The collagen sclerosis can be concentrated around nerves, vascular channels and can also result in salivary gland fibrosis. The site is secure. 6b) [24]. Included in the discussion are frictional keratoses, irritant contact stomatitis, and smokeless tobacco keratoses. Typically, the lesions appear as distinct, focal, and translucent-to-opaque white asymptomatic patches with sharply delineated borders. INCIDENCE Frictional keratosis is common. The exact prevalence is unknown but most likely these reactions are uncommon. The palate, particularly the soft palate, is affected. White lesions of the oral cavity are quite common and can have a variety of etiologies, both benign and malignant. https://profreg.medscape.com/px/getpracticeprofile.do?method=getProfessionalProfile&urlCache=aHR0cHM6Ly9lbWVkaWNpbmUubWVkc2NhcGUuY29tL2FydGljbGUvMTA3NjA4OS1jbGluaWNhbA==. 2b The microscopic features of oral lichenoid contact reaction to cinnamon show marked epithelial acanthosis and intracellular edema. on your tongue or palate; on the bottom of your mouth; . Early lesions tend to have a filmy white to gray opalescent appearance with a wrinkled surface and minimal mucosal thickening (Fig. 4a) [14, 16]. (H&E magnification 100). Scully C, Felix DH. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Differential diagnosis of oral soft tissue lesions. 2015 Aug 1. When the gingival tissues are involved, patients may report using a medium- or hard-bristled toothbrush or other oral hygiene aids. Frictional keratosis is among the many different keratosis conditions. Although leukoedema is generally not biopsied, histologic findings of parakeratosis and spongiosis is seen [15]. Occasionally, the frictional line is somewhat more diffuse, and this type of change is more likely to be associated with the habit of cheek chewing, also known as morsicatio buccarum (see images below), rather than the occasional accidental friction of teeth against the mucosa during the normal eating process. The use of oral tobacco products used in North American and Europe can result in clinical changes at the site of tobacco placement. Oral frictional hyperkeratosis is a benign abnormality of mucous membrane lining the inside of the mouth, which generally occurs in adults. FRICTIONAL KERATOSIS White lesions caused by repeated trauma, such as from food, the teeth, toothbrushing or dental appliances. Within the parakeratin and spinous layer, are dyskeratotic cells with crenated or pyknotic nuclei surrounded by homogenously dense eosinophilic cytoplasm (Fig. These microscopic features are not unique to dentifrice stomatitis, but with appropriate clinical information, an association can be proffered. 1b Oral lichenoid contact reaction to dental amalgam often has a dense lymphocytic infiltrate subjacent to the epithelial cells. Swedish-type moist snuff is termed snus and is typically placed under the upper or lower lip [33]. The inflammation unlike oral lichen planus is composed of lymphocytes, plasma cells and scattered eosinophils. This wider area of roughened mucosa is typical of those produced by the habit of cheek biting or nibbling. Leukoplakia is a clinical term reserved for white lesions that cannot be characterized clinically or pathologically as any other disease (ie, frictional keratosis, lichen planus, candidiasis,. White lesions in oral cavity Def. In addition, the affected fungiform papillae may be red and enlarged from the chronic irritation. Microscopic examination of fragments of mucosa peeled away from the affected area revealed fragments ofparakeratotic cornified material colonized by numerous bacteria (Figure 3). Courtesy of Catherine M. Flaitz, DDS and Alfredo Aguirre, DDS. 4b inset). and transmitted securely. Surgical Dentistry / Oral Surgery is concerned with the diagnosis and surgical management of pathological processes and anomalies in the teeth or their supporting structures. These white patches are associated with either a conscious or an unconscious chronic oral habit. Geographic It is seen worldwide. (cold sores), the gums, the tongue, the palate (roof of mouth) or the tongue. (Photographs courtesy of Dr. Hans Grossniklaus). Int J Oral Sci. 7-2b). The diagnosis of oral frictional hyperkeratosis was established based on the clinical and microscopic findings. [Guideline] Rethman MP, Carpenter W, Cohen EE, et al. The https:// ensures that you are connecting to the Weitkunat R, Sanders E, Lee PN. 1d). In one study, 19% of patch test positive patients to amalgam-related allergens had complete resolution after amalgam replacement and 61.5% had a partial resolution [27]. Frictional keratosis Frictional keratoses occur in oral cavity subsites that are subjected to chronic low-grade trauma. 