White tongue is the result of an overgrowth and swelling of the fingerlike projections papillae on the surface of your tongue. Five common tongue conditions often mistaken for thrush the. Fighting bad breath from a coated tongue is as simple as maintaining good oral care habits. Other areas of the oral cavity such as the ventral surface of the tongue, labial mucosa, soft palate. White surface lesions erythema migrans geographic tongue, benign migratory glossitis is a common, harmless lesion that can typically be diagnosed by its clinical features.
Oral thrush is most commonly seen in infants and the elderly. Differential diagnosis of white patches flashcards quizlet. Describe the clinical features, differential diagnosis and treatment of leukoplakia of hard palate. Nutritional deficiencies include iron, folate and vitamin b12 deficiency. Aug, 2018 independent studies suggest that rigorous monitoring for 23 years, after the initial oral leukoplakia diagnosis, may be important for studying malignancyrelated developments. White surface lesions a guide to clinical differential diagnosis of. Dec 15, 2004 a 32yearold white man who had tested positive for human immunodeficiency virus hiv presented with a twoyear history of white papules and plaques on the lateral borders of his tongue figures. One of the keys to improve accuracy in diagnosing oral lesions is forming an appropriate differential diagnosis. There are likely to be other possible causes, so ask your doctor about your symptoms. Jul 20, 2016 a single white spot or single white plaque. Oral hairy leukoplakia is a condition triggered by the epsteinbarr virus ebv.
In most cases, white tongue is not a serious or longlasting condition. Common tongue conditions in primary care american family. Apr 12, 2018 many white lesions involving the oral mucosa are benign and do not require treatment. A whitening of the top layer of the tongue or the presence of white spots or patches on the tongue can also be seen with infection, irritation, or chronic. She had a 15year history of oral lichen planus olp managed with betamethasone dipropionate, 0. Click on the combination that matches your symptoms to find the conditions that may cause these problems. White lesions of the oral mucosaa diagnostic dilemma. Free access to excerpts from published medical book extracts about the causes and diagnosis of mouth white patches from the following published medical books is available for more detailed information that is related to white patches mouth. If it is single, look for local sources of irritation, such as cheek, tongue or lip biting. According to the world health organization, the term leukoplakia should be reserved for white plaques of questionable risk, having excluded other known diseases or disorders that carry no increased risk for cancer 1. The appearance of a white coating is caused by debris, bacteria and dead cells getting lodged between the enlarged and sometimes inflamed papillae. Describe the aetiology, clinical features and management of leukoplakia. Webmd symptom checker helps you find the most common symptom combinations and medical conditions related to white patches on tongue.
Mar, 2019 oral leukoplakia ol is a white patch or plaque that cannot be rubbed off, cannot be characterized clinically or histologically as any other condition, and is not associated with any physical or chemical causative agent except tobacco. Sometimes a white patch is initially believed to represent leukoplakia, but the biopsy reveals another specific diagnosis. Sometimes the patches happen in other parts of your mouth. Oral leukoplakia is an oral potentially malignant disorder opmd that presents as white patches of the oral mucosa.
If the patches last longer than two weeks, consult your dentist. May, 2014 differential diagnosis for oral white lesions 1. Common sites are the buccal mucosa, lateral border of the tongue, floor of the mouth, and hard palate. Research the causes of these symptoms that are similar to, or related to, the symptom throat white patches. Selected differential diagnosis of white oropharyngeal lesions. Geographic tongue is sometimes referred to as migratory because its location and pattern of presentation tend to change. Leukoplakia is a firmly attached white patch on a mucous membrane which is associated with an increased risk of cancer.
An exudative membrane forms over the medial surface of the tonsils, along with the features of acute tonsillitis, like red and swollen tonsils with marked hyperaemia of the pillars, uvula and soft palate. Muscle cramps or spasms painful, white patches on tongue. A differential diagnosis lists all the possible causes of the signs and symptoms. Whitish papules and plaques on the tongue photo quiz. Leukoplakia is a firmly attached white patch on a mucous membrane which is associated with. A dry white coating can indicate cold turning to heat and starting to dry body fluids. Differential diagnosis of white lesions of the oral cavity. Leukoplakia is a white or gray patch that develops on the tongue, the inside of the cheek, or on the floor of the mouth. For example, a white tongue lesion may have the differential diagnosis of lichen planus, leukoplakia, or contact. A black hairy tongue in the setting of chronic administration of penicillins is often fungal overgrowth, particularly of aspergillus. Keratosis pharyngis usually white lumps on the tonsils. Differential diagnosis for oral white lesions slideshare. White patches on tongue causes, pictures side, back.
Some white patches on the tongue, known as leukoplakia, can be precancerous lesions. Stomatitis nicotina is a diffuse white patch on the hard palate, usually caused by tobacco smoking, usually pipe or cigar smoking. Anatomy of the palatine tonsils occupies the tonsillar sinus or fossa between the palatoglossal and the palatopharyngeal arches. May 09, 2017 white patch on the tonsil differential diagnosis 1. This is where your tongues surface becomes colonised by dead cells and. The differential diagnosis for geographic tongue includes erythroplakia or candidiasis. White surface lesions a guide to clinical differential diagnosis of oral mucosal. Considering the patients age, traumatic or frictional keratosis was included.
The most common cause of red and white tongue are canker sores, which present as oval or round lesions with white central part surrounded by a red border. With a moist and pale tongue, a thicker white coating can indicate dampcold. White lesions in highrisk areas, such as the ventral surface of the tongue and floor of the mouth, have a high propensity for neoplastic change. In such cases, the lesion should no longer be categorized as a leukoplakia. A white macule is a flat lesion simply reflecting a change of the mucosal colour. Webmd symptom checker helps you find the most common medical conditions indicated by the symptoms numbness or tingling, sore tongue and white patches on tongue including migraine headache. Oral leukoplakia plaques are clinically different from mouth lesions present in other conditions or diseases like.
Strawberry tongue, or raspberry tongue, is glossitis which manifests with hyperplastic enlarged fungiform papillae, giving the appearance of a strawberry. Oral frictional hyperkeratosis differential diagnoses. It is a systematic process of weighing the probability of one disease versus that of other diseases that may account for the tongue problem. White surface lesions a guide to clinical differential. Doctors often cant pinpoint its cause, but it usually gets better on its own.
Leukoplakia could be classified as mucosal disease, and also as a premalignant condition. Diagnosis of oral white lesions might be quite challenging. Jan 09, 2015 frictional keratosis should be included in the differential diagnosis. A thin white tongue coating can also indicate external cold patterns when the appropriate clinical symptoms are present. Glossitis, by causing swelling of the tongue, may also cause the tongue to appear smooth. These arise most commonly on the postcommissural buccal mucosa and dorsal tongue and may be associated with red areas. May 17, 2017 white tongue is often related to oral hygiene. The following medical conditions are some of the possible causes of white tongue. These include congenital or developmental conditions such as white sponge nevus, keratosis follicularis, hereditary benign intraepithelial dyskeratosis, pachyonychia congenita, and fordyce granules. Homogeneous type speckled type white and red patches verrucous typespeckled type. A network of raised white lines on your tongue with a lacelike appearance can be a sign of this condition. White strawberry tongue is where there is a white coating on the tongue through which the hyperplastic fungiform papillae protrude. Although the white color in leukoplakia is a result of hyperkeratosis or acanthosis, similarly appearing white lesions that are caused by reactive keratosis smokers keratosis or frictional keratoses e.
Therefore, a process of exclusion establishes the diagnosis of the disease. They vary in size and depth, generally have an irregular outline, and may be solitary or multifocal. Unusual taste in mouth, white patches inside mouth, white patches on tongue. Tongue exam stanford medicine 25 stanford medicine. Multiple red patches with irregular yellowwhite border. Pdf white lesions of the oral mucosaa diagnostic dilemma. Other conditions, such as oral lichen planus, lupus erythematous and drug reactions, can occasionally mimic this condition. Numbness or tingling, sore tongue and white patches on tongue. Enlarged or swollen glands, white patches on tongue. Jan 30, 2020 tongue cancer is a type of mouth cancer, or oral cancer, that usually develops in the squamous cells on the surface of the tongue. Nov 14, 2011 white lesions of the oral mucosa are a multifactorial group of disorders,the color of which is produced by the scattering of the light through an altered epithelial surface. This involves surgically removing tissue from the leukoplakia patch or removing the entire patch if its small.
A more pronounced appearance can occur with reverse smoking, sometimes distinguished from stomatitis nicotina by the term reverse smokers keratosis. Numbness or tingling, sore tongue and white patches on. Regardless of whats causing your white coated tongue, bad breath is usually a byproduct. But other irritants can cause this condition as well.
Surface debris that is easily wiped off suggests candidiasis, while a speckled white patch that cannot be rubbed off is potentially precancerous, carcinoma in situ or squamous cell carcinoma. Frictional keratosis should be included in the differential diagnosis. White tongue is a condition in which the tongue is coated by a noticeable white film. It is the mouths reaction to chronic irritation of the mucous membranes of. The usage of the term leukoplakia continues to undergo refinement. Teeth wear in the elderly can cause frictional keratosis in the lateral aspect of the tongue. White surface lesions of oral mucosa a guide to clinical. White hairs along the sides of the tongue are the classic appearance of oral hairy leukoplakia, the result of ebv infection in hivpositive individuals.
If it has been established that the lesions are nonpapillaryverrucous then the first question would be. Treatment, close follow up, stop smoking, limit alcohol, surgical removal. Whitening of the tongue can occur when there is a buildup or coating of bacteria and debris on the surface of the tongue due to mild dehydration, illness when there is less use of the tongue for talking or eating, or dryness of the mouth. This is a noninvasive procedure, but does not always result in a definitive diagnosis. It presents as multiple red patches surrounded by a thickened, irregular, white border. Oral leukoplakia differential diagnoses medscape reference. The appearance of geographic tongue may fluctuate within hours, with lesions presenting for days or months or even longer. It usually occurs within the mouth, although sometimes mucosa in other parts of the gastrointestinal tract, urinary. What are the keratinizing lesions of the oral cavity. Geographic tongue is a condition in which some areas of the tongue lack the papillae normally present on the tongue surface, resulting in irregular red patches on the tongue with a white border.
The coating may cover the entire surface of the tongue, the back part of the tongue only, or may appear in patches. Causes of similar symptoms to throat white patches. Some spots on your tongue may be both red and white. Geographic tongue is characterised by irregularly shaped red, smooth, swollen patches on the tongue, often with a white border, giving rise to a maplike appearance. Your tongue can turn white when the tiny bumps papillae that line it swell up and become inflamed bacteria, fungi, dirt, food, and dead cells can. This patient had crowns in the right posterior quadrant with no sharp margins or edges ruling out the diagnosis of traumatic or frictional keratosis. Five common tongue conditions often mistaken for thrush. It is usually selflimiting and does not require treatment, however, if symptomatic treatments can include topical anaesthetic preparations andor soluble corticosteroids used as a.
Evaluate the mouth to see if the white lesion is single or multiple. Sometimes leukoplakia of the floor of mouth or under the tongue is called. The condition results in white patches that are often cottage cheeselike in consistency on the surfaces of the mouth and tongue. A guide to clinical differential diagnosis of oral mucosal lesions. Mar 01, 2010 recognition and diagnosis of tongue abnormalities require examination of tongue morphology and a thorough history, including onset and duration, antecedent symptoms, and tobacco and alcohol use. Types of white lesions divided based on scrapping off feature.
An imbalance of the healthy bacteria in your gut can lead to oral thrush and a white. The white, elevated patches of plaquelike oral lichen planus are less prevalent. An 80yearold white woman presented with an asymptomatic white patch affecting the tongue of 1 months duration. The most common cause of a smooth tongue is the use of dentures. Apr 04, 2012 white mucosal lesions may result from thickening of one or several layers of the oral epithelium. B12 deficiency will also make the tongue sore and beefyred in color. I get those extraswollen taste buds, thats common i guess, but i also get what seems to be patches of skin on the sides of my tongue. A white patch on the tongue dermatology jama dermatology. May 10, 2019 leukoplakia is a condition in which thick, white or grayish patches form usually inside your mouth. Differential diagnosis of white lesion of oral cavity. It is painless, and it is caused by a response of the palatal oral mucosa to chronic heat. The white patches do feel sensitive to touch just the same as the swollen taste buds do.
The diagnosis and differential diagnosis of oral white lesions should be made on the basis of the medical history, clinical features, and laboratory tests. Attempts to rub off these lesions with a tongue blade were unsuccessful. Mouth sores, spots on throat, white patches on tongue. Differential diagnosis of white lesions slideshare. Note a plaque is flatter than a papillaryverrucous lesion. August 4, 2016these lesions must be differentiated from the papillaryverrucous lesions, whose appearance is often white or white and red, is shown in this section and for which there is a different flowchart. The edges of the lesion are typically abrupt and the lesion changes with time. White mucosal lesions may result from thickening of one or several layers of the oral epithelium. Below, we discuss the causes of white patches on tongue, with signs such as painful patches, white spots on side of tongue and patch under and on side of tongue. Learn vocabulary, terms, and more with flashcards, games, and other study tools. Start studying differential diagnosis of white patches.389 1 516 995 1552 1162 954 85 642 1438 1569 339 446 1121 962 818 558 532 1225 194 1244 723 700 117 1556 240 687 521 109 1226 634 1024 1115 937 1257 61 1261 785 772 688 1327 517 1317 44 975 636 795 196 286 1264