa intermittently for approximately 3 years. Semin Cutan Med Surg. Michael J Wells, MD, FAAD Dermatologic/Mohs Surgeon, The Surgery Center at Plano Dermatology Oral frictional hyperkeratosis of the lateral border of the tongue from chronic biting habit. 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). 2c Acanthosis, dyskeratotic cells and inflammatory exocytosis is seen along with interface mucositis. Oral frictional keratosis is considered a benign lesion caused by chronic rubbing between 2 surfaces, occurring at higher frequency in areas prone to mechanical trauma. Careers. Indian J Dent Res. Clipboard, Search History, and several other advanced features are temporarily unavailable. Biopsies should be performed on these lesions that do not heal to rule out a (Photographs courtesy of Dr. Kristin K. McNamara). Prevalence of oral mucosal lesions in a Kenyan population with special reference to oral leukoplakia. Inset: High-power photomicrograph highlights the dyskeratotic cells which have crenated or pyknotic nuclei surrounded by dense hypereosinophilic cytoplasm giving the appearance of intraepithelial dyskeratosis. Frictional Keratosis. J N J Dent Assoc. Linea alba is the term used to describe the white keratotic line on the buccal mucosa approximating the occlusal plane. Farah CS, Simanovic B, Savage NW. 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. This website also contains material copyrighted by 3rd parties. government site. McParland H, Warnakulasuriya S. Oral lichenoid contact lesions to mercury and dental amalgama review. Malignant surface epithelial tumours: squamous cell carcinoma. c Alveolar ridge keratosis presenting as a relatively discrete keratotic plaque on the retromolar pad. The inflammation unlike oral lichen planus is composed of lymphocytes, plasma cells and scattered eosinophils. 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). 10(2):114-5. The collagen sclerosis can be concentrated around nerves, vascular channels and can also result in salivary gland fibrosis. With discontinuation of smokeless tobacco most lesions resolve within 6 weeks [32, 35, 37]. 15(4):43-8. Frictional keratosis is a reactive white lesion caused by prolonged mild irritation of the mucous membrane. Surgical Dentistry / Oral Surgery is concerned with the diagnosis and surgical management of pathological processes and anomalies in the teeth or their supporting structures. Patients may report that they are aware of sucking the mucosa or thrusting their tongue against their teeth. Some patients report that their cheeks and tongue feel swollen. Biting, sucking, or chewing habits should be discontinued, and fractured or rough tooth surfaces or irregularly fitting dentures or other appliances should be corrected. 8600 Rockville Pike East Afr Med J. My tongue is very irritated right now from eating spicy food. Alveolar ridge keratosis is a frictional keratosis located on the edentulous alveolar ridge and/or retromolar pad. In addition to PVL there are benign conditions that can have clinical overlap with frictional keratosis. Slight variations in the clinical presentation are directly related to the nature and the source of the physical trauma. sharing sensitive information, make sure youre on a federal This lesion should quickly resolve after removal of the provoking stimulus. [QxMD MEDLINE Link]. Oral Pathology Quiz #74. The 3rd is about a week ago showing the way it's raised. This habit most probably led to the biting of the cheek mucosa. 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. Biopsies of affected mucosa however rule out vesiculo-bullous disease, as the histology shows acanthosis and intracellular edema of the stratum spinosum. Physical and Chemical Injuries. 1989 Nov;96(11):538-9. keratin layer on the surface of the tongue is thickened (arrow). The .gov means its official. MeSH terms Adolescent Adult Age Distribution Aged Aged, 80 and over 141(5):509-20. Typically, the lesions appear as distinct, focal, and translucent-to-opaque white asymptomatic patches with sharply delineated borders. 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]. Toothpaste-related oral lesions. squamous cell carcinoma). Oral Medicine--update for the dental practitioner: oral white patches. It usually involves the lateral tongue, cheeks, or lips. 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. 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. However, there are instances when the leukoplakia may . Acta Bioeng Biomech. 7-1a) [8, 12, 26]. Keratosis of unknown significance and leukoplakia: a preliminary study. Frictional keratosis must also be considered as it can affect the margins of the tongue. 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. 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. Larsson, et al. Prominent linea alba with evidence of cheek biting. or fever, they should speak to a doctor. Med Oral. 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]. . When such friction is allowed to continue, it promotes keratin to grow thereby creating white lesions a product of keratin thickening. Scope of practice, referral patterns and lesion occurrence of an oral medicine service in Australia. Of unknown etiology, PVL is associated with high recurrence and malignant transformation rates. Woo SB, Lin D. Morsicatio mucosae orisa chronic oral frictional keratosis, not a leukoplakia. Unable to load your collection due to an error, Unable to load your delegates due to an error. Lesions associated with infections such as oral hairy leukoplakia and hyperplastic candidiasis can have a clinical presentation similar to frictional keratoses. This occurs on the maxillary and mandibular alveolar ridges particularly after extraction of teeth, and particularly in the area of extracted mandibular third molars on the retromolar pad area. The clinical findings can be of an ill-defined area of gray or white papules and plaques and may be associated with erosions and ulcers if the bite trauma is extensive. On clinical examination and palpation, frictional keratosis lesions tend to be white and rough but can also get ulcerated and become red and white if the patient bites the area deeply or forcefully. Eczema is also called dermatitis. Differential diagnosis of oral soft tissue lesions. (H&E magnification 400). Kashani HG, Mackenzie IC, Kerber PE. The patient denied biting her tongue and the histology is not consistent with chronic tongue chewing/biting. 1b). Similar to WSN, HBID presents as white spongy plaques on the buccal mucosa and tongue, but in addition, HBID has ocular findings of white gelatinous conjunctival plaques [19]. The 2023 edition of ICD-10-CM K13.21 became effective on October 1, 2022. Perivascular inflammation composed of lymphocytes and plasma cells are observed in the deeper lamina propria. Smoker's keratosis - Pipe smoking is the usual cause. Bouquot JE, Gorlin RJ. The white line observed on the cheek is level with the biting plane of the teeth. Cai W, Jiang B, Yu F, Yang J, Chen Z, Liu J, Wei R, Zhao S, Wang X, Liu S. Current approaches to the diagnosis and treatment of white sponge nevus. Bacterial colonies are present on the keratin surface without an inflammatory response (H&E, magnification 100). Therefore, it is prudent to sample any questionable lesion to rule out OPMD. High-power view of the surface keratin layer and a prominent granular cell layer. Larsson A, Warfvinge G. Immunohistochemistry of tertiary lymphoid follicles in oral amalgam-associated lichenoid lesions. 203(6):E12; discussion 336-7. 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]. 199(9):565-72. Jose Luis Tapia, DDS is a member of the following medical societies: American Academy of Oral and Maxillofacial PathologyDisclosure: Nothing to disclose. Atlanta Oral Pathology, Emory Decatur Hospital, Emory University School of Medicine, 2701 N. Decatur Road, Decatur, GA 30033 USA. The epithelium exhibits epithelial hyperplasia and intracellular edema is common presenting as ballooned cells in the spinous layer. A dense inflammatory cell infiltrate is seen in the superficial lamina propria and generally extends deeper into the lamina propria around vascular spaces (H&E magnification 100). The corresponding tooth can be slightly recontoured and polished. Larsson A, Axll T, Andersson G. Reversibility of snuff dippers lesion in Swedish moist snuff users: a clinical and histologic follow-up study. 2012 Winter;83(1):13, 16. Cinnamon is used a wide array of products such as toothpaste, mouthwash, gum, candy and soft drinks. INCIDENCE Frictional keratosis is common. Generally, there is a lack of inflammation in the superficial connective tissue with the exception of cases where secondary ulceration is present. 2004 Sep. 135(9):1279-86. Such keratosis conditions as oral frictional keratosis do not affect ones health to a great extent. The connective tissue is uninflamed. Oral frictional hyperkeratosis of the attached maxillary gingiva from inappropriate toothbrushing technique. A bite guard was recommended by an oral and maxillofacial surgeon, but the patient has yet to use it. 1d) and requires clinical correlation (H&E, magnification 100). Improve Article. The number of people suffering from seborrheic keratosis is on the increase. Neville BW, Damm DD, Allen CM, Bouquot JE. Courtesy of Catherine M. Flaitz, DDS and Alfredo Aguirre, DDS. Head Neck Pathol. 2000. 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. Snuff dippers keratosis or snuff pouch. K13.29 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. 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. At times the superficial parakeratin is completely detached from the underlying stratified squamous epithelium or this superficial sloughing is all that is submitted for histologic examination. A mild lymphoplasmacytic infiltrate in the subepithelial lamina propria is typical. government site. [20] Occasionally, ill-fitting or broken mouthguards or occlusal splints irritate the oral mucosa, resulting in frictional keratosis. 6b) [24]. [QxMD MEDLINE Link]. Clinical features of cinnamon-induced contact stomatitis. Oral contact lesions to amalgam dental restorations can present as a keratotic or lichenoid lesion (Fig. The most important management protocol includes the following: Establish a diagnosis. However, using clinical features to classify lesions is difficult because they vary in appearance and are likely to be interpreted subjectively by the clinician. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. Courtesy of Catherine M. Flaitz, DDS and Alfredo Aguirre, DDS. Leukoplakia is a patch that is white to gray in color. Kovac-Kovacic M, Skaleric U. Int J Oral Sci. Many kids and older ones are having Seborrheic keratosis is one of the most common skin conditions on earth today. In the 2005 WHO section of epithelial precursor lesions, squamous cell hyperplasia was considered a precursor lesion and thus, termed leukoplakia [2]. [Guideline] Rethman MP, Carpenter W, Cohen EE, et al. Br Dent J. This occurs mostly in the mouth area. on your tongue or palate; on the bottom of your mouth; . Courtesy of Catherine M. Flaitz, DDS and Alfredo Aguirre, DDS. Mller S. Update from the 4th edition of the world health organization of head and neck tumours: tumours of the oral cavity and mobile tongue. However, these microscopic findings are relatively non-specific (H&E, magnification 200). Oral frictional hyperkeratosis of the retromolar pad is also referred to as a ridge callus. Cinnamon flavoring agents including cinnamic aldehyde, cinnamic acid and cinnamon oil, can cause a contact stomatitis [30]. Typically we see this finding in the grouping of "premalignant" lesions of epithelial origin. The hyperkeratosis is orthokeratotic, lacking nuclei. 4.59A) and may be seen in the retromolar region or along the crest of an edentulous ridge because of trauma from dentition or a denture, where it typically is called frictional keratosis. 2008 Jan. 58(1):151-7. Observe and monitor the patient to be certain that the frictional area is resolving in a timely fashion. a Leukoedema of the left buccal mucosa in a 58-year-old Black female presenting as an ill-defined opalescent filmy gray to white lesion. [QxMD MEDLINE Link]. 19(2):99-103. Haisley-Royster CA, Allingham RR, Klintworth GK, Prose NS. In most STK, no epithelial dysplasia is identified although the basal layer nuclei may be hyperchromatic. 16:39-78; discussion 79. 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. Scattered throughout the epithelium but most appreciated in the upper spinous layer are dyskeratotic cells. a Irregular, shaggy macerated appearance of the left buccal mucosa typical for cheek biting (morsicatio mucosae). Most cases of cinnamon stomatitis are associated with prolonged contact of the offending agent. Apart from altering the beauty of the mouth, this white patch has no problems associated with it. [QxMD MEDLINE Link]. With progression the lesions become more keratotic with furrowing of the epithelium and thickening (Fig. These plaques are moveable over the underlying tissue. Would you like email updates of new search results? What causes frictional keratosis? White patches of the oral mucosa are common and may represent a benign disorder (e.g. Occasionally, patchy erythema with or without petechiae is observed with recent trauma to the site. In one study, 19% of patch test positive patients to amalgam-related allergens had complete resolution after amalgam replacement and 61.5% had a partial resolution [27]. In one patient, the surface of the last molar tooth showed considerable occlusal wear, which is evidence that the patient had the habit of grinding his teeth (see first image above). 3a, b). If you notice a spot on your skin that looks red, feels rough & will not heal, what you Privacy Policy | Security Statement | Terms & Conditions. Normal variations of oral anatomy and common oral soft tissue lesions: evaluation and management. A model study. 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. such as dorsum of the tongue, hard palate, and attached gingiva, sometimes . These white patches in the mouth only disappear when the source of friction is removed. Lee PN, Hamling J. Time is the main characteristic that separates an oral . Leukoplakia of gingiva, lips, tongue. This is in contrast to the diffuse, ill-defined keratotic plaques seen in proliferative verrucous leukoplakia (Fig. Numerous papers have been published on the clinical and histologic features of oral leukoplakia and will not be repeated herein. Diagnosis can often be very tricky. Is alveolar ridge keratosis a true leukoplakia? We report the first example, to our knowledge, of a frictional keratosis from exuberant sucking in a breastfeeding infant. The first image below shows a frictional keratosis lesion that displays marked keratinization. There are times that the bumps Seborrheic keratosis can come up on nay part of the skin. In these instances, normal mitotic figures may be present in the basal or parabasal layer, but the features of epithelial dysplasia are absent. It was concluded that the hyperkeratosis was likely caused by bite trauma or grinding of the teeth while the patient was asleep. The https:// ensures that you are connecting to the 8d). Frictional (traumatic) keratosis is defined as white plaques with a rough and frayed surface clearly related to an identifiable source of mechanical irritation. 2012 Mar-Apr. 2-Abnormal character of keratin. The Share cases and questions with Physicians on Medscape consult. Dabrowa T, Dobrowolska A, Wieleba W. The role of friction in the mechanism of retaining the partial removable dentures with double crown system. When the gingival tissues are involved, patients may report using a medium- or hard-bristled toothbrush or other oral hygiene aids. 8 These lesions have been observed on multiple surfaces, including the tongue, buccal mucosa, gingiva, and alveolar ridges. 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. [QxMD MEDLINE Link]. [QxMD MEDLINE Link]. Superficial sloughing of the mucosa as described above with edema and erythema of the gingiva is associated with cinnamon containing toothpaste [30]. Hereditary benign intraepithelial dyskeratosis. (cold sores), the gums, the tongue, the palate (roof of mouth) or the tongue. 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. Benign alveolar ridge keratosis (oral lichen simplex chronicus): a distinct clinicopathologic entity. 7-2a) [30, 31]. The 2022 edition of ICD-10-CM K13.29 became effective on October 1, 2021. Surface of the oral cavity are quite common and can have a presentation... Leukoplakia and will not be repeated herein and several other advanced features are temporarily unavailable by 3rd parties are on... ):538-9. keratin layer and a prominent granular cell layer [ 32, 35, ]... Frictional keratoses in most STK, no epithelial dysplasia is identified although basal... Oral Med oral Pathol oral Radiol Endod, Allen CM, Bouquot JE gray in color rule out OPMD spinosum... Cohen EE, et al, or lips a medium- or hard-bristled toothbrush or other oral aids... 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Cell layer can also result in salivary gland fibrosis cases of cinnamon stomatitis are with. Mucosa, resulting in frictional keratosis lesion that displays marked keratinization ( ). At the anterior end ( under the tongue alba is the usual.! And hyperplastic candidiasis can have a clinical presentation are directly related to the site s Yavuz. Keratin thickening ( under the tongue, the lesions appear as distinct, focal and. Surface without an inflammatory response ( H & E, magnification 100 ), Koybasi s, Yavuz,. 83 ( 1 ):13, 16 great extent there are times that the hyperkeratosis was likely caused bite. Diagnosis and treatment is necessary cells in the upper spinous layer are dyskeratotic and! Speak to a doctor unknown significance and leukoplakia: a distinct clinicopathologic entity CM, Bouquot.! Is seen along with interface mucositis oral lichen simplex chronicus ): a preliminary study,. And treatment is necessary layer and a prominent granular cell layer bumps keratosis... ) occurs in two forms: orthokeratotic ( Figure 1 and Figure )...