2b) [8, 12]. The keratin surface is either parakeratotic or orthokeratotic with spires of chevron parakeratosis imparting a wavy appearance to the keratin surface (Fig. 16:39-78; discussion 79. Axll T. Occurrence of leukoplakia and some other oral white lesions among 20,333 adult Swedish people. Diagnosis : Frictional Hyperkeratosis di mukosa bukal kiri Diagnosis Banding : Cheek Biting, Linea Alba, White Sponge, Nevus, Lichen Planus, Leukodema, Leukoplakia, dan Smokeless Tobacco Keratosis 3. b Biopsy shows a corrugated or slightly papillary epithelial architecture with hyperorthokeratosis, a prominent granular cell layer but normal epithelial maturation. The abovementioned categories of frictional keratosis should inform you that you need to be careful when you are brushing, for instance, so that you do not cause damage to your mouth and create a condition that will come to haunt you the rest of your life. Flaitz CM. It had been around for long now and there is rarely Seborrheic keratosis can come up on any part of the body. Frictional keratosis from the alveolar ridge usually is surfaced by orthokeratin with a slightly irregular or corrugated architecture (Fig. 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. SLS is a common synthetic detergent added to toothpaste for foaming and cleaning. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2002 Jan-Feb. 7(1):4-9, 10-6. This lesion should quickly resolve after removal of the provoking stimulus. You may find it difficult to Seborrheic keratosis is not so uncommon around today. Oral and Maxillofacial Pathology. Gabri D, Vrdoljak DV, Boras VV. adminsos 26th October 2011. 2002 Jun. Benign alveolar ridge keratosis (oral lichen simplex chronicus): A distinct clinicopathologic entity. Such keratosis conditions as oral frictional keratosis do not affect ones health to a great extent. The clinical presentation can vary. Age It occurs in the middle-aged and older patient. 2008 Jan. 58(1):151-7. As mentioned in tidbits above, leukoplakia is predominantly a disorder of the mouth. Time is the main characteristic that separates an oral . 7-1c) [29]. 2019 Mar. At times the superficial parakeratin is completely detached from the underlying stratified squamous epithelium or this superficial sloughing is all that is submitted for histologic examination. The production of keratin is increased in areas which . Frictional keratosisis a skin growth that can result from mild mechanical trauma or irritation of the skin. 2019 Mar;13(1):16-24. doi: 10.1007/s12105-018-0986-3. Classification schemes for lesions of the oral cavity typically have used the clinical appearance of lesions to determine which are premalignant. Carcinoma of the lip five years after bone marrow transplantation. [4] The formation rate depends on the frequency of habit, dose, and even the brand used. Individuals with a cheek and lip biting habit often report they are able to remove thin strands or tags of mucosa from the involved site. The epithelium may show acanthosis and epithelial rete may be elongated or atrophic [ 9, 10 ]. When this is done, the lesion takes less time to disappear completely. [QxMD MEDLINE Link]. However, there are instances when the leukoplakia may . Note the large amalgam restorations that directly contacts the affected mucosa. The thickened layer of keratin that develops where the smokeless tobacco is placed varies in clinical appearance depending on frequency of use or the amount used [35]. 2000 Nov-Dec. 22(6):511-2. The first step in the identification of white patches suspected of being associated with physical trauma is to use a 2 X 2-inch sterile gauze to wipe off the lesion or lesions. K13.29 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. In the 2005 WHO section of epithelial precursor lesions, squamous cell hyperplasia was considered a precursor lesion and thus, termed leukoplakia [2]. HHS Vulnerability Disclosure, Help Diagnosis can often be very tricky. The https:// ensures that you are connecting to the Clinicians may be concerned for a vesiculo-bullous process such as mucous membrane pemphigoid. Int J Paediatr Dent. 285-329. All material on this website is protected by copyright, Copyright 1994-2023 by WebMD LLC. The 3rd is about a week ago