Close
New

Medscape is available in 5 Language Editions – Choose your Edition here.

 

Oral Frictional Hyperkeratosis Treatment & Management

  • Author: Jose Luis Tapia, DDS; Chief Editor: William D James, MD  more...
 
Updated: Feb 10, 2016
 

Medical Care

See the list below:

  • The most important management protocol includes the following:
    • Establish a diagnosis.
    • Be sure that any frictional irritant is removed. Biting, sucking, or chewing habits should be discontinued, and fractured or rough tooth surfaces or irregularly fitting dentures or other appliances should be corrected.
    • Observe and monitor the patient to be certain that the frictional area is resolving in a timely fashion. In general, the patient should be reevaluated in 2-3 weeks for signs of lesion regression or resolution.
    • In the absence of resolution, even when the cause has been eliminated, obtain a biopsy specimen of the tissue to confirm that no dysplastic or neoplastic change is present.
Next

Consultations

Consultation with a dentist, an oral and maxillofacial surgeon, an oral and maxillofacial pathologist, a dermatologist, or otolaryngologist may be indicated if a lesion does not resolve after elimination of the suspected irritant. For aggressive cheek and lip biting habits, a psychological evaluation may be appropriate.

Previous
Next

Diet

The patient's diet is typically not of concern unless the frictional keratosis is a result of constant chewing of hard foods against an edentulous ridge. The patient should be encouraged to eat on the dentate side, if possible, to avoid trauma to the alveolar mucosa during mastication.

Previous
 
 
Contributor Information and Disclosures
Author

Jose Luis Tapia, DDS Assistant Professor, Department of Oral Diagnostic Sciences, State University of New York at Buffalo

Jose Luis Tapia, DDS is a member of the following medical societies: American Academy of Oral and Maxillofacial Pathology

Disclosure: Nothing to disclose.

Coauthor(s)

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

Alfredo Aguirre, DDS, MS is a member of the following medical societies: American Academy of Oral and Maxillofacial Pathology

Disclosure: Nothing to disclose.

Specialty Editor Board

Michael J Wells, MD, FAAD Associate Professor, Department of Dermatology, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine

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 Association

Disclosure: Nothing to disclose.

Drore Eisen, MD, DDS Consulting Staff, Department of Dermatology, Dermatology Research Associates of Cincinnati

Drore Eisen, MD, DDS is a member of the following medical societies: American Academy of Dermatology, American Academy of Oral Medicine, American Dental Association

Disclosure: Nothing to disclose.

Chief Editor

William D James, MD Paul R Gross Professor of Dermatology, Vice-Chairman, Residency Program Director, Department of Dermatology, University of Pennsylvania School of Medicine

William D James, MD is a member of the following medical societies: American Academy of Dermatology, Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Additional Contributors

Daniel J Hogan, MD Clinical Professor of Internal Medicine (Dermatology), Nova Southeastern University College of Osteopathic Medicine; Investigator, Hill Top Research, Florida Research Center

Daniel J Hogan, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Contact Dermatitis Society, Canadian Dermatology Association

Disclosure: Nothing to disclose.

Acknowledgements

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

References
  1. Neville BW, Damm DD, Allen CM, Bouquot JE. Physical and Chemical Injuries. Oral and Maxillofacial Pathology. 3rd ed. St. Louis, Mo: WB Saunders; 2009. 285-329.

  2. Cam K, Santoro A, Lee JB. Oral frictional hyperkeratosis (morsicatio buccarum): an entity to be considered in the differential diagnosis of white oral mucosal lesions. Skinmed. 2012 Mar-Apr. 10(2):114-5. [Medline].

  3. 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. J Am Dent Assoc. 2004 Sep. 135(9):1279-86. [Medline].

  4. Shulman JD. Prevalence of oral mucosal lesions in children and youths in the USA. Int J Paediatr Dent. 2005 Mar. 15(2):89-97. [Medline].

  5. Bouquot JE, Gorlin RJ. Leukoplakia, lichen planus, and other oral keratoses in 23,616 white Americans over the age of 35 years. Oral Surg Oral Med Oral Pathol. 1986 Apr. 61(4):373-81. [Medline].

  6. Kashani HG, Mackenzie IC, Kerber PE. Cytology of linea alba using a filter imprint technique. Clin Prev Dent. 1980. 2:21-4.

  7. Axéll T. Occurrence of leukoplakia and some other oral white lesions among 20,333 adult Swedish people. Community Dent Oral Epidemiol. 1987 Feb. 15(1):46-51. [Medline].

  8. Macigo FG, Mwaniki DL, Guthua SW. Prevalence of oral mucosal lesions in a Kenyan population with special reference to oral leukoplakia. East Afr Med J. 1995 Dec. 72(12):778-82. [Medline].

  9. Kovac-Kovacic M, Skaleric U. The prevalence of oral mucosal lesions in a population in Ljubljana, Slovenia. J Oral Pathol Med. 2000 Aug. 29(7):331-5. [Medline].

  10. Parlak AH, Koybasi S, Yavuz T, et al. Prevalence of oral lesions in 13- to 16-year-old students in Duzce, Turkey. Oral Dis. 2006 Nov. 12(6):553-8. [Medline].

