RECOGNIZING WHITE LESIONS PART I Reactive, Idiopathic,.ppt

RECOGNIZING WHITE LESIONS PART I: Reactive, Idiopathic, Hereditary David E. Wojtowicz, DDS, MBA White Lesions A Lesion Appears WHITE Because Some Material Is Obscuring the Normal PINK or Racial Color. Is the WHITE Material Directly on the Surface? 3 Mechanismsto Achieve White Appearance Epithelial Thickening Rough / Does NOT Rub Off Surface Material Rough / Does Rub Off Subepithelial Change Smooth / Does NOT Rub Off Six Common Etiologies for White Lesions Reactive (Snuff) Idiopathic (Hairy Tongue) Hereditary (Leukoedema) Auto-Immune (Lichen Planus) Infectious (Candidiasis) Neoplastic (SCC) 1. Six Reactive White Hyperkeratotic Lesions(These are HYPERKERATOTIC. They Do NOT Rub Off.) a. Snuff Dipper’s Lesion b. Nicotinic Stomatitis c. Chemical Burn d. Linea Alba e. Actinic Cheilitis f. Denture Acanthosis 1. Six Reactive White Hyperkeratotic Lesions(Do They Rub Off?)a. Snuff Dipper’s Lesion Wrinkled, Velvety US Canada, Lower Carcinogenic Rate Asia Higher Rate Due to Added Carcinogens Treatment = Quit Habit, Switch Site 1. Six Reactive White Lesionsb. Nicotinic Stomatitis Grey, White and Red on Hard Palate Pipe and Tobacco Smoking (Heat) Red Spots, Inflamed Minor Salivary Gland Orifices Treatment = Quit Smoking 1. Six Reactive White Hyperkeratotic Lesionsc. Chemical Burn Caused by Aspirin Painful Usually in Molar Region Treatment = Discontinue Aspirin Use 1. Six Reactive White Hyperkeratotic Lesionsd. Linea Alba Most Common White Lesion White Line @ Occlusal Plane Bilateral on the Buccal Mucosa No Treatment Needed 1. Six Reactive White Hyperkeratotic Lesionse. Actinic Cheilitis Sun Damage Lower Lip Obliteration of Border Treatment = Avoid Sun, Use Sunblock 1. Six Reactive White Hyperkeratotic Lesionsf. Denture Acanthosis Caused by Irritants Clinical Appearance is Similar to Hyperkeratosis Thickened Intermediate Cell layer Elongation of Rete Pegs Treatment = Avoid Irritants, ie. Ill-fitting Dentures 2. Two Idiopathic White Hyperkeratotic Lesions G