c Photomicrograph of smokeless tobacco keratosis shows a corrugated parakeratotic surface and epithelial acanthosis. 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. d Histopathologic features of ridge keratosis characterized by marked hyperorthokeratosis, hypergranulosis and acanthosis. Amalgam reactions are generally considered type IV hypersensitivity reactions [26]. 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. 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. Michael J Wells, MD, FAAD Dermatologic/Mohs Surgeon, The Surgery Center at Plano Dermatology 1986 Apr. In addition, the affected fungiform papillae may be red and enlarged from the chronic irritation. Erythema and ulceration may be present. 2019 Mar. Br Dent J. In the recent WHO (2017), squamous cell hyperplasia has been omitted as an OPMD [1]. Corresponding to the clinical presentation, the surface keratin can have a macerated appearance with fissures and clefting [6, 8]. [QxMD MEDLINE Link]. Community Dent Oral Epidemiol. The corresponding tooth can be slightly recontoured and polished. Admittedly there is histologic overlap with oral lichen planus and amalgam contact reactions however some microscopic findings may favor a contact reaction (Fig. Sloan P, Gale N, Hunter K, et al. Courtesy of Catherine M. Flaitz, DDS and Alfredo Aguirre, DDS. Greer RO., Jr Oral manifestations of smokeless tobacco use. The diagnosis of oral frictional hyperkeratosis was established based on the clinical and microscopic findings. 2-Abnormal character of keratin. Changing trends in oral squamous cell carcinoma with particular reference to young patients: 19712006. Occasionally, patchy erythema with or without petechiae is observed with recent trauma to the site. Other mucosal sites of involvement include nasal, esophageal and anogenital. An official website of the United States government. Br Dent J. Dabrowa T, Dobrowolska A, Wieleba W. The role of friction in the mechanism of retaining the partial removable dentures with double crown system. Accessibility b Photomicrograph demonstrates marked parakeratosis, acanthosis and intracellular edema. Courtesy of Catherine M. Flaitz, DDS and Alfredo Aguirre, DDS. [QxMD MEDLINE Link]. The plaque had a slightly irregular surface, had no surrounding erythema, and was the only such plaque in the . Smith JF. Generally, there is a lack of inflammation in the superficial connective tissue with the exception of cases where secondary ulceration is present. [QxMD MEDLINE Link]. Macdonald JB, Tobin CA, Hurley MY. [20] Occasionally, ill-fitting or broken mouthguards or occlusal splints irritate the oral mucosa, resulting in frictional keratosis. Some patients report that their cheeks and tongue feel swollen. b Biopsy shows a corrugated or slightly papillary epithelial architecture with hyperorthokeratosis, a prominent granular cell layer but normal epithelial maturation. Larsson A, Axll T, Andersson G. Reversibility of snuff dippers lesion in Swedish moist snuff users: a clinical and histologic follow-up study. Oral Pathology Quiz #74. b A more advanced lesion demonstrates obvious mucosal thickening and wrinkling of the mucosa with intervening furrows. Alveolar ridge keratosis is a frictional keratosis located on the edentulous alveolar ridge and/or retromolar pad. The clinical presentation can vary. 5 inset). Mller S. Frictional keratosis, contact keratosis and smokeless tobacco keratosis: features of reactive white lesions of the oral mucosa. This occurs mostly in the mouth area. Other findings include a mixed inflammatory infiltrate, including eosinophils, and focal perivascular inflammation [28, 29]. The oral mucosa is exposed to a wide variety of external irritants. This area is exactly level with the occlusal plane and was being chewed constantly by the patient. Although the vast majority of publications focus on leukoplakia and other potentially malignant lesions, most oral lesions that appear white are benign. This material is negative for Congo red and positive with periodic acid-Schiff confirming the collagen nature [36]. 2019 Mar;13(1):16-24. doi: 10.1007/s12105-018-0986-3. Evidence-based clinical recommendations regarding screening for oral squamous cell carcinomas. A thicker patch of mucosa is at the anterior end (under the tongue blade edge). An example of a common lesion that has a frictional component is cheek chewing or morsicatio buccarum. the keratinized epithelium is consist of 4 layers which are basal cell layer , prickle cell layer , granular cell layer and cornified celllayer , but non keratinized epithelium is consist of 3 layers only which are the . Eur J Dermatol. [QxMD MEDLINE Link]. INCIDENCE Frictional keratosis is common. 