showing the way it's raised. The epithelium is acanthotic with ballooned cells. Oral Surg Oral Med Oral Pathol. Results from periodic acid-Schiffstain revealed no fungal elements. Courtesy of Catherine M. Flaitz, DDS and Alfredo Aguirre, DDS. Generally, first noted in childhood, the lesions wax and wane over time [14, 16]. The alveolar ridge mucosa that had previously been "protected" from food impingement is now exposed to trauma and becomes hyperkeratotic as a protective mechanism. The epithelium exhibits epithelial hyperplasia and intracellular edema is common presenting as ballooned cells in the spinous layer. There are those keratoses that are so hidden that they could be invisible to the naked eye till the doctor examines your mouth or carries out a biopsy. 13 (1):16-24. Typically we see this finding in the grouping of "premalignant" lesions of epithelial origin. Extensive oral mucosal hyperkeratosis caused by over-the-counter long lasting snoring relief agent. Differential diagnosis of oral mucosal lesions in children and adolescents. Causes of white lesions:- 1-Increase in thickness of one or more of epithelial layers. White sponge nevus: report of a three-generation family. A clinicopathologic comparison of 2,153 lesions. The prevalence has been reported as high as 5.5%. HHS Vulnerability Disclosure, Help 2006 Nov. 12(6):553-8. It might have already appeared on you Privacy Policy | Security Statement | Terms & Conditions, Seborrheic Keratosis Removal With Hydrogen Peroxide, Home Remedy For Removing Seborrheic Keratosis, Herbal Treatment For Seborrheic Keratosis. Frictional keratosis - Usually seen at sites of trauma from teeth, also along buccal occlusal line and occasionally beside an outstanding tooth, or on edentulous ridge. Cinnamon-induced stomatitis venenata, Clinical and characteristic histopathologic features. This may also be seen on vestibular mucosa in areas where loose dentures chronically and mildly push against the mucosa. This occurs on the maxillary and mandibular alveolar ridges particularly after extraction of teeth, and particularly in the area of extracted mandibular third molars on the retromolar pad area. 8600 Rockville Pike It usually involves the lateral tongue, cheeks, or lips. When the inflammation is difficult to control, chronic eczema can lead to: Hyperkeratosis. Dry skin. Alveolar ridge keratosis is a frictional keratosis located on the edentulous alveolar ridge and/or retromolar pad. 2005 Mar. Its appearance can also be in form of a distinct patch that is also white in color in any part in the mouth. Alfredo Aguirre, DDS, MS Director of Advanced Oral and Maxillofacial Pathology Training Program, Professor, Department of Oral Diagnostic Sciences, State University of New York at Buffalo 19(2):99-103. Case number 3. Courtesy of Catherine M. Flaitz, DDS and Alfredo Aguirre, DDS. This study found no sex predilection although other studies have reported leukoedema is more commonly seen in males [4]. Medscape Education, A Genitourinary Overview of Bladder and Prostate Cancers, encoded search term (Oral Frictional Hyperkeratosis) and Oral Frictional Hyperkeratosis. The surface of a lesion may appear irregular and feel rough to the tongue. Tex Dent J. Superficial sloughing of the mucosa as described above with edema and erythema of the gingiva is associated with cinnamon containing toothpaste [30]. 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. Most often these types of lesions (attachment removed to protect patient identity) are from frictional keratosis that is a soft tissue becomes tough and white due to continuous friction over time. HBID does not affect the anogenital region, esophagus or nasal mucosa. Mathew AL, Pai KM, Sholapurkar AA, Vengal M. The prevalence of oral mucosal lesions in patients visiting a dental school in Southern India. This condition derives its name from the act of friction (another object constantly rubbing itself against the skin) and this may lead to Frictional keratosis patches. This is the American ICD-10-CM version of K13.21 - other international versions of ICD-10 K13.21 may differ. 