DTUS1110

Pattern a. Thin elevated white line at the occlusal plane b. White patch or plaque (homogenous type)/mixed red and white lesion (non-homog- enous type) c. White “milk curd” (pseu- domembranous type)/white patch or plaque (hypertrophic type)/red (atrophic type) d. Milky white alterations of the buccal mucosa, bilateral e. Raised thin white lines in arcuate pattern (reticular type)/white elevated plaque (plaque type)/red (erythema- tous) areas with thin striae at the periphery (atrophic and erosive type). Lesions 1. Leukoplakia 2. Linea alba 3. Candidiasis 4. Lichen planus 5. Leukoedema We can narrow down the various specific clinical types of the lesions and exclude linea alba from the differential diagnosis (D/D): a. Leukoplakia (homog- enous type) b. Lichen planus (plaque type) c. Leukoedema d. Candidiasis (hypertro- phic/pseudomembranous type) Clue No. 3 Is the lesion scrapable (S) or non-scrapable (NS)? 4) Mark scrapable (S) or non- scrapable (NS) next to each lesion. a. Leukoplakia b. Linea alba c. Lichen planus d. Leukoedema e. Candidiasis Clue 4 Smoking five to six bidis per day for the last four years. 5) Mark smoking (SK) or non- smoking (NSK) next to each lesion. a) Leukoplakia b) Linea alba c) Lichen planus d) Leukoedema e) Candidiasis Thus, we now have four D/ Ds to work upon (excluding linea alba). Other features that help in reaching a diag- nosis: Stretch: Leucoedema will fade away. Antifungal treatment: Candi- diasis will be cured. Site: Plaque type of lichen planus is most often seen on the dorsum surface of the tongue. It is generally nodular in nature with or without areas of reticular type of lichen pla- nus around it. Most clinicians can eas- ily distinguish lichen planus from leukoplakia; however, if you have difficulty in doing so or are in doubt, please do a biopsy. Foremost, the biopsy is done to diagnose. It is also com- pleted to discover any dysplas- tic features associated with lichen planus. In this case, a biopsy was done for the lesion and the histopathological diagnosis made was moderate epithelial dysplasia. Part II: Digging deeper Let’s explore your knowledge of oral leukoplakia. 6) Mark true (T) or false (F) next to the following state- ments. a) A predominantly white lesion of the oral mucosa that cannot be characterized as any other definable lesion. b) It is a pure clinical term and has nothing to do with some specific histology. c) The etiology proposed includes tobacco, alcohol, can- didiasis, electrogalvanic reac- tions and (possibly) herpes simplex and papillomaviruse have been implicated. d) True leukoplakia is most often related to alcohol usage e) Oral hairy leukoplakia is a type of leukoplakia with hair-like projections on the buccal mucosa. f) It has two main clinical types. Homogeneous type: lesions are white, uniformly flat and thin and exhibit shal- low cracks of the surface keratin. Non-homogeneous type: lesions are mixed, i.e., red and white with nodular or verrucous type of growth. Histology assessment 7) Mark true (T) or false (F) next to the following state- ments. a) It may show atrophy or hyperplasia (acanthosis) and may or may not demonstrate epithelial dysplasia. b) The majority of leukopla- kias will not show dysplasia and correspond to the hyper- plasia category. c) The dysplastic changes typically begin in the superfi- cial zones of the epithelium. d) The higher the extent of epithelial involvement, the higher the grade of dysplasia. Treatment and prognosis 8) Mark true (T) or false (F) next to the following ques- tions. a) For the persistent lesion, definitive diagnosis is estab- lished by tissue biopsy. b) Definitive treatment involves surgical excision or cryosurgery and laser abla- tion. Total excision is aggres- sively recommended when microscopic dysplasia is iden- tified, particularly if the dys- plasia is classified as severe or moderate. c) Non-homogeneous lesions carry a lesser risk of malignant transformation than homogenous lesions. d) It has a variable behav- ioral pattern but with an assessable tendency to malig- nant transformation. DT Oral Pathology DENTAL TRIBUNE | April 201016A f DT page 15A t Dr. Monica Malhotra is an assistant professor at the Sudha Rustagi Dental College in India and also maintains a private practice. In 2008 she was presented with a national award for the best scientific study presentation by the Indian Association of Oral and Maxillofacial Pathology. Malhotra completed her master’s in oral pathology at the Manipal Institute, India, in 2009. You may contact her at drmonicamalhotra@ yahoo.com. About the author Answers 2)1=c;2=b;3=a 3)1=b;2=a;3=c;4=e;5=d 4)Lettersa–dareNS;lettere isS. 5)a=SK;b=NSK;c=SK (caseshavebeenreportedbut notproven);d=NSK(studies doneintheearly’70sfound someassociation);e=SK. 6)a=True;b=True;c=True; d=False;e=False;f=True 7)a=True;b=True;c=False; d=True 8)a=True;b=True;c=False; d=True