[QxMD MEDLINE Link]. 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. The connective tissue is uninflamed. This causes irritation to the gum and cheek in the mouth. A frictional keratosis lesion may be elevated from the surface, and patients may find that they develop the habit of nibbling further at these thickened mucosal sites. These lesions can occasionally mimic dysplastic leukoplakia. 3rd ed. However, there are instances where the etiology is unknown, or the keratotic lesion is in a high-risk area for OPMDs. 7 The characteristic white appearance of oral frictional keratosis is due to generation of keratin filaments from chronic irritation. You may find it difficult to Seborrheic keratosis is not so uncommon around today. Oral Medicine--update for the dental practitioner: oral white patches. MeSH Frictional keratosis. In rare examples, individuals may give a history of picking the oral mucosa with long fingernails or some other external object. 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. Prominent linea alba with evidence of cheek biting. [QxMD MEDLINE Link]. Frictional Keratosis. 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. Biting, sucking, or chewing habits should be discontinued, and fractured or rough tooth surfaces or irregularly fitting dentures or other appliances should be corrected. Localized hair loss. . The lesions usually present on the buccal mucosa or tongue where prolonged contact of the mucosa with the amalgam occur. The site is secure. 8d). Normal variations of oral anatomy and common oral soft tissue lesions: evaluation and management. Benign alveolar ridge keratosis (oral lichen simplex chronicus): a distinct clinicopathologic entity. Interface mucositis is identified, and the superficial connective tissue contains a predominately lymphocytic band-like inflammatory cell infiltrate which includes plasma cells, histiocytes and scattered eosinophils (Fig. Physical and Chemical Injuries. Oral leukoplakia can best be defined, in a broad sense, as any white plaque or patch that adheres to the mucosal surface and will not routinely rub off. The white patch that is the greatest sign of oral frictional keratosis is caused by the constant friction on the soft tissues in the mouth. The 2022 edition of ICD-10-CM K13.29 became effective on October 1, 2021. Please confirm that you would like to log out of Medscape. [QxMD MEDLINE Link]. Ardore M, Berrone M, Marchitto G, Gandolfo S, Pentenero M. Ann Stomatol (Roma). epigenetics; oral epithelial dysplasia; oral squamous cell carcinoma; 5-hydroxymethylcytosine 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. 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. Cinnamon flavoring agents including cinnamic aldehyde, cinnamic acid and cinnamon oil, can cause a contact stomatitis [30]. One of the more common presentations of frictional keratosis is the linea alba (white line). 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. 6a). They include: The list can go on and on. Oral frictional hyperkeratosis of the lateral border of the tongue from chronic biting habit. The prevalence has been reported as high as 5.5%. Jones KB, Jordan R. White lesions in the oral cavity: clinical presentation, diagnosis, and treatment. 1 d). 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. 6b) [24]. Contact allergy to cinnamon: case report. Consult privately with the doctor of your choice. The alteration in texture within his mouth created an uncomfortable sensation and, at times, the lesions spontaneously peeled away requiring him to spit repeatedly. 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. Ask one of your family member to evaluate if you grind . adminsos 26th October 2011. This finding can be best appreciated on exfoliative cytology with Papanicolaou staining (Fig. The lesions resolve after discontinuing the suspected product. This might give you immediate relief. Frictional keratosis from the alveolar ridge usually is surfaced by orthokeratin with a slightly irregular or corrugated architecture (Fig. Skinmed. Oral frictional hyperkeratosis of the attached maxillary gingiva from inappropriate toothbrushing technique. 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. 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. Larsson A, Axll T, Andersson G. Reversibility of snuff dippers lesion in Swedish moist snuff users: a clinical and histologic follow-up study. PVL lesions histologically can have a varied appearance and usually corresponds to the clinical appearance. Neville BW, Damm DD, Allen CM, Bouquot JE. The myriad of clinical findings of reactive white lesions can be challenging when attempting to distinguish from other disorders, including OPMDs. 2019 Mar. 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. J Am Dent Assoc. 2013. Although some authors have likened keratosis of the alveolar ridge to cutaneous lichen simplex chronicus and emphasize that these benign keratoses should be removed from the category of leukoplakia, this viewpoint is not universally accepted [9]. 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). PMC Cifuentes M, Davari P, Rogers III RS. 2007 Sep 22. Patients may report that they are aware of sucking the mucosa or thrusting their tongue against their teeth. Kashani HG, Mackenzie IC, Kerber PE. Frictional Keratosis, Contact Keratosis and Smokeless Tobacco Keratosis: Features of Reactive White Lesions of the Oral Mucosa. 7-2a) [30, 31]. Martinez Diaz-Canel AI, Garcia-Pola Vallejo MJ. National Library of Medicine I bought a new waterpik today and when I used it the first time, there was a lot of blood in the sink. Hassona Y, Scully C. Oral mucosal peeling. A thicker patch of mucosa is at the anterior end (under the tongue blade edge). 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 . Castellanos JL, Daz-Guzmn L. Lesions of the oral mucosa: an epidemiological study of 23785 Mexican patients. . Frictional keratosis from the alveolar ridge usually is surfaced by orthokeratin with a slightly irregular or corrugated architecture (Fig. 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]. It is more common in African-Americans than in white Americans occurring in 49% of African-Americans and in 4% of white Americans in one survey of 13,000 patients [15]. Most patients with frictional keratosis are free of symptoms, with the exception of those with aggressive cheek and lip biting habits. Dry skin. In the 2005 WHO section of epithelial precursor lesions, squamous cell hyperplasia was considered a precursor lesion and thus, termed leukoplakia [2]. 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. J Oral Maxillofac Surg. It evens regresses a little and then comes back even worse than before. However, if lesions persist, complete removal is advisable. Although the clinical presentation of irritant contact stomatitis share similarities with allergic contact stomatitis, patch testing is negative [20]. A persons mouth is one of the most sensitive and important parts of the human body and should therefore be protected from any form of friction or irritation that has potential to cause frictional keratosis. Tongue lacerations can also result in scarring or swelling. Diagnosis : Geographic Tongue (Erythema Migrans) Diagnosis Banding : Erythematous Candidiasis, Lichen Planus, Lupus Erythematosus, dan Leukoplakia 4. The epithelium exhibits epithelial hyperplasia and intracellular edema is common presenting as ballooned cells in the spinous layer. Pentenero M, Meleti M, Vescovi P, Gandolfo S. Oral proliferative verrucous leucoplakia: are there particular features for such an ambiguous entity? b A more advanced lesion demonstrates obvious mucosal thickening and wrinkling of the mucosa with intervening furrows. The basal cells show nuclear hyperchromatism but no dysplasia is seen. 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]. Typically, the lesions appear as distinct, focal, and translucent-to-opaque white asymptomatic patches with sharply delineated borders. Leukoplakia of gingiva, lips, tongue. 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. It may affect any area of the mouth such as the tongue, roof of the mouth, gums and the insides of the cheek. Alveolar ridge keratosis is a frictional keratosis located on the edentulous alveolar ridge and/or retromolar pad. However, there are instances when the leukoplakia may . Early lesions tend to have a filmy white to gray opalescent appearance with a wrinkled surface and minimal mucosal thickening (Fig. Parlak AH, Koybasi S, Yavuz T, et al. In the superficial epithelium, eosinophilic perinuclear condensation, representing compact aggregates of keratin tonofilaments, unique to WSN, is present [16, 17]. This review will focus exclusively on reactive white oral lesions. Frictional keratosis is a reactive white lesion caused by prolonged mild irritation of the mucous membrane. [QxMD MEDLINE Link]. 1a). Leukoedema is a common, asymptomatic buccal mucosal finding of unknown etiology and is considered to represent a normal variation [4, 5, 14]. J Am Dent Assoc. An example of a common lesion that has a frictional component is cheek chewing or morsicatio buccarum. 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. Head Neck Pathol. Perivascular inflammation in the deeper lamina propria is present, a feature not typical for oral lichen planus (H&E magnification 40). Kessler HP. and transmitted securely. 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. This lesion should quickly resolve after removal of the provoking stimulus. White, thickened plaques with irregular, rough surface change are noted on the gingiva of the right maxilla and mandible. 15(2):89-97. The wear on the occlusal surfaces of the molar teeth suggests that the patient had a habit of bruxism. [20] Occasionally, ill-fitting or broken mouthguards or occlusal splints irritate the oral mucosa, resulting in frictional keratosis. It is possible to treat pigmentation yourself at home. Tuberculosis of the oral cavity: a case report. A patient may notice a thickening or roughness of the involved mucosal site, or frictional keratosis may be discovered as an incidental finding during a routine oral examination. 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]. Benign alveolar ridge keratosis (oral lichen simplex chronicus): A distinct clinicopathologic entity. PMC legacy view Suter VG, Warnakulasuriya S. The role of patch testing in the management of oral lichenoid reactions. Bethesda, MD 20894, Web Policies Of unknown etiology, PVL is associated with high recurrence and malignant transformation rates. These include frictional keratosis arising from excessive force while brushing the teeth (toothbrush. The whiteness is as a result of more cells being set by the body as it reacts to the irritation caused by friction. frictional keratosis), an oral potentially malignant disorder (e.g. 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. Hereditary benign intraepithelial dyskeratosis: report of two cases with prominent oral lesions. There is both clinical and histologic overlap in the features of benign keratosis and keratosis associated with proliferative verrucous leukoplakia (PVL) which is a recognized OPMD (Fig. Mravak-Stipeti M, Lonar-Brzak B, Bakale-Hodak I, Sabol I, Seiwerth S, Majstorovi M, Grce M. Clinicopathologic correlation of oral lichen planus and oral lichenoid lesions: a preliminary study. Lee PN, Hamling J. A prominent granular cell layer is noted. These microscopic features are not unique to dentifrice stomatitis, but with appropriate clinical information, an association can be proffered. [QxMD MEDLINE Link]. 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. Note the lack of inflammation (H&E, magnification 100). Accessibility lesions appear as white patches in oral cavity. Frictional keratosis is mostly associated with the gum and the cheek. 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). 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. 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]. It shows rough and frayed surface and upon removal of the offending agent, the lesion resolves in 2 weeks.
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