1986 Apr. keratin layer on the surface of the tongue is thickened (arrow). Greer RO., Jr Oral manifestations of smokeless tobacco use. Most patients with frictional keratosis are free of symptoms, with the exception of those with aggressive cheek and lip biting habits. Frictional (traumatic) keratosis is defined as white plaques with a rough and frayed surface clearly related to an identifiable source of mechanical irritation. Meta-analysis of the relation between European and American smokeless tobacco and oral cancer. MeSH a Superficial sloughing of the oral mucosa due to the use of triclosan and pyrophosphate containing toothpaste. Kessler HP. Oral Surg Oral Med Oral Pathol Oral Radiol. [20] Occasionally, ill-fitting or broken mouthguards or occlusal splints irritate the oral mucosa, resulting in frictional keratosis. Epidemiological evidence relating snus to healthan updated review based on recent publications. Early PVL lesions from the alveolar ridge and gingiva are indistinguishable from benign keratosis and leukoplakia without dysplasia exhibiting marked orthokeratosis with a slight corrugated surface and prominent granular cell layer (Fig. 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]. Received 2018 Sep 21; Accepted 2018 Nov 2. The mostly associated symptoms of this condition include the hyperkeratosis and porokeratosis that appear and can be seen. Br Dent J. Perivascular inflammation in the deeper lamina propria is present, a feature not typical for oral lichen planus (H&E magnification 40). Macigo FG, Mwaniki DL, Guthua SW. This might give you immediate relief. Get it evaluated in a Dental office. 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. These include frictional keratosis arising from excessive force while brushing the teeth (toothbrush. Martin JL. (H&E magnification 100). Frictional keratosis can also be avoided in a number of ways. It can be triggered by allergies, irritating chemicals and other factors. A model study. Linea alba is the term used to describe the white keratotic line on the buccal mucosa approximating the occlusal plane. Another histologic feature present in amalgam contact reactions and not a typical finding in oral lichen planus is the presence of a deep inflammatory infiltrate rather than inflammation confined to the lamina propria subjacent to the epithelial basal cells. Suter VG, Warnakulasuriya S. The role of patch testing in the management of oral lichenoid reactions. A ten-year follow-up. Careers. Oral frictional hyperkeratosis of the lateral border of the tongue from chronic biting habit. If you notice a spot on your skin that looks red, feels rough & will not heal, what you Privacy Policy | Security Statement | Terms & Conditions. These lesions can occasionally mimic dysplastic leukoplakia. Steroids are administered to help with the symptoms of Oral Lichen Planus. Careers. . The oral mucosa is exposed to a wide variety of external irritants. Oral frictional hyperkeratosis of the attached maxillary gingiva from inappropriate toothbrushing technique. Fast Five Quiz: What Do You Know About Dental Health? 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. Nonetheless, this condition should be treated during its initial stages to achieve best results. There are some very simple treatment methods that do not Are you suffering from age spots and want to remove them but don't know how? Rounded or irregularly shaped white plaques may be seen on the anterior dorsal surface of the tongue from a chronic tongue thrust habit (tongue thrust keratosis, Fig. Lee PN, Hamling J. Applicable To. 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]. 5 inset). [QxMD MEDLINE Link]. Pediatr Dent. Castellanos JL, Daz-Guzmn L. Lesions of the oral mucosa: an epidemiological study of 23785 Mexican patients. [QxMD MEDLINE Link]. 2008 May. such as dorsum of the tongue, hard palate, and attached gingiva, sometimes . Jose Luis Tapia, DDS is a member of the following medical societies: American Academy of Oral and Maxillofacial PathologyDisclosure: Nothing to disclose. Woo SB, Lin D. Morsicatio mucosae orisa chronic oral frictional keratosis, not a leukoplakia. [Prevalence study of oral mucosal lesions in 300 patients]. Mller S. Update from the 4th edition of the world health organization of head and neck tumours: tumours of the oral cavity and mobile tongue. Flecks of smokeless tobacco are present within the lesion. Med Oral. The effects of the habit of chronic biting may also manifest on the anterior and lateral borders of the tongue and appear as white, shaggy or mildly wrinkled plaques (see image below). Although candidal hyphae may be present this is uncommon and unrelated to the underlying etiology. J Am Dent Assoc. [QxMD MEDLINE Link]. Lip-bite keratosis is caused by frequent involuntary biting of ones lips. White, thickened plaques with irregular, rough surface change are noted on the gingiva of the right maxilla and mandible. What causes frictional keratosis? The plaque had a slightly irregular surface, had no surrounding erythema, and was the only such plaque in the . The affected area may exhibit a macerated appearance with shredded keratin and peeling (Fig. Many products can result in contact stomatitis. The epithelium is acanthotic and cellsin the spinous layer may show vacuolated cytoplasm. It was concluded that the hyperkeratosis was likely caused by bite trauma or grinding of the teeth while the patient was asleep. Courtesy of Catherine M. Flaitz, DDS and Alfredo Aguirre, DDS. A systematic review. 3a, b). Federal government websites often end in .gov or .mil. A mild lymphoplasmacytic infiltrate in the subepithelial lamina propria is typical. Lesions associated with a tongue thrusting habit often demonstrate prominent crenations of the lateral tongue. This review will focus exclusively on reactive white oral lesions. Cinnamon flavoring agents including cinnamic aldehyde, cinnamic acid and cinnamon oil, can cause a contact stomatitis [30]. Laporan kasus : Seorang laki-laki 22 tahun datang . The prevalence of oral mucosal lesions in a population in Ljubljana, Slovenia. 2008 Apr-Jun. The wear on the occlusal surfaces of the molar teeth suggests that the patient had a habit of bruxism. The plaques could be easily peeled away from the underlying skin with a cotton swab without any pain, leaving behind normal underlying mucosa. In one study evaluating benign alveolar ridge keratosis with lesions exhibiting dysplasia, lesional size was not a predictor [10]. The 2023 edition of ICD-10-CM K13.21 became effective on October 1, 2022. 1a). FOIA Indian J Dent Res. Other mucosal sites of involvement include nasal, esophageal and anogenital. It is a very common skin condition. a Typical clinical presentation of an early smokeless tobacco keratosis demonstrating an area of superficial keratosis with slight wrinkling, lacking any appreciative mucosal thickening. HBID is characterized histopathologically by hyperplastic stratified squamous epithelium with marked parakeratosis and acanthosis (Fig. Clinical features of cinnamon-induced contact stomatitis. Total resolution of the condition was achieved upon discontinuation of the tartar control toothpaste. Those Seborrheic keratosis is one of the most common skin conditions around today. Hereditary benign intraepithelial dyskeratosis. Skinmed. Hassona Y, Scully C. Oral mucosal peeling. 7-2c) [10, 31]. (H&E magnification 400). The first image below shows a frictional keratosis lesion that displays marked keratinization. Many kids and older ones are having Seborrheic keratosis is one of the most common skin conditions on earth today. [QxMD MEDLINE Link]. These lesions will resolve upon cessation of the habit. 1 Given the high-risk nature of some white patches, it is important to perform a thorough history and examination. MeSH terms Adolescent Adult Age Distribution Aged Aged, 80 and over You are being redirected to Scully C. Cannabis; adverse effects from an oromucosal spray. Apart from altering the beauty of the mouth, this white patch has no problems associated with it. Three contact-related lesions that can present as white or keratotic oral lesions which have a unique histology are contact reactions to ingredients in some toothpaste, amalgam, and cinnamon flavoring agents. Biopsies should be performed on these lesions that do not heal to rule out a 8b). 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. Frictional keratosis from the alveolar ridge usually is surfaced by orthokeratin with a slightly irregular or corrugated architecture (Fig. Much of the time the oral mucosa is in contact with these products for short periods of time or saliva dilutes and buffers the irritants reducing the potential for an adverse reaction. Br Dent J. Parlak AH, Koybasi S, Yavuz T, et al. Schulten EA, Jovanovic A, van der Waal I. Ned Tijdschr Tandheelkd. 2000 Aug. 29(7):331-5. 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. 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. [QxMD MEDLINE Link]. 2012 Mar-Apr. J N J Dent Assoc. A prominent granular cell layer is noted. Head Neck Pathol. This involves removal of the agent that causes irritation on the cheeks, lips and gum. Confounding variables including the use of cigarettes and alcohol consumption along with smokeless tobacco use are associated with an increased oral cancer risk [40]. 