DTUS1310

Most common on the anterior buc- cal mucosa, labial mucosa and lat- eral border of tongue. c. The lesion appears as a white diffuse, broad-based, well-demar- cated, painless, thick plaque with papillary or verruciform surface projections. Site often corresponds to the site of placement of tobacco, e.g., mandibular ridge or gingivae. d. Blotchy, marble-like pal- lor or progressive stiffness due to fibrous bands formation. Most often involves the buccal mucosa or pos- terior part of oral cavity. e. Symmetric, thickened, white, corrugated or velvety, diffuse plaques. Affect the buccal mucosa bilaterally. Clue No. 5 Chewing smokeless tobacco for the past two to three years. 6) Mark chewer (C) or non-chewer (NC) next to the following lesions: a. Oral submucous fibrosis b. White sponge nevus c. Tobacco pouch keratosis d. Verrucous carcinoma e. Factitial injury At this point, we have three D/Ds to work upon (excluding OSF and WSN). Other features that would help us reach the diagnosis include the following. Factitial injury (morasicato buccarum/labiorum/linguarum) Etiology • Due to chronic chewing/suck- ing on mucosa. Associated with stress or psychologic condition. • Patients are generally aware of this habit. • Infrequently combined with intervening zones of erythema, ero- sion or focal traumatic ulceration. Verrucous carcinoma vs. TPK Etiology • Chronic tobacco chewing or snuff. Site Typically in the area where the tobacco is habitually placed, e.g., mandibular vestibule. Identifying features of VC • Old age • Usually becomes extensive before diagnosis • “Verrucae” show white, well- demarcated, thick plaque with pap- illary or verruciform surface projec- tions (VC can become a D/D only in the very early stages because later it shows verrucae formation). Thus, we made a diagnosis of tobacco pouch keratosis. Going further 7) Mark true (T) or false (F) next to the following questions: a.This lesion can also occur because of smoking tobacco. b. This is a pre-cancerous lesion. c. Develops shortly after heavy tobacco use and remains unchanged indefinitely unless is habit altered. d. It is seen at the same site where the coarsely cut tobacco leaves or finely ground tobacco leaves (“snuff”) are kept. e. Stretching of mucosa reveals a distinct “pouch” (snuff pouch, tobacco pouch) caused by flaccidity in the chronically stretched tissues. f. Histologically, shows parakera- tin chevrons, acanthosis, intracellu- lar vacuolization and unusual depo- sition of amorphous eosinophilic material in connective tissue and salivary glands. g.Epithelial dysplasia is uncom- mon (if present, mild). Treatment and prognosis 8) Mark true (T) or false (F) next to the following questions: a. Malignant transformation potential of TPK is low. b. Biopsy is needed only for more severe lesions. c. Alternating the tobacco chew- ing sites between left and right sides will eliminate/reduce. DT Oral Pathology DENTAL TRIBUNE | May 20106 ADS t Dr. Monica Malhotra is an assistant professor at the Sudha Rustagi Dental College in India and also maintains a private practice. Malhotra completed her master’s in oral pathology at the Manipal Institute, India, in 2009. In 2008 she was presented with a national award for the best scientific study presentation by the Indian Association of Oral and Maxillofacial Pathology. You may contact her at drmonicamalhotra@ yahoo.com. About the author f DT page 5 Answers 1)Tobaccopouchkeratosis 2)a.VCN=oldage;b.WSN=atbirthorduringearlychildhood 3)a,c,d Explanation Mobilityof#33andsensitivityoflowerleftsideofteeth;mobilityoccurs becauseoflossofattachmentandlossofbone;sensitivityofacoupleof teethwouldoccurbecauseoflossoftoothstructureorattachmentloss;the twocanoccurbecauseofthehabitofkeepingsomeabrasivematerialin theoralcavity.Thiscouldbeduetotheuseof“smokelesstobacco”asin thecaseofTPK,OSForVC.Wecan’tnarrowdownonthisbasisasthere couldbesomeotheretiology,e.g.,incorrecttoothbrushdexterity. 4)a,b,c,dareNS.LettereisNStoo,butmightbescrapableinafew cases. 5)a=TPK;b=factitialinjury;3=VC);4=OSF;5=WSN. Thus,OSFistheonlydifferentialwecanomitbecauseitneverpresents asaplaque. 6)a=C;b=NC;c=C:d=C;e=NC. NowwecanexcludeWSNbecauseitisseenatbirthorearlychildhood andisnotassociatedwithchewing. 7)a=F;b=F;c=T;d=T;e=T;f=T;g=T 8)a=T;b=T;c=T