PACHYDERMA PACHYDERMA ORALISORALIS

KIM, JI HYUNKIM, JI HYUN

DMD2BDMD2B

Pachyderma OralisPachyderma Oralis

It may also be called:It may also be called:White folded gingivo stomatitisWhite folded gingivo stomatitis familial white folded hypertrophy of the mufamilial white folded hypertrophy of the mucous membranecous membrane white spongy naevus of the mucosawhite spongy naevus of the mucosa congenital leuko-keratosis of the oral mucocongenital leuko-keratosis of the oral mucosasa leukokeratosis orisleukokeratosis oris

Pachyderma OralisPachyderma Oralis

is an atypical Leukoplakia according to Kinis an atypical Leukoplakia according to Kinney and Derifield (1956). The names it has ney and Derifield (1956). The names it has received suggest that it occurs only in the received suggest that it occurs only in the mouth, this is not correct, it may involve anmouth, this is not correct, it may involve any mucous surface, of the Respiratory, urinay mucous surface, of the Respiratory, urinary and Digestive tracts (vagina, rectum and ry and Digestive tracts (vagina, rectum and anal canal) anal canal)

Kinney and derifield used the term “pKinney and derifield used the term “pachyderma oralis” to achyderma oralis” to designate white spondesignate white sponge nevusge nevus, which latter term was used by , which latter term was used by CCannonannon. However, as . However, as Shafer, Hine and Levy Shafer, Hine and Levy statedstated “pachyderma oralis“pachyderma oralis” is often used to ” is often used to describe just a describe just a white plaque or Hyperkeratwhite plaque or Hyperkeratosisosis..

Types of hyperkeratosisTypes of hyperkeratosis

Hyperkeratosis simplexHyperkeratosis simplex-- is an irregular smo is an irregular smooth white patch which appear dry and may oth white patch which appear dry and may be raised on a non- erthematous base. Lebe raised on a non- erthematous base. Lesions may be on the floor of the mouth, vesions may be on the floor of the mouth, ventral/dorsum surface of the tongue, cheekntral/dorsum surface of the tongue, cheeks, palate, lips and gingiva. It is often painles, palate, lips and gingiva. It is often painless and may be unnoticed by the patient anss and may be unnoticed by the patient and only pointed out during a clinical examinad only pointed out during a clinical examination. tion.

Hyperkeratosis SimplexHyperkeratosis Simplex

Hyperkeratosis complexHyperkeratosis complex-- often often leading to carcinoma- in- situ, leading to carcinoma- in- situ, appears as an irregular gray white appears as an irregular gray white plaque, possibly roughened or plaque, possibly roughened or cracked with ulceration frequently cracked with ulceration frequently occurring occurring

Hyperkeratosis ComplexHyperkeratosis Complex

Clinical features:Clinical features:

Mucosal lesion anywhere Mucosal lesion anywhere in the oral cavityin the oral cavity

It may be flat or raisedIt may be flat or raised May be roughMay be rough Duration may be weeks to Duration may be weeks to

monthsmonths Cannot be wiped offCannot be wiped off Usually adult occurance.Usually adult occurance.

Signs and symptomsSigns and symptoms::

Lump or mass in mouthLump or mass in mouthWart like lesionWart like lesionPain when chewing if severePain when chewing if severeUsually asymptomaticUsually asymptomatic

Histologic featuresHistologic features::

Thickening of the keratin and Thickening of the keratin and granular layers of epithelium. granular layers of epithelium. No other epithelial changes. No other epithelial changes. No inflammation in the No inflammation in the corium. corium.

Causes:Causes:

Denture Denture irritationirritation

Frequent x- ray Frequent x- ray radiationradiation

Physical rubbing Physical rubbing or injuryor injury

Cheek bitingCheek biting Heavy smokingHeavy smoking

Treatment:Treatment:

Elimination of all possible factors of irritatiElimination of all possible factors of irritationon

SurgerySurgery ElectrocauteryElectrocautery Fulguration- a procedure to destroy tissue Fulguration- a procedure to destroy tissue

using an electric current. using an electric current. Dessication- excessive loss of moisture; thDessication- excessive loss of moisture; th

e process of drying upe process of drying up