Reactive Lesions

BY: ABEGAIL R. TACUYAN

FOCAL HYPERKERATOSIS

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 FOCAL HYPERKERATOSIS

ETIOLOGY

• It is a white lesion caused by chronic rubbing or friction

• Results in hyperkeratotic lesion  callus on the skin
• A sharp or broken cusp that rubs against the buccal mucosa or lateral/ventral
tongue may cause an area of hyperkeratosis

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 FOCAL HYPERKERATOSIS

PATHOGENESIS

Excessive formation of tenaciously attached keratin in the mouth, which

can result from friction.

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 FOCAL HYPERKERATOSIS

CLINICAL FEATURES
• Occurs in most commonly traumatized areas like
the lips, lateral margins of the tongue, buccal
mucosa (occlusal line) and alveolar ridges
(edentulous)
• Edentulous ridges and vestibules may be affected
in denture wearers
• Chronic cheek / lip chewing  opacification in
the affected area

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 FOCAL HYPERKERATOSIS

HISTOPATHOLOGY
• Hyperkeratosis – primary change
• Thickening of granular cell layer
• Acanthosis
• Few chronic inflammatory cells in the adjacent
connective tissue

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 FOCAL HYPERKERATOSIS

DIFFERENTIAL DIAGNOSIS

CANDIDIASIS

LEUKOPLAKIA

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 FOCAL HYPERKERATOSIS

TREATMENT AND MANAGEMENT

• Observation of the lesion

• Control of the habit
• No malignant potential exists

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DENTIFRICE-ASSOCIATED SLOUGH

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 DENTIFRICE-ASSOCIATED SLOUGH

ETIOLOGY
Chemical burn due to the use of different brand of toothpaste

PATHOGENESIS

Epithelial desquamation resulting from the use of dentifrices

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 DENTIFRICE-ASSOCIATED SLOUGH

CLINICAL FEATURES

• Painless superficial whitish / grayish-white slough of

the buccal mucosa
• Oral peeling that easily swipes away
• Culprit: sodium lauryl sulfate in toothpastes

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 DENTIFRICE-ASSOCIATED SLOUGH

HISTOPATHOLOGY

Sanguinaria-associate Keratosis commonly

Seen in maxillary vestibule

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 DENTIFRICE-ASSOCIATED SLOUGH

DIFFERENTIAL DIAGNOSIS
• Oral lichen planus
- white, homogenous, slightly elevated, multifocal,
smooth lesion commonly seen in posterior buccal
mucosa
- painful

• Leukoplakia
- white or grayish patches form usually inside the
mouth
- cannot be rub off
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 DENTIFRICE-ASSOCIATED SLOUGH

TREATMENT AND MANAGEMENT

• Shift to another brand of toothpaste

• Cocoamidropyl-betaine has been considered a milder detergent with
less risk for DAS

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 REFERENCES

Allen, C., & Woo, S. (2018). Visual Dx. Oral Frictional Hyperkeratosis – Oral Mucosal lesion. Retrieved from:
https://www.visualdx.com/visualdx/diagnosis/oral+frictional+hyperkeratosis?diagnosisId=53662&m
oduleId=20

Jordan, R., Regezzi, J & Scuibba, J. Oral Pathology: Clinical Pathology Correlations (7th Ed.)

Tapia, J. (2021). Medscape. Oral Frictional Hyperkeratosis. Retrieved from:

https://emedicine.medscape.com/article/1076089-overview

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