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 . Parlak AH, Koybasi S, Yavuz T, et al. Oral Surg Oral Med Oral Pathol Oral Radiol. SLS is a common synthetic detergent added to toothpaste for foaming and cleaning. J Am Acad Dermatol. Differential diagnosis of oral mucosal lesions in children and adolescents. 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. 2010 May. It seems to grow pretty steadily. Microscopic examination of fragments of mucosa peeled away from the affected area revealed fragments ofparakeratotic cornified material colonized by numerous bacteria (Figure 3). The prevalence has been reported as high as 5.5%. The prevalence of oral mucosal lesions in a population in Ljubljana, Slovenia. A bite guard was recommended by an oral and maxillofacial surgeon, but the patient has yet to use it. Frictional (traumatic) keratosis is defined as white plaques with a rough and frayed surface clearly related to an identifiable source of mechanical irritation. HHS Vulnerability Disclosure, Help Semin Cutan Med Surg. STK with dysplasia should be treated as oral dysplasia as there is a greater risk for cancer development. Snuff-dippers lesion. These white patches in the mouth only disappear when the source of friction is removed. Case number 3. 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. Breastfeeding keratosis P White, thick plaque of lip mucosa . This is the American ICD-10-CM version of K13.21 - other international versions of ICD-10 K13.21 may differ. Tuberculosis of the oral cavity: a case report. Frictional keratosis is among the many different keratosis conditions. Linea alba can present unilateral or bilateral and varies in color intensity and thickness [4, 5]. My tongue is very irritated right now from eating spicy food. 2b The microscopic features of oral lichenoid contact reaction to cinnamon show marked epithelial acanthosis and intracellular edema. 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. In some individuals who repeatedly traumatize the tissues, tenderness, swelling, and a burning sensation may be presenting symptoms. Therefore, it is prudent to sample any questionable lesion to rule out OPMD. Kowitz G, Jacobson J, Meng Z, Lucatorto F. The effects of tartar-control toothpaste on the oral soft tissues. As mentioned in tidbits above, leukoplakia is predominantly a disorder of the mouth. MeSH terms Adolescent Adult Age Distribution Aged Aged, 80 and over It started off as one small white area at the beginning of January and the 2nd pic is today. 8a) [32, 35]. Without appropriate clinical information these lesions should be diagnosed not as frictional keratoses but as keratoses without dysplasia or as keratosis of unknown significance [13]. Epidemiological study of oral mucosa pathology in patients of the Oviedo School of Stomatology. A model study. These deposits can be seen around nerves, vessels, salivary glands, and at the epithelial-stroma interface. 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. This friction mostly is from the teeth and dentures. Natarajan E, Woo SB. Typically we see this finding in the grouping of "premalignant" lesions of epithelial origin. Classification schemes for lesions of the oral cavity typically have used the clinical appearance of lesions to determine which are premalignant. Eczema is also called dermatitis. 2a) [8, 10]. 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. This feature can be appreciated on cytologic preparations with Papanicolaou staining [18, 19]. Included in the discussion are frictional keratoses, irritant contact stomatitis, and smokeless tobacco keratoses. Eczema causes itching, redness and tiny blisters. 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. 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. I have frictional keratosis under my tongue. adminsos 26th October 2011. 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). Many products can result in contact stomatitis. 15(4):43-8. On initial examination, the patient was asymptomatic and the oral mucosa had no abnormal findings, but on repeat examination when symptoms were present, the patient had shaggy white plaques on the bilateral buccal mucosa limited to the line of dental occlusion (Figure 1). Flaitz CM, Felefli S. Complications of an unrecognized cheek biting habit following a dental visit. The plaques could be easily peeled away from the underlying skin with a cotton swab without any pain, leaving behind normal underlying mucosa. Daniel J Hogan, MD Clinical Professor of Internal Medicine (Dermatology), Nova Southeastern University College of Osteopathic Medicine; Investigator, Hill Top Research, Florida Research Center 7 The characteristic white appearance of oral frictional keratosis is due to generation