• CLINICAL STOMATOLOGY


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    • Abstract: CLINICAL STOMATOLOGYCONFERENCE Red and mixed red-whitelesionsDNSC D9910.00September 19, 2007Overview Erythroplakia• Definition:

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CLINICAL STOMATOLOGY
CONFERENCE Red and mixed red-white
lesions
DNSC D9910.00
September 19, 2007
Overview Erythroplakia
• Definition:
Red lesions
“A red patch that cannot be clinically or
• Erythroplakia
pathologically diagnosed as any other condition”
• [Squamous cell carcinoma]
• Most (~90%) do represent epithelial dysplasia,
carcinoma in situ, or squamous cell carcinoma
Mixed red-white lesions
• May be combined with leukoplakic areas =
• Geographic tongue
erythroleukoplakia, speckled leukoplakia
• Morsicatio (chewing injury)
• Chemical injuries
• Contact reaction to cinnamon
• [Squamous cell carcinoma]
Erythroplakia
• Etiology: Likely same as oral SCC and
leukoplakia
• Incidence: ~ 77x less than leukoplakias
• Gender: Male predilection
• Age: Peak incidence at 65-74 yo
• Site: Floor of mouth, tongue, soft palate
• Clinical:
Red macule or plaque
Soft, velvety
* May be combined with areas of leukoplakia * Erythroplakia
- histology: SCC
1
Erythroplakia Erythroleukoplakia
- histology: CIS - histology: SCC
Erythroplakia
• Differential diagnosis:
1) Trauma
2) Geographic tongue; ectopic erythema migrans
3) Nutritional deficiency, anemia
4) Allergic mucosal reactions
Contact mucosal reaction
Geographic tongue
Iron deficiency anemia
- generalized
Contact reaction to
cinnamon
2
Erythroplakia Erythroplakia
• Histology: • Treatment:
- lack of keratinization
Biopsy should be performed
- epithelial atrophy
Treatment guided by histopathologic diagnosis
- underlying chronic
inflammation Recurrence, multifocality common
- + dysplasia, usually severe
- + carcinoma-in-situ
** Careful long-term follow-up **
- + squamous cell carcinoma
Geographic tongue Geographic tongue
• AKA: Erythema migrans • Clinical features:
• Etiology: Unknown Zones of erythema surrounded by white,
? Hypersensitivity reaction serpentine borders
• Prevalence: 1-3% of population Lesions migrate in days to weeks
• Gender: F>M
Often associated with fissured tongue
• Age: No predilection
+ burning with spicy foods
• Site: Dorsum of tongue
Can occur in other oral sites, including
buccal and labial mucosa, soft palate
(“ectopic” geographic tongue)
3
Geographic tongue
• Differential diagnosis:
1) Candidiasis
2) Leukoplakia + erythroplakia
- rare on dorsum of tongue
3) Contact allergic reaction
4) Lichen planus
Ectopic geographic tongue
Candidiasis Median rhomboid glossitis
Geographic tongue
• Histology:
- ~ psoriasis
- hyperkeratosis; epithelial
spongiosis
- neutrophils in epithelium
- lymphocytes and
neutrophils in connective
tissue
• Treatment: No treatment; reassure patient
Lichen planus
If burning – topical steroids
4
Morsicatio (chewing injury) Morsicatio (chewing injury)
• Etiology: Frictional irritation from chewing habit • Site: Buccal mucosa
Similar lesions in glassblowers and Can be seen on la mucosa, lat tongue
some musicians • Clinical features:
• Risk: Stress; psychological illnesses; edge-edge White, diffuse
bite + erythema
• Gender: F > M Shredded/ragged, macerated appearance
• Age: Any age
After age of 35 yo – stress
5
Morsicatio
• Differential diagnosis:
1) Leukoplakia
2) Chemical injuries (e.g. aspirin)
3) Contact stomatitis – allergic; cinnamon
4) Inherited mucosal disorders
- White sponge nevus
- Hereditary benign intraepithelial dyskeratosis
Leukoplakia
Chemical injury White sponge nevus
ASA burn
- aspirin burn
- congenital; bilateral
Morsicatio Chemical injuries
• Histology: • Etiology: Contact with caustic chemicals and
- hyperparakeratosis drugs (over-the-counter, prescribed)
- ragged surface Examples: Aspirin, hydrogen peroxide (>3%),
products containing phenol (Anbesol), silver
- intercellular edema nitrate, endo materials (formocresol, sodium
- surface bacterial hypochlorite)
colonies • Age and gender: Any
• Site: Any site of chemical/drug contact
• Clinical: White, wrinkled
Later, white slough with red base
Ulcerated lesions – fibrinopurulent
•Treatment: None indicated membrane
Oral acrylic shield Injection into bone – bone necrosis
6
Aspirin burn Aspirin burn
Endo material
Chemical injury from Commit lozenges
Chemical injuries
• Differential diagnosis:
1) Candidiasis
2) Leukoplakia – does not wipe off
3) Thermal burn
4) Desquamative gingivitis
5) Lichen planus; lichenoid reaction
6) Traumatic ulcer; chronic trauma
Candidiasis
7
Thermal burn
- Border mould Erosive lichen planus
Chemical injuries
• Histology:
- coagulative necrosis
- acute and chronic
inflammatory cells
• Prevention: Endo materials – rubber dam, avoid
excessive injection pressure
Drugs, chemicals – pt education
Traumatic ulcer
• Treatment: Will resolve in 10-14 d
Contact stomatitis - Cinnamon
• Etiology: Mucosal reaction to cinnamon oil
Prolonged/frequent contact
• Gender: No predilection
• Age: Any
• Site: Gingiva – toothpaste
Bu mucosa, tongue – chewing gums, candy
• Clinical features:
Gingiva – enlargement, erythema
– “plasma cell gingivitis”
Bu mucosa, tongue – white, ragged surface
Plasma cell gingivitis
– erythematous base
8
Contact stomatitis - Cinnamon
• Differential diagnosis:
Gingiva
1) Gingivitis – local factors, desquamative,
granulomatous
Buccal mucosa, tongue
1) Morsicatio (chewing injury)
2) Candidiasis
Desquamative gingivitis
3) Leukoplakia; erythroplakia
- mucous membrane
4) Oral hairy leukoplakia Contributor: Bobby M. Collins, DDS
pemphigoid
Contact stomatitis - Cinnamon
• Differential diagnosis:
Gingiva
1) Gingivitis – local factors, desquamative,
granulomatous
Buccal mucosa, tongue
1) Morsicatio (chewing injury)
2) Candidiasis
Desquamative gingivitis 3) Leukoplakia; erythroplakia
- lichen planus 4) Oral hairy leukoplakia
9
Contact stomatitis - Cinnamon
• Histology:
- hyperkeratosis
- heavy chronic
inflammation (lymphocytes,
plasma cells, eosinophils)
- inflammation around
blood vessels
Oral hairy leukoplakia
Contact stomatitis - Cinnamon
• Treatment:
Disappears after discontinuation of
cinnamon products
Will reappear if cinnamon intake resumed
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