Reactive white lesions oral pathology

Reactive white lesionsFaisal Moteq Al-Qahtani

431803127

Reactive white lesions1. Linea Alba (White Line)2. Frictional (Traumatic) Keratosis3. Cheek Chewing4. Chemical Injuries of the Oral

Mucosa5. Actinic Keratosis (Cheilitis)6. Smokeless Tobacco–Induced

Keratosis7. Nicotine Stomatitis8. Sanguinaria-Induced Leukoplakia

Linea Alba (White Line)

Definition• It is a horizontal streak on the buccal mucosa at

the level of the occlusal plane. • It is a very common finding most likely

associated with pressure, frictional irritation, or sucking trauma from the facial surfaces of the teeth.


a horizontal streak at the level occlusal plane.


Tretment • No treatment is indicated for patients with

linea alba. • The white streak may disappear spontaneously

in some people.

Frictional (Traumatic) Keratosis

Definition• defined as a white plaque with a rough and

frayed surface that is clearly related to an identifiable source of mechanical irritation

• Usually resolve on elimination of the irritant.


Leukoplakic-appearing area of frictional keratosis from an ill-fitting denture.


Tretment • Upon removal of the offending agent, the

lesion should resolve.• within 2 weeks, Biopsies should be performed

on lesions that do not heal to rule out a dysplastic lesion.

Cheek biting

Definition • Ragged, irregular white tissue of the buccal

mucosa in the line of occlusion• May be ulcerated• Due to chewing or biting the cheeks• May also be seen on labial mucosa

Cheek biting

Morsicatio buccarum represented by a frayed macerated irregular leukoplakicarea in the cheek.

Cheek biting

Tretment• Since the lesions result from an unconscious

and/or nervous habit, no treatment is indicated.

• For those desiring treatment and unable to stop the chewing habit, a plastic occlusal night guard may be fabricated.

Chemical Injuries of the Oral Mucosa

Definition • Transient nonkeratotic white lesions of the oral

mucosa .• Are often a result of chemical injuries caused by

a variety of caustic agents retained in the mouth for long periods of time.

• The white lesions are attributable to the formation of a superficial pseudomembrane composed of a necrotic surface tissue and an inflammatory exudates.


B- Aspirin burn, creating a pseudomembranous necrotic white area.

C- Extensive tissue necrosis caused by injudicious use of silver nitrate.

A- Severe ulceration and sloughing of mucosa, caused by use of a cinnamon-containing dentifrice

A B C


Tretment• The best treatment of chemical burns of the oral

cavity is prevention.• Most superficial burns heal within 1 or 2 weeks. • A protective emollient agent such as a film of

methyl cellulose may provide relief. • However, deep-tissue burns and necrosis may

require careful débridement of the surface, followed by antibiotic coverage

Actinic Keratosis (Cheilitis)

Definition • Actinic (or solar) keratosis is a premalignant

epithelial lesion directly related to long-term sun exposure

• classically found on the vermilion border of the lower lip as well as on other sun-exposed areas of the skin.

• A small percentage of these lesions will transform into squamous cell carcinoma.


Distinctive raised white plaque, representing actinic cheilitis.


Tretment• The mainstay of treatment of actinic keratosis

is surgery.• Chemotherapeutic agents such as topical 5-

fluorouracil have been used with some success.

• Patients treated with nonsurgical methods therefore require long-term follow-up, about 10% of these lesions will undergo malignant transformation.

Nicotine Stomatitis

Definition • Palate initially becomes diffusely erythematous

and eventually turns grayish white secondary to hyperkeratosis .

• multiple keratotic papules with depressed red centers correspond to dilated and inflamed excretory duct openings of the minor salivary glands .

Nicotine Stomatitis

A B

A- Histologic appearance of nicotine stomatitis, showing hyperkeratosis and acanthosis with squamous metaplasia of the dilated salivary duct.

B- Nicotine stomatitis with diffuse white change in the palatal mucosa, along with elevated papules with red centers.

Nicotine Stomatitis

Tretment• Nicotine stomatitis is completely reversible once

the habit is discontinued. • The lesions usually resolve within 2 weeks of

cessation of smoking. • Biopsy of nicotine stomatitis is rarely indicated

except to reassure the patient.• biopsy should be performed on any white lesion

of the palatal mucosa that persists after month of discontinuation of smoking habit

Smokeless Tobacco–Induced Keratosis

Definition • Chewing tobacco is an important established risk

factor for the development of oral carcinoma .• Smokeless tobacco keratosis is the term for white

plaques that form on the oral mucosa, usually vestibule, and the gingiva in the areas which habitually come into direct contact with tobacco in a smokeless tobacco user .

• These lesions are characterized by thickened, white mucosa that is typically wrinkled.


A B C

C- Snuff pouch showing extensive periodontal tissue destruction and a thickened area of leukoplakia.

B- Snuff pouch with a white wrinkled mucosal surface.

A- White leathery nodular tobacco pouch. These thickened areas are more worrisome for malignant transformation


Tretment• Cessation of use almost always leads to a normal

mucosal appearance within 1 to 2 weeks.• The risk of malignant transformation is increased

fourfold for chronic smokeless tobacco users

Sanguinaria-Induced Leukoplakia

Definition• a mixture of benzophenanthridine alkaloids

derived from the common bloodroot plant ( Sanguinaria canadensis ), has been used in oral rinses and toothpaste.

• The most widely used product with Sanguinaria, Viadent, has been shown, through extensive clinical trials, to be effective against plaque buildup and gingivitis.


A- Typical white corrugated leukoplakia in the maxillary vestibule, associated with sanguinaria use.

A B

B- Mandibular vestibular lesion inthe same patient


Tretment• No appropriate treatment has been established

for sanguinariainduced leukoplakia .• In all cases, complete discontinuation of

Sanguinaria-containing products and cessation of any other harmful habits such as tobacco or alcohol use is mandatory.

• All patients should be given careful clinical followup, with a biopsy of any recurrent or worsening lesion(s).

be careful !!

Reactive white lesions oral pathology

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