[QxMD MEDLINE Link]. The white area on your tongue could mostly be due to friction which causes Frictional keratosis. Leukoedema affects the bilateral buccal and labial mucosa and appears as an opalescent, filmy gray to white lesion that characteristically diminishes upon stretching of the mucosa (Fig. It is, however, more common in younger patients. 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]. If you were to go and see an oral surgeon for evaluation and possible biopsy they would likely look for sharp edges on your teeth in the area, smooth them down and give it a few weeks. The white line shows a slightly scalloped appearance, which correlates with the buccal surfaces of the teeth against which the mucosa is rubbed. Ask one of your family member to evaluate if you grind . Please confirm that you would like to log out of Medscape. In most cases, oral frictional keratosis appears as a thin line that is white in color across the cheek opposite the meeting point of the teeth. Classification schemes for lesions of the oral cavity typically have used the clinical appearance of lesions to determine which are premalignant. Typically we see this finding in the grouping of "premalignant" lesions of epithelial origin. Termed snuff dippers lesion, snuff pouch and spit tobacco keratosis among other terms, smokeless tobacco keratosis (STK) is the keratotic changes in the oral mucosa where smokeless tobacco product is placed [32]. Most patients with frictional keratosis are free of symptoms, with the exception of those with aggressive cheek and lip biting habits. This area is exactly level with the occlusal plane and was being chewed constantly by the patient. The Dentrifice-related stomatitis, contact reactions to amalgam and cinnamon can cause keratotic lesions. Woo SB, Grammer RL, Lerman MA. Lesions associated with infections such as oral hairy leukoplakia and hyperplastic candidiasis can have a clinical presentation similar to frictional keratoses. Sucking on the cheeks, lips, or sides of the tongue may be a habit to relieve the discomfort from temporomandibular disorder or burning mouth syndrome. A systematic review. There are times that the bumps Seborrheic keratosis can come up on nay part of the skin. Applicable To Erythroplakia of mouth or tongue What you have is also called a frictional keratosis (due to friction, obviously) which always lines up with the cause - in your case, the upper teeth. Bhattacharyya I. The patches can appear to a number of reasons, ranging from simple one such as dentures scratching called frictional keratosis, a fungal infection in the mouth a condition called thrush candidiasis to serious condition such as oral cancer. The connective tissue lacks inflammation. [QxMD MEDLINE Link]. 2000 Aug. 29(7):331-5. Catherine M Flaitz, DDS, MS Professor of Oral and Maxillofacial Pathology and Pediatric Dentistry, Department of Diagnostic and Biomedical Sciences, University of Texas Health Sciences Center at Houston School of Dentistry, Catherine M Flaitz, DDS, MS is a member of the following medical societies: American Academy of Oral and Maxillofacial Pathology, American Academy of Oral Medicine, American Academy of Pediatric Dentistry, American Dental Association, International Association for Dental Research, and International Association of Oral Pathologists, Disclosure: Trimira, LLC Clinical contract for study Co-investigator on clinical grant; Trimira, LLC Honoraria Speaking and teaching; GC America Clinical contract for study Co-investigator on clinical grant; Forward Science LLC Device evaluation Product evaluation for school use. 61(4):373-81. . sharing sensitive information, make sure youre on a federal What causes frictional keratosis? Triamcinolone 0.1% ointment in Orabase and tretinoin 0.05% gel were ineffective. Sometimes it is extremely difficult to read the symptoms of frictional keratosis until after you start feeling pain. This website also contains material copyrighted by 3rd parties. Extensive oral mucosal hyperkeratosis caused by over-the-counter long lasting snoring relief agent. 8b). 4a) [14, 16]. Oral frictional hyperkeratosis (morsicatio buccarum): an entity to be considered in the differential diagnosis of white oral mucosal lesions. What is white sponge nevus? This habit most probably led to the biting of the cheek mucosa. 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. 1b). [QxMD MEDLINE Link]. These white patches are associated with either a conscious or an unconscious chronic oral habit. White, thickened plaques with irregular, rough surface change are noted on the gingiva of the right maxilla and mandible. squamous cell carcinoma). Differential diagnosis of oral mucosal lesions in children and adolescents. 7-1c) [29]. 7-1a) [8, 12, 26]. Learn more Time is the main characteristic that separates an oral . Marked hyperkeratosis, either orthokeratosis or parakeratosis and neutrophilic exocytosis is present. 1 Given the high-risk nature of some white patches, it is important to perform a thorough history and examination. Atlanta Oral Pathology, Emory Decatur Hospital, Emory University School of Medicine, 2701 N. Decatur Road, Decatur, GA 30033 USA. In some patients the frictional keratoses can be extensive involving the entire cheek and extending to the lips. [QxMD MEDLINE Link]. 1a). Systematic review of the relation between smokeless tobacco and cancer in Europe and North America. The https:// ensures that you are connecting to the Br J Oral Maxillofac Surg. This category includes linea alba, and cheek, lip, and tongue chewing. lesions appear as white patches in oral cavity. [QxMD MEDLINE Link]. 8600 Rockville Pike 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. [QxMD MEDLINE Link]. This might give you immediate relief. This condition derives its name from the act of friction (another object constantly rubbing itself against the skin) and this may lead to Frictional keratosispatches. Case of the month. Clinicians may be concerned for a vesiculo-bullous process such as mucous membrane pemphigoid. Anterior rough surface area at the occlusal plane of the teeth. 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. Eczema causes itching, redness and tiny blisters. Kashani HG, Mackenzie IC, Kerber PE. It is a very common skin condition. It had been around for long now and there is rarely Seborrheic keratosis can come up on any part of the body. 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. Frictional keratosis, though, is not in the same category as dysplasia. Meta-analysis of the relation between European and American smokeless tobacco and oral cancer. Courtesy of Catherine M. Flaitz, DDS and Alfredo Aguirre, DDS. The .gov means its official. They therefore do not need treatment as they often disappear after sometime unless the affected area is rubbed against repeatedly. Epidemiological study of oral mucosa pathology in patients of the Oviedo School of Stomatology. 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. Within the spinous layer occasional cells with bright eosinophilic perinuclear condensation representing keratin tonofilaments can be observed. Macigo FG, Mwaniki DL, Guthua SW. Its affecting many people both kids and even the Seborrheic keratosis can come up in the form of bumps on the skin. Share cases and questions with Physicians on Medscape consult. 2a Oral lichenoid contact reaction of the right buccal mucosa to cinnamon flavored chewing gum. Cifuentes M, Davari P, Rogers III RS. Typically, the lesions appear as distinct, focal, and translucent-to-opaque white asymptomatic patches with sharply delineated borders. It was concluded that the hyperkeratosis was likely caused by bite trauma or grinding of the teeth while the patient was asleep. 2c Acanthosis, dyskeratotic cells and inflammatory exocytosis is seen along with interface mucositis. This review will focus exclusively on reactive white oral lesions. The alteration in texture within his mouth created an uncomfortable sensation and, at times, the lesions spontaneously peeled away requiring him to spit repeatedly. The inflammation unlike oral lichen planus is composed of lymphocytes, plasma cells and scattered eosinophils. J Oral Pathol Med. One of the more common presentations of frictional keratosis is the linea alba (white line). White lesions in oral cavity Def. Superficial sloughing of the mucosa as described above with edema and erythema of the gingiva is associated with cinnamon containing toothpaste [30]. This histology is virtually indistinguishable from ridge keratosis (Fig. Frictional keratosis typically occurs on the lateral borders of the tongue as a consequence of tongue biting by the molar teeth or some other abrasive irritant (eg, from rubbing upon poorly fitting dental work), as shown in the image below. Dabrowa T, Dobrowolska A, Wieleba W. The role of friction in the mechanism of retaining the partial removable dentures with double crown system. 10(2):114-5. 2006 Nov-Dec. 16(6):674-6. HBID does not affect the anogenital region, esophagus or nasal mucosa. Leukokeratosis of oral mucosa. 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 Generally, there is a lack of inflammation in the superficial connective tissue with the exception of cases where secondary ulceration is present. 1c) [9, 10]. Irritant contact stomatitis caused by chemical products used in toothpastes, mouthwashes,and dental restorations can result in oral mucosal injury. Shaggy hyperkeratotic oral lesions are usually seen in cinnamon stomatitis from gums and candy (Fig. With few exceptions, marked hyperparakeratosis with a shaggy or shredded keratin surface is noted (Fig. Dry skin. The new PMC design is here! The prevalence of oral mucosal lesions in a population in Ljubljana, Slovenia. Surgical Dentistry / Oral Surgery is concerned with the diagnosis and surgical management of pathological processes and anomalies in the teeth or their supporting structures. An official website of the United States government. A review of the prior biopsy of the affected mucosa revealed an irregularly hyperplastic epithelium with foci of ballooned epithelial cells within the upper layer, parakeratosis, and bacterial overgrowth (Figure 2). Epidemiological evidence relating snus to healthan updated review based on recent publications. Erythema and ulceration may be present. Frictional keratosis is a skin growth that can result from mild mechanical trauma or irritation of the skin. and transmitted securely. Toothbrush keratosis can develop when a person uses excessive force while brushing teeth and causes inflammations in ones mouth. In North American, moist smokeless tobacco is usually placed in the lower buccal vestibule or chewed if chewing tobacco is used. 5) Frictional Keratosis. a White sponge nevus of the right buccal mucosa in a 36-year-old Black man. Type 1 Excludes. The use of oral tobacco products used in North American and Europe can result in clinical changes at the site of tobacco placement. This may also be seen on vestibular mucosa in areas where loose dentures chronically and mildly push against the mucosa. All material on this website is protected by copyright, Copyright 1994-2023 by WebMD LLC. Introduction. American Academy of Oral and Maxillofacial Pathology, International Association for Dental Research, International Association of Oral Pathologists. 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. from habit of pushing tongue against teeth. White lesions of the oral cavity are quite common and can have a variety of etiologies, both benign and malignant. In one patient, the surface of the last molar tooth showed considerable occlusal wear, which is evidence that the patient had the habit of grinding his teeth (see first image above). The keratin surface is either parakeratotic or orthokeratotic with spires of chevron parakeratosis imparting a wavy appearance to the keratin surface (Fig. Patients with persistent cheek and lip biting habits tend to have increased stress and psychologic disorders. Geographic It is seen worldwide. Alfredo Aguirre, DDS, MS is a member of the following medical societies: American Academy of Oral and Maxillofacial PathologyDisclosure: Nothing to disclose. Courtesy of Catherine M. Flaitz, DDS and Alfredo Aguirre, DDS. 1987 Feb. 15(1):46-51. Snuff-dippers lesion. The epithelium exhibits epithelial hyperplasia and intracellular edema is common presenting as ballooned cells in the spinous layer. The whiteness is as a result of more cells being set by the body as it reacts to the irritation caused by friction. Clinical features of cinnamon-induced contact stomatitis. Included in the discussion are frictional keratoses, irritant contact stomatitis, and smokeless tobacco keratoses. Head Neck Pathol. The clinical appearance can vary depending on the degree of trauma. Most epidemiologic studies in North America and Europe show a minor increased risk of oral cancer [33, 39, 40]. Martinez Diaz-Canel AI, Garcia-Pola Vallejo MJ. . The 2023 edition of ICD-10-CM K13.21 became effective on October 1, 2022. When the gingival tissues are involved, patients may report using a medium- or hard-bristled toothbrush or other oral hygiene aids. 2009 Jan;67(1):140-6. doi: 10.1016/j.joms.2008.08.040. These white patches in the mouth only disappear when the source of friction is removed. It can also lead to serious complications and timely diagnosis and treatment is necessary. Hyperkeratosis is a skin condition that occurs when a person's skin becomes thicker than usual in certain places. Weitkunat R, Sanders E, Lee PN. 2007 Sep 22. This occurs mostly in the mouth area. In addition to PVL there are benign conditions that can have clinical overlap with frictional keratosis. This is the American ICD-10-CM version of K13.21 - other international versions of ICD-10 K13.21 may differ. Pediatr Dent. Smokeless tobacco keratosis is caused by constant frictional irritation of smokeless tobacco against the oral mucosa resulting in keratosis. Indian J Dent Res. Daniel J Hogan, MD Clinical Professor of Internal Medicine (Dermatology), Nova Southeastern University College of Osteopathic Medicine; Investigator, Hill Top Research, Florida Research Center INCIDENCE Frictional keratosis is common. Generally, the clinical findings are adequate in determining the etiology of the white lesions and do not require confirmatory biopsy. 2a) [8, 10]. Applicable To. 30100 Telegraph Road, Suite 408, Bingham Farms, Michigan 48025 (USA) 2015 Dec. 34 (4):161-70. The lips, the lateral margins of the tongue, the buccal mucosa (mainly along the occlusal line), and the edentulous alveolar ridges are the most common sites to find frictional keratosis and its variants. If the cause of the white patches is a precancerous . The patient denied biting her tongue and the histology is not consistent with chronic tongue chewing/biting. 2008 Apr-Jun. We report the first example, to our knowledge, of a frictional keratosis from exuberant sucking in a breastfeeding infant. A prominent granular cell layer is noted. Prevalence of oral mucosal lesions in a Kenyan population with special reference to oral leukoplakia. The exact prevalence is unknown but most likely these reactions are uncommon. However, these microscopic findings are relatively non-specific (H&E, magnification 200). on your tongue or palate; on the bottom of your mouth; . . St. Louis, Mo: WB Saunders; 2009. Collagen sclerosis appearing as a band of homogeneous, acellular eosinophilic amyloid-like material has been reported (Fig. Smith JF. The white line observed on the cheek is level with the biting plane of the teeth. Each of these lesions have microscopic findings that can assist in patient management. Courtesy of Catherine M. Flaitz, DDS and Alfredo Aguirre, DDS. The site is secure. d Subepithelial collagen eosinophilia that can be mistaken for amyloid is an unusual finding in smokeless tobacco keratoses. Therefore, it is prudent to sample any questionable lesion to rule out OPMD. 141(5):509-20. However, there are instances where the etiology is unknown, or the keratotic lesion is in a high-risk area for OPMDs. 8 These lesions have been observed on multiple surfaces, including the tongue, buccal mucosa, gingiva, and alveolar ridges. Is alveolar ridge keratosis a true leukoplakia? The epithelium has elongated anastomosing rete. Other findings include a mixed inflammatory infiltrate, including eosinophils, and focal perivascular inflammation [28, 29]. Michael J Wells, MD, FAAD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, Texas Medical AssociationDisclosure: Nothing to disclose. Eczema is also called dermatitis. 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. Laporan kasus : Seorang laki-laki 22 tahun datang . 8a) [32, 35]. Castellanos JL, Daz-Guzmn L. Lesions of the oral mucosa: an epidemiological study of 23785 Mexican patients. Diagnosis can often be very tricky. East Afr Med J. Intraepithelial linear clefting of the superficial parakeratin is seen. Courtesy of Catherine M. Flaitz, DDS and Alfredo Aguirre, DDS. The alveolar ridge mucosa that had previously been "protected" from food impingement is now exposed to trauma and becomes hyperkeratotic as a protective mechanism. Causes of white lesions:- 1-Increase in thickness of one or more of epithelial layers. External factors that mostly cause frictional keratosis are through smoking though that occurs mostly in lips. Semin Cutan Med Surg. Leukoedema: an epidemiological study in white and African Americans. 2015 Aug 1. 2002 Jun. With progression the lesions become more keratotic with furrowing of the epithelium and thickening (Fig. Endo H, Rees TD. 2-Abnormal character of keratin. 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]. WSN is inherited as an autosomal dominant trait that presents as asymptomatic thickened soft white plaques most commonly on the buccal mucosa (Fig. The epithelium may show acanthosis and epithelial rete may be elongated or atrophic [ 9, 10 ]. (Photographs courtesy of Dr. Hans Grossniklaus). Other mucosal sites of involvement include nasal, esophageal and anogenital. [QxMD MEDLINE Link]. 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]. 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. This feature can be appreciated on cytologic preparations with Papanicolaou staining [18, 19]. Tongue lacerations can also result in scarring or swelling. The histologic features of frictional keratosis from the tongue, lip or buccal mucosa vary slightly depending on the site of the biopsy. It was mixed with saliva and water so maybe it seemed like more than there really was. Low-power view of stratified squamous epithelium with marked hyperkeratinization, acanthosis, and a prominent granular cell layer. Two rare genodermatoses that can have clinical overlap with frictional keratoses but have distinct histologic features are white sponge nevus (WSN) and hereditary benign intraepithelial dyskeratosis (HBID). Leukoplakia, Frictional keratosis, Smokeless tobacco keratosis, Stomatitis, Leukoedema, Cinnamon. Frictional keratosis must also be considered as it can affect the margins of the tongue. The treatment for frictional keratosis is a simple procedure by itself. 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. Scope of practice, referral patterns and lesion occurrence of an oral medicine service in Australia. government site. Another way to prevent frictional keratosis is through ensuring that the buccal cavity is kept free from germs and bacteria, as their buildup cause the white lesions that are mostly associated with this kind of keratosis. Coleman GC, Flaitz CM, Vincent SD. Skaare A, Eide G, Herlofson B, Barkvoll P. The effect of toothpaste containing triclosan on oral mucosal desquamation. Frictional keratosis is among the many different keratosis conditions. In some instances, patients give a history of wearing orthodontic appliances or removable full or partial dental prostheses that may traumatize the soft tissues. Fast Five Quiz: What Do You Know About Dental Health? Chronic frictional / factitial keratosis : Shaggy / macerated parakeratosis with superficial bacterial colonization Epithelial hyperplasia with keratinocyte edema but no epithelial atypia Variable fibrosis, acute and chronic inflammation and leukocyte exocytosis Lichen planus / lichenoid mucositis : 15(4):43-8. 4. Inflammatory etiologies of oral white lesions including infective and non-infective causes will be discussed elsewhere in this special issue. These microscopic features are not unique to dentifrice stomatitis, but with appropriate clinical information, an association can be proffered. It could also arise from excess deposit of keratin due to a process called hyperkeratinization. Early lesions tend to have a filmy white to gray opalescent appearance with a wrinkled surface and minimal mucosal thickening (Fig. Med Oral. The connective tissue can be uninvolved in STK with little to minimal inflammation. The affected area may exhibit a macerated appearance with shredded keratin and peeling (Fig. Eur J Dermatol. . In the superficial epithelium, eosinophilic perinuclear condensation, representing compact aggregates of keratin tonofilaments, unique to WSN, is present [16, 17]. Suter VG, Warnakulasuriya S. The role of patch testing in the management of oral lichenoid reactions. Inset: High-power photomicrograph of exfoliative cytology with Papanicolaou staining demonstrating the eosinophilic perinuclear condensation (magnification 400). [QxMD MEDLINE Link]. Differentiating between frictional keratosis and lesions from smoking or smokeless tobacco is of utmost important given that their prognoses is different from that of the typical frictional keratosis. Oral frictional hyperkeratosis of the attached maxillary gingiva from inappropriate toothbrushing technique. 1d) and requires clinical correlation (H&E, magnification 100). Changes in skin color. 2005 Nov 12. keratin layer on the surface of the tongue is thickened (arrow). 2019 Mar. In orthokeratotic hyperkeratosis (sometimes referred to as orthokeratosis), the dead keratinocytes are anuclear, whereas in parakeratotic hyperkeratosis (sometimes referred to as parakeratosis), the dead keratinocytes have retained pyknotic nuclei. The palate, particularly the soft palate, is affected. SLS is a common synthetic detergent added to toothpaste for foaming and cleaning. Numerous papers have been published on the clinical and histologic features of oral leukoplakia and will not be repeated herein. Bouquot JE, Gorlin RJ. Swedish-type moist snuff is termed snus and is typically placed under the upper or lower lip [33]. Flaitz CM, Felefli S. Complications of an unrecognized cheek biting habit following a dental visit. 13 (1):16-24. Nevertheless, if any of the frictional keratosis fails to fade after four weeks, it is recommended that you visit your doctor for accurate diagnosis and treatment. or fever, they should speak to a doctor. Bookshelf Courtesy of Catherine M. Flaitz, DDS and Alfredo Aguirre, DDS. National Library of Medicine Histologically, amalgam contact reactions can have tertiary lymphoid follicle formation composed of B-cells containing follicular dendritic cells surrounded by T-cells and macrophages similar to normal tonsils (Fig. 7-1b) [26, 28]. 2012 Winter;83(1):13, 16. [QxMD MEDLINE Link]. 1b Oral lichenoid contact reaction to dental amalgam often has a dense lymphocytic infiltrate subjacent to the epithelial cells. Keeping the buccal cavity free from germs and bacteria can be achieved through having regular checkups with dentists and health professionals or simply by keeping the cavity clean. The epithelium may show acanthosis and epithelial rete may be elongated or atrophic [ 9, 10 ]. White patches of the oral mucosa are common and may represent a benign disorder (e.g. [QxMD MEDLINE Link]. Flaitz CM. Mller S. Frictional keratosis, contact keratosis and smokeless tobacco keratosis: features of reactive white lesions of the oral mucosa. 1a Oral lichenoid contact reaction to dental amalgam presenting as areas of erythema and white plaques on the left buccal mucosa. 7-2b). The connective tissue is uninflamed. Similar to frictional keratosis of the buccal mucosa and tongue, a paucity of inflammatory cells is present. In some individuals certain dentifrices can result in superficial sloughing of the oral mucosa (Fig. Tremblay S, Avon SL. (cold sores), the gums, the tongue, the palate (roof of mouth) or the tongue. A thicker patch of mucosa is at the anterior end (under the tongue blade edge). Leukoplakia is a patch that is white to gray in color. The basal cells show nuclear hyperchromatism but no dysplasia is seen. Cinnamon is used a wide array of products such as toothpaste, mouthwash, gum, candy and soft drinks. Prevalence of oral mucosal lesions in children and youths in the USA. Hereditary benign intraepithelial dyskeratosis: an evaluation of diagnostic cytology. A prominent granular cell layer is noted. This is the American ICD-10-CM version of K13.29 - other international versions of ICD-10 K13.29 may differ. Scaling. This occurs when the tongue constantly rubs against one's teeth. [QxMD MEDLINE Link]. Hereditary benign intraepithelial dyskeratosis. The careful evaluation of sharp dental margins or cuspid fractures and incongruous fillings can cause hyperkeratotic traumatic reactions at the site where they persist [ 22 ]. government site. Although leukoedema is generally not biopsied, histologic findings of parakeratosis and spongiosis is seen [15]. It occurs as a white patch in the mouth. Frictional hyperkeratosis. A 55-year-old man presented with desquamating lesions on his bilateral buccal mucosa intermittently for approximately 3 years. An official website of the United States government. You are being redirected to [QxMD MEDLINE Link]. Parafunctional habits whereby there is constant rubbing, chewing or sucking of the oral mucosa against the teeth can result in keratoses of the buccal mucosa (morsicatio buccarum), tongue (morsicatio linguarum) and lip . 285-329. In some published series in children and adolescents the reported range is 0.265.3% [5]. 2000. With discontinuation of smokeless tobacco most lesions resolve within 6 weeks [32, 35, 37]. This is in contrast to the diffuse, ill-defined keratotic plaques seen in proliferative verrucous leukoplakia (Fig. Frictional keratosis can also be avoided in a number of ways. The patient admitted to nibbling at the thickened mucosa (see second image below), which, in turn, made it thicker and easier to feel and, therefore, encouraged further nibbling.

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