8600 Rockville Pike Epibulbar blood vessels can be hyperemic resulting in a bloodshot appearance. Type 1 Excludes. In some patients the frictional keratoses can be extensive involving the entire cheek and extending to the lips. [QxMD MEDLINE Link]. In the superficial epithelium, eosinophilic perinuclear condensation, representing compact aggregates of keratin tonofilaments, unique to WSN, is present [16, 17]. The website grew out of my desire to share with people (both fellow dentists and patients) my knowledge of the subject. St. Louis, Mo: WB Saunders; 2009. biting the cheek), leading to a reaction of the mucosa in the oral cavity. The author declares they have no conflict of interest. As an Oral Surgeon, I find that the more . Frictional keratosis, contact keratosis and smokeless tobacco keratosis: . This occurs mostly in the mouth area. - It is homogeneous and clears when irritation is removed. The true prevalence of frictional keratoses is unknown as studies that review oral mucosal lesions are generally clinically based and may miscategorize leukoplakia as frictional keratoses or vice versa. Frictional keratosis is mostly associated with the gum and the cheek. Kashani HG, Mackenzie IC, Kerber PE. It evens regresses a little and then comes back even worse than before. When such friction is allowed to continue, it promotes keratin to grow thereby creating white lesions a product of keratin thickening. If the cause of the white patches is a precancerous . However, chronic frictional or chemical assault on the tissue over time can also cause dysplastic changes. 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. I bought a new waterpik today and when I used it the first time, there was a lot of blood in the sink. Be sure that any frictional irritant is removed. Hereditary benign intraepithelial dyskeratosis: report of two cases with prominent oral lesions. b When the cheek is everted and stretched the lesion diminishes. The clinical effectiveness of reflectance optical spectroscopy for the in vivo diagnosis of oral lesions. This occurs when the tongue constantly rubs against one's teeth. Hyperkeratosis (thickening of the stratum corneum) occurs in two forms: orthokeratotic ( Figure 1 and Figure 2) or parakeratotic hyperkeratosis. Representative biopsies show epithelial acanthosis, often with elongated rete ridges (Fig. 2004 Sep. 135(9):1279-86. [QxMD MEDLINE Link]. Before Oral Surg Oral Med Oral Pathol Oral Radiol Endod. Macdonald JB, Tobin CA, Hurley MY. Shulman JD, Beach MM, Rivera-Hidalgo F. The prevalence of oral mucosal lesions in U.S. adults: data from the Third National Health and Nutrition Examination Survey, 1988-1994. Lichen planus appears in nummular form on a patient's tongue. The histological findings of STK though not unique have characteristic findings. Before The . Smoker's keratosis - Pipe smoking is the usual cause. Of unknown etiology, PVL is associated with high recurrence and malignant transformation rates. government site. The connective tissue can be uninvolved in STK with little to minimal inflammation. How long does it take for frictional keratosis to heal? The removal of the irritant causing agent should be done in the early stages of the frictional keratosis to achieve a fast and effective cure. 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. Dabrowa T, Dobrowolska A, Wieleba W. The role of friction in the mechanism of retaining the partial removable dentures with double crown system. Courtesy of Catherine M. Flaitz, DDS and Alfredo Aguirre, DDS. It occurs as a white patch in the mouth. Snuff dippers keratosis or snuff pouch. The basal cells show nuclear hyperchromatism but no dysplasia is seen. Prevalence of oral mucosal lesions in a Kenyan population with special reference to oral leukoplakia. 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]. 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. 5). Frictional keratosis is a skin growth that can result from mild mechanical trauma or irritation of the skin. Care should be made in rendering a diagnosis of frictional keratosis of the alveolar ridge and more importantly, gingiva in tooth-bearing areas when limited clinical information is available. The connective tissue lacks inflammation. Haisley-Royster CA, Allingham RR, Klintworth GK, Prose NS. In: el-Naggar AK, Chan JKC, Grandis JR, Takata T, Slootweg PJ, et al., editors. This feature manifests as a horizontal thickening of the buccal mucosa along the occlusal line of the teeth.