  11. Martinez Diaz-Canel AI, Garcia-Pola Vallejo MJ. Epidemiological study of oral mucosa pathology in patients of the Oviedo School of Stomatology. Med Oral. 2002 Jan-Feb. 7(1):4-9, 10-6.

  12. Mathew AL, Pai KM, Sholapurkar AA, Vengal M. The prevalence of oral mucosal lesions in patients visiting a dental school in Southern India. Indian J Dent Res. 2008 Apr-Jun. 19(2):99-103. [Medline].

  13. Farah CS, Simanovic B, Savage NW. Scope of practice, referral patterns and lesion occurrence of an oral medicine service in Australia. Oral Dis. 2008 May. 14(4):367-75. [Medline].

  14. Castellanos JL, Díaz-Guzmán L. Lesions of the oral mucosa: an epidemiological study of 23785 Mexican patients. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2008 Jan. 105(1):79-85. [Medline].

  15. Dabrowa T, Dobrowolska A, Wieleba W. The role of friction in the mechanism of retaining the partial removable dentures with double crown system. Acta Bioeng Biomech. 2013. 15(4):43-8. [Medline].

  16. Natarajan E, Woo SB. Benign alveolar ridge keratosis (oral lichen simplex chronicus): A distinct clinicopathologic entity. J Am Acad Dermatol. 2008 Jan. 58(1):151-7. [Medline].

  17. Sarifakioglu E, Gunduz C, Gorpelioglu C. Oral mucosa manifestations in 100 pregnant versus non-pregnant patients: an epidemiological observational study. Eur J Dermatol. 2006 Nov-Dec. 16(6):674-6. [Medline].

  18. Scully C. Cannabis; adverse effects from an oromucosal spray. Br Dent J. 2007 Sep 22. 203(6):E12; discussion 336-7. [Medline].

  19. Flaitz CM. Differential diagnosis of oral mucosal lesions in children and adolescents. Adv Dermatol. 2000. 16:39-78; discussion 79. [Medline].

  20. Coleman GC, Flaitz CM, Vincent SD. Differential diagnosis of oral soft tissue lesions. Tex Dent J. 2002 Jun. 119(6):484-8, 490-2, 494-503. [Medline].

  21. Scully C, Felix DH. Oral Medicine--update for the dental practitioner: oral white patches. Br Dent J. 2005 Nov 12. 199(9):565-72. [Medline].

  22. Miller RL, Gould AR, Bernstein ML. Cinnamon-induced stomatitis venenata, Clinical and characteristic histopathologic features. Oral Surg Oral Med Oral Pathol. 1992 Jun. 73(6):708-16. [Medline].

  23. Messadi DV, Younai FS, Liu HH, Guo G, Wang CY. The clinical effectiveness of reflectance optical spectroscopy for the in vivo diagnosis of oral lesions. Int J Oral Sci. 2014 Sep. 6 (3):162-7. [Medline].

  24. [Guideline] Rethman MP, Carpenter W, Cohen EE, et al. Evidence-based clinical recommendations regarding screening for oral squamous cell carcinomas. J Am Dent Assoc. 2010 May. 141(5):509-20. [Medline].

  25. Flaitz CM, Felefli S. Complications of an unrecognized cheek biting habit following a dental visit. Pediatr Dent. 2000 Nov-Dec. 22(6):511-2. [Medline].

  26. Jones KB, Jordan R. White lesions in the oral cavity: clinical presentation, diagnosis, and treatment. Semin Cutan Med Surg. 2015 Dec. 34 (4):161-70. [Medline].

  27. Gabrić D, Vrdoljak DV, Boras VV. Extensive oral mucosal hyperkeratosis caused by over-the-counter long lasting snoring relief agent. Br J Oral Maxillofac Surg. 2015 Aug 1. [Medline].

  28. Makino T, Mizawa M, Inoue S, Noguchi M, Shimizu T. The expression profile of filaggrin-2 in the normal and pathologic human oral mucosa. Arch Dermatol Res. 2016 Feb 8. [Medline].

Previous
Next
 
The white line observed on the cheek is level with the biting plane of the teeth. The wear on the occlusal surfaces of the molar teeth suggests that the patient had a habit of bruxism. Courtesy of Catherine M. Flaitz, DDS and Alfredo Aguirre, DDS.
Prominent linea alba with evidence of cheek biting. The white line shows a slightly scalloped appearance, which correlates with the buccal surfaces of the teeth against which the mucosa is rubbed. Courtesy of Catherine M. Flaitz, DDS and Alfredo Aguirre, DDS.
This wider area of roughened mucosa is typical of those produced by the habit of cheek biting or nibbling. Courtesy of Catherine M. Flaitz, DDS and Alfredo Aguirre, DDS.
This frictional keratotic line shows a roughened surface. A thicker patch of mucosa is at the anterior end (under the tongue blade edge). This area is exactly level with the occlusal plane and was being chewed constantly by the patient. Courtesy of Catherine M. Flaitz, DDS and Alfredo Aguirre, DDS.
Anterior rough surface area at the occlusal plane of the teeth. Courtesy of Catherine M. Flaitz, DDS and Alfredo Aguirre, DDS.
Oral frictional hyperkeