Linea alba is the term used to describe the white keratotic line on the buccal mucosa approximating the occlusal plane. Gender It occurs in more men than women. 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. Frictional keratosis presents as a white lesion (macule or plaque) determined by repeatedly trauma, in turn caused by particularly sharp dentures, ill-fitting dentures or poor oral habits (e.g. 1992 Jun. These ways include regulated or decreased smoking of cigarettes as it is a major contributor and cause of frictional keratosis. . An official website of the United States government. Microscopic examination of fragments of mucosa peeled away from the affected area revealed fragments ofparakeratotic cornified material colonized by numerous bacteria (Figure 3). Keratin is a tough, fibrous protein found in fingernails, hair, and skin. Oral Medicine--update for the dental practitioner: oral white patches. Fast Five Quiz: What Do You Know About Dental Health? Frictional keratosis is characterized by a corrugated hyperkeratotic surface with bacterial colonization, extremely rare presence of Candida, and intracellular edema at the upper cell layers. 7-2c) [10, 31]. MeSH terms Adolescent Adult Age Distribution Aged Aged, 80 and over Pentenero M, Meleti M, Vescovi P, Gandolfo S. Oral proliferative verrucous leucoplakia: are there particular features for such an ambiguous entity? Although there are clinical similarities to frictional keratoses the histology is distinct. In most cases, oral frictional keratosis appears as a thin line that is white in color across the cheek opposite the meeting point of the teeth. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. There are those keratoses that are so hidden that they could be invisible to the naked eye till the doctor examines your mouth or carries out a biopsy. Messadi DV, Younai FS, Liu HH, Guo G, Wang CY. The prevalence has been reported as high as 5.5%. Frictional Keratosis. 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? [20] Occasionally, ill-fitting or broken mouthguards or occlusal splints irritate the oral mucosa, resulting in frictional keratosis. Improve Article. [QxMD MEDLINE Link]. Mller S. Frictional keratosis, contact keratosis and smokeless tobacco keratosis: features of reactive white lesions of the oral mucosa. FOIA In some instances, patients give a history of wearing orthodontic appliances or removable full or partial dental prostheses that may traumatize the soft tissues. [4] The formation rate depends on the frequency of habit, dose, and even the brand used. Mathew AL, Pai KM, Sholapurkar AA, Vengal M. The prevalence of oral mucosal lesions in patients visiting a dental school in Southern India. If the patch is not easily wiped off, this suggests the presence of hyperkeratinization. Frictional keratosis Introduction The oral mucosa Is consist of stratified squamous epithelium which may be keratinized or non kertinized ,(para) . These clinical features may mimic frictional keratoses from cheek or tongue biting, however the histology is distinct from frictional keratoses. HBID is characterized histopathologically by hyperplastic stratified squamous epithelium with marked parakeratosis and acanthosis (Fig. Tremblay S, Avon SL. PMC Jones KB, Jordan R. White lesions in the oral cavity: clinical presentation, diagnosis, and treatment. Int J Oral Sci. Therefore, it is prudent to sample any questionable lesion to rule out OPMD. PREDISPOSING FACTORS This is in contrast to the diffuse, ill-defined keratotic plaques seen in proliferative verrucous leukoplakia (Fig. 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. The site is secure. 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. It may affect any area of the mouth such as the tongue, roof of the mouth, gums and the insides of the cheek. Bacteria is usually present on the keratin surface in biopsies from the tongue, but not as often on the buccal mucosa or lip. This category includes linea alba, and cheek, lip, and tongue chewing. White, thickened plaques with irregular, rough surface change are noted on the gingiva of the right maxilla and mandible. 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]. Leukokeratosis of oral mucosa. Differential diagnosis of oral mucosal lesions in children and adolescents. The . This might give you immediate relief. Dentrifice-related stomatitis, contact reactions to amalgam and cinnamon can cause keratotic lesions. government site. In some published series in children and adolescents the reported range is 0.265.3% [5]. Applicable To Erythroplakia of mouth or tongue Inflammatory etiologies of oral white lesions including infective and non-infective causes will be discussed elsewhere in this special issue. However, most traumatized gingiva of the tooth bearing area expresses as erythema, ulceration, or other reactive lesions such as pyogenic granuloma. Frictional Keratosis, Contact Keratosis and Smokeless Tobacco Keratosis: Features of Reactive White Lesions of the Oral Mucosa. In orthokeratotic hyperkeratosis (sometimes referred to as orthokeratosis), the dead keratinocytes are anuclear, whereas in parakeratotic hyperkeratosis (sometimes referred to as parakeratosis), the dead keratinocytes have retained pyknotic nuclei. Changes in skin color. a Typical clinical presentation of an early smokeless tobacco keratosis demonstrating an area of superficial keratosis with slight wrinkling, lacking any appreciative mucosal thickening. In some patients the frictional keratoses can be extensive involving the entire cheek and extending to the lips. Meta-analysis of the relation between European and American smokeless tobacco and oral cancer. Leukoplakia of gingiva, lips, tongue. Med Oral. The oral mucosa is exposed to a wide variety of external irritants. White sponge nevus is a condition characterized by the formation of white patches of tissue called nevi (singular: nevus) that appear as thickened, velvety . 2019 Mar;13(1):16-24. doi: 10.1007/s12105-018-0986-3. 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. Typically, the lesions appear as distinct, focal, and translucent-to-opaque white asymptomatic patches with sharply delineated borders. Oral contact lesions to amalgam dental restorations can present as a keratotic or lichenoid lesion (Fig. 8b). Histologic features of WSN are distinct with prominent parakeratosis and acanthosis and clearing of the spinous cell layer (Fig. 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]. 1 d). Hassona Y, Scully C. Oral mucosal peeling. When the gingival tissues are involved, patients may report using a medium- or hard-bristled toothbrush or other oral hygiene aids. Its affecting many people both kids and even the Seborrheic keratosis can come up in the form of bumps on the skin. Oral and Maxillofacial Pathology. 1a Oral lichenoid contact reaction to dental amalgam presenting as areas of erythema and white plaques on the left buccal mucosa. National Library of Medicine 15(4):43-8. Alfredo Aguirre, DDS, MS is a member of the following medical societies: American Academy of Oral and Maxillofacial PathologyDisclosure: Nothing to disclose. Before lesions appear as white patches in oral cavity. Hyperkeratosis (thickening of the stratum corneum) occurs in two forms: orthokeratotic ( Figure 1 and Figure 2) or parakeratotic hyperkeratosis. Irritant contact stomatitis caused by chemical products used in toothpastes, mouthwashes,and dental restorations can result in oral mucosal injury. Leukoedema: an epidemiological study in white and African Americans. Frictional keratosis can also be avoided in a number of ways. Scully C. Cannabis; adverse effects from an oromucosal spray. 2006 Nov-Dec. 16(6):674-6. The connective tissue is uninflamed. Bhattacharyya I. Lee PN, Hamling J. 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). Kessler HP. With discontinuation of smokeless tobacco most lesions resolve within 6 weeks [32, 35, 37]. 2006 Nov. 12(6):553-8. This is the American ICD-10-CM version of K13.29 - other international versions of ICD-10 K13.29 may differ. This condition derives its name from the act of friction (another object constantly rubbing itself against the skin) and this may lead to Frictional keratosis patches. Learn more about navigating our updated article layout. 7 Oral frictional keratosis lesions typically reduce or resolve . [QxMD MEDLINE Link]. The patient denied biting her tongue and the histology is not consistent with chronic tongue chewing/biting. FRICTIONAL KERATOSIS White lesions caused by repeated trauma, such as from food, the teeth, toothbrushing or dental appliances. Amalgam contact reactions have clinical overlap with oral lichen planus, but unlike lichen planus, contact reactions to amalgam are usually single and can resolve upon amalgam removal [8, 12]. It is possible to treat pigmentation yourself at home. This review will focus exclusively on reactive white oral lesions. 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]. 2a) [8, 10]. Int J Paediatr Dent. These plaques are moveable over the underlying tissue. 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. The wear on the occlusal surfaces of the molar teeth suggests that the patient had a habit of bruxism. 1c) [9, 10]. The keratin surface is either parakeratotic or orthokeratotic with spires of chevron parakeratosis imparting a wavy appearance to the keratin surface (Fig. Triamcinolone 0.1% ointment in Orabase and tretinoin 0.05% gel were ineffective. Generally, first noted in childhood, the lesions wax and wane over time [14, 16]. from habit of pushing tongue against teeth. c Photomicrograph of smokeless tobacco keratosis shows a corrugated parakeratotic surface and epithelial acanthosis. The first image below shows a frictional keratosis lesion that displays marked keratinization. Accessibility The https:// ensures that you are connecting to the biting the cheek), leading to a reaction of the mucosa in the oral cavity. The gingiva is the most common site for PVL and in a 2014 systematic review of PVL, the gingiva was the most common site for malignant transformation [11]. 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). Frictional hyperkeratosis. Semin Cutan Med Surg. This habit most probably led to the biting of the cheek mucosa. Cam K, Santoro A, Lee JB. 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. 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. Leukoplakia, lichen planus, and other oral keratoses in 23,616 white Americans over the age of 35 years. In addition to these ingredients, flavoring agents are added to mask the bitter taste of pyrophosphate. b Photomicrograph showing marked hyperparakeratosis with a shaggy appearance with surface fissures and clefts. This friction mostly is from the teeth and dentures. It is, however, more common in younger patients. Martin JL. government site. 3-Abnormal permeability of epithelium. The author declares they have no conflict of interest. Before Introduction. Br Dent J. Woo SB, Lin D. Morsicatio mucosae orisa chronic oral frictional keratosis, not a leukoplakia. However, chronic frictional or chemical assault on the tissue over time can also cause dysplastic changes. Histologically, amalgam contact reactions can have tertiary lymphoid follicle formation composed of B-cells containing follicular dendritic cells surrounded by T-cells and macrophages similar to normal tonsils (Fig. 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. As mentioned in tidbits above, leukoplakia is predominantly a disorder of the mouth. Jose Luis Tapia, DDS Assistant Professor, Department of Oral Diagnostic Sciences, State University of New York at Buffalo The myriad of clinical findings of reactive white lesions can be challenging when attempting to distinguish from other disorders, including OPMDs. In some individuals certain dentifrices can result in superficial sloughing of the oral mucosa (Fig. As the name suggests these patches occur due to friction or . [QxMD MEDLINE Link]. Although the clinical presentation of irritant contact stomatitis share similarities with allergic contact stomatitis, patch testing is negative [20]. Sometimes it is extremely difficult to read the symptoms of frictional keratosis until after you start feeling pain. Be sure that any frictional irritant is removed. [QxMD MEDLINE Link]. Courtesy of Catherine M. Flaitz, DDS and Alfredo Aguirre, DDS. Triamcinolone 0.1% ointment in Orabase and tretinoin 0.05% gel were ineffective. 30100 Telegraph Road, Suite 408, Bingham Farms, Michigan 48025 (USA) However, with increased concentration, duration, or frequency of the chemical the patient may have a reaction and develop keratoses, ulcerations, vesicles, erythema, edema or a combination of these. 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. Cifuentes M, Davari P, Rogers III RS. Courtesy of Catherine M. Flaitz, DDS and Alfredo Aguirre, DDS. This feature can be appreciated on cytologic preparations with Papanicolaou staining [18, 19]. epigenetics; oral epithelial dysplasia; oral squamous cell carcinoma; 5-hydroxymethylcytosine Smokeless tobacco keratosis. Sucking on the cheeks, lips, or sides of the tongue may be a habit to relieve the discomfort from temporomandibular disorder or burning mouth syndrome. 8 These lesions have been observed on multiple surfaces, including the tongue, buccal mucosa, gingiva, and alveolar ridges. Scaling. and transmitted securely. The epithelium is acanthotic and cellsin the spinous layer may show vacuolated cytoplasm. Haisley-Royster CA, Allingham RR, Klintworth GK, Prose NS. 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]. Bookshelf Axll T. Occurrence of leukoplakia and some other oral white lesions among 20,333 adult Swedish people. A 55-year-old man presented with desquamating lesions on his bilateral buccal mucosa intermittently for approximately 3 years. When there is reasonable doubt about the etiology of a white lesion of the oral mucosa, biopsy should be the gold standard for ruling out true leukoplakia. 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. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2b The microscopic features of oral lichenoid contact reaction to cinnamon show marked epithelial acanthosis and intracellular edema. Contact stomatitis. Benign alveolar ridge keratosis (oral lichen simplex chronicus): A distinct clinicopathologic entity. The diagnosis of oral frictional hyperkeratosis was established based on the clinical and microscopic findings. All material on this website is protected by copyright, Copyright 1994-2023 by WebMD LLC. Dabrowa T, Dobrowolska A, Wieleba W. The role of friction in the mechanism of retaining the partial removable dentures with double crown system. MeSH Daniel J Hogan, MD Clinical Professor of Internal Medicine (Dermatology), Nova Southeastern University College of Osteopathic Medicine; Investigator, Hill Top Research, Florida Research Center Observe and monitor the patient to be certain that the frictional area is resolving in a timely fashion. Gupta B, Johnson NW. 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. Ardore M, Berrone M, Marchitto G, Gandolfo S, Pentenero M. Ann Stomatol (Roma). Acta Bioeng Biomech. Each of these lesions have microscopic findings that can assist in patient management. 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). Patients may report that they are aware of sucking the mucosa or thrusting their tongue against their teeth. 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. Adv Dermatol. d Subepithelial collagen eosinophilia that can be mistaken for amyloid is an unusual finding in smokeless tobacco keratoses. Courtesy of Catherine M. Flaitz, DDS and Alfredo Aguirre, DDS. The epithelium has elongated anastomosing rete. The use of oral tobacco products used in North American and Europe can result in clinical changes at the site of tobacco placement. The patient admitted to nibbling at the thickened mucosa (see second image below), which, in turn, made it thicker and easier to feel and, therefore, encouraged further nibbling. Classification schemes for lesions of the oral cavity typically have used the clinical appearance of lesions to determine which are premalignant. Epidemiological study of oral mucosa pathology in patients of the Oviedo School of Stomatology. Share cases and questions with Physicians on Medscape consult. Frictional keratosis from the alveolar ridge usually is surfaced by orthokeratin with a slightly irregular or corrugated architecture (Fig. The exact prevalence is unknown but most likely these reactions are uncommon. Other findings include a mixed inflammatory infiltrate, including eosinophils, and focal perivascular inflammation [28, 29]. 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. It can occur at any age and has no gender predilection. Courtesy of Catherine M. Flaitz, DDS and Alfredo Aguirre, DDS. SLS is a common synthetic detergent added to toothpaste for foaming and cleaning. on your tongue or palate; on the bottom of your mouth; . 2015 Aug 1. The histologic features of frictional keratosis from the tongue, lip or buccal mucosa vary slightly depending on the site of the biopsy. Alveolar ridge keratosis is a frictional keratosis located on the edentulous alveolar ridge and/or retromolar pad. 1995 Dec. 72(12):778-82. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The website grew out of my desire to share with people (both fellow dentists and patients) my knowledge of the subject. The epithelium may show acanthosis and epithelial rete may be elongated or atrophic [ 9, 10 ]. Forceful or aberrant nutritional sucking on the nipple of the bottle or breast may result in calluses on the lips of infants. It could also arise from excess deposit of keratin due to a process called hyperkeratinization. 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. Frictional keratosis must also be considered as it can affect the margins of the tongue. [QxMD MEDLINE Link]. These microscopic features are not unique to dentifrice stomatitis, but with appropriate clinical information, an association can be proffered. It can also lead to serious complications and timely diagnosis and treatment is necessary. Kowitz G, Jacobson J, Meng Z, Lucatorto F. The effects of tartar-control toothpaste on the oral soft tissues. An official website of the United States government. Low-power view of stratified squamous epithelium with marked hyperkeratinization, acanthosis, and a prominent granular cell layer. This site needs JavaScript to work properly. 2000 Nov-Dec. 22(6):511-2. Coleman GC, Flaitz CM, Vincent SD. 1 d). 4b inset). Case number 3. 2008 Jan. 58(1):151-7. Occasionally, patchy erythema with or without petechiae is observed with recent trauma to the site. Farah CS, Simanovic B, Savage NW. Frictional keratosis, contact keratosis and smokeless tobacco keratosis: . 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. Tuberculosis of the oral cavity: a case report. 2004 Sep. 135(9):1279-86. Such keratosis conditions as oral frictional keratosis do not affect ones health to a great extent. Sloan P, Gale N, Hunter K, et al. Both triclosan, an antimicrobial agent, and sodium pyrophosphate are added to toothpaste either as a single ingredient or combined in tartar-control toothpaste to prevent plaque development. The plaques could be easily peeled away from the underlying skin with a cotton swab without any pain, leaving behind normal underlying mucosa. Oral frictional hyperkeratosis of the retromolar pad is also referred to as a ridge callus. 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). HHS Vulnerability Disclosure, Help Hereditary benign intraepithelial dyskeratosis: an evaluation of diagnostic cytology. A model study. 2015 Dec. 34 (4):161-70. 7-2b). In addition, the affected fungiform papillae may be red and enlarged from the chronic irritation. This wider area of roughened mucosa is typical of those produced by the habit of cheek biting or nibbling. The most important management protocol includes the following: Establish a diagnosis. Slight variations in the clinical presentation are directly related to the nature and the source of the physical trauma. official website and that any information you provide is encrypted Woo SB, Grammer RL, Lerman MA. I'm hoping it's some sort of frictional keratosis but I'm not aware of me doing . It's been there for a long time. K13.29 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. Lesions associated with a tongue thrusting habit often demonstrate prominent crenations of the lateral tongue. Biopsies should be performed on these lesions that do not heal to rule out a and transmitted securely. See your doctor if the lesions become chronic and painful. Inset: High-power photomicrograph of exfoliative cytology with Papanicolaou staining demonstrating the eosinophilic perinuclear condensation (magnification 400). The connective tissue can be uninvolved in STK with little to minimal inflammation. J N J Dent Assoc. Would you like email updates of new search results? When the frictional component is removed, the lesion will subside. [QxMD MEDLINE Link]. There are different types of frictional keratoses whose classification is based on the area that suffers friction and develops patches. Frictional keratosisis a skin growth that can result from mild mechanical trauma or irritation of the skin. 2-Abnormal character of keratin. Tex Dent J. 1 Given the high-risk nature of some white patches, it is important to perform a thorough history and examination. Geographic It is seen worldwide. Natarajan E, Woo SB. [QxMD MEDLINE Link]. Mller S. Oral lichenoid lesions: distinguishing the benign from the deadly. Accessibility In Seborrheic keratosis is a very common skin condition. Most cases of cinnamon stomatitis are associated with prolonged contact of the offending agent. The site is secure. Br Dent J. Oral Surg Oral Med Oral Pathol Oral Radiol. Ask one of your family member to evaluate if you grind . Received 2018 Sep 21; Accepted 2018 Nov 2. Flaitz CM, Felefli S. Complications of an unrecognized cheek biting habit following a dental visit.
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