of keratin filaments from chronic irritation. Marked hyperkeratosis, either orthokeratosis or parakeratosis and neutrophilic exocytosis is present. Cummings TJ, Dodd LG, Eedes CR, Klintworth GK. Its affecting many people both kids and even the Seborrheic keratosis can come up in the form of bumps on the skin. Frictional keratosis from the alveolar ridge usually is surfaced by orthokeratin with a slightly irregular or corrugated architecture (Fig. Lip-bite keratosis is caused by frequent involuntary biting of ones lips. Drore Eisen, MD, DDS Consulting Staff, Dermatology of Southwest Ohio 1c) [9, 10]. Oral frictional hyperkeratosis (morsicatio buccarum): an entity to be considered in the differential diagnosis of white oral mucosal lesions. 2009 Jan;67(1):140-6. doi: 10.1016/j.joms.2008.08.040. 10(2):114-5. 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]. Tongue lacerations can also result in scarring or swelling. 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 retromolar pad and edentulous alveolar ridge can exhibit benign keratosis as the area is susceptible to both masticatory forces, occlusal trauma or ill-fitting dentures or other dental appliances (Fig. leukoplakia), or malignancy (e.g. Frictional keratosis from the alveolar ridge usually is surfaced by orthokeratin with a slightly irregular or corrugated architecture (Fig. However, there are instances where the etiology is unknown, or the keratotic lesion is in a high-risk area for OPMDs. The hyperkeratosis is orthokeratotic, lacking nuclei. The 2022 edition of ICD-10-CM K13.29 became effective on October 1, 2021. Occasionally, the affected fungiform papillae in persons with a tongue biting or thrusting habit may be tender and sometimes associated with a burning sensation. Jose Luis Tapia, DDS Assistant Professor, Department of Oral Diagnostic Sciences, State University of New York at Buffalo MeSH A prominent granular cell layer is noted. Adv Dermatol. The histological findings of STK though not unique have characteristic findings. HBID does not affect the anogenital region, esophagus or nasal mucosa. Coleman GC, Flaitz CM, Vincent SD. Frictional keratosis must also be considered as it can affect the margins of the tongue. It usually involves the lateral tongue, cheeks, or lips. Madani FM, Kuperstein AS. 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. The connective tissue lacks inflammation. 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]. You may find it difficult to Seborrheic keratosis is not so uncommon around today. What causes frictional keratosis? 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]. Oral frictional hyperkeratosis of the retromolar pad is also referred to as a ridge callus. . The abovementioned categories of frictional keratosis should inform you that you need to be careful when you are brushing, for instance, so that you do not cause damage to your mouth and create a condition that will come to haunt you the rest of your life. epigenetics; oral epithelial dysplasia; oral squamous cell carcinoma; 5-hydroxymethylcytosine This may also be seen on vestibular mucosa in areas where loose dentures chronically and mildly push against the mucosa. The epithelium has elongated anastomosing rete. 2006 Nov. 12(6):553-8. Head Neck Pathol. 199(9):565-72. 1d). 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. Forceful or aberrant nutritional sucking on the nipple of the bottle or breast may result in calluses on the lips of infants. Gabri D, Vrdoljak DV, Boras VV. 2012 Mar-Apr. Termed snuff dippers lesion, snuff pouch and spit tobacco keratosis among other terms, smokeless tobacco keratosis (STK) is the keratotic changes in the oral mucosa where smokeless tobacco product is placed [32]. The epithelium is acanthotic and cellsin the spinous layer may show vacuolated cytoplasm. Many individuals are having it. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. HHS Vulnerability Disclosure, Help Smokeless tobacco keratosis is caused by constant frictional irritation of smokeless tobacco against the oral mucosa resulting in keratosis. 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. The white area on your tongue could mostly be due to friction which causes Frictional keratosis. Prevalence of oral mucosal lesions in a Kenyan population with special reference to oral leukoplakia. 1b). Oral and Maxillofacial Pathology. 2008 Apr-Jun. 7-1c) [29]. 7-1b) [26, 28]. East Afr Med J. 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. The effects of the habit of chronic biting may also manifest on the anterior and lateral borders of the tongue and appear as white, shaggy or mildly wrinkled plaques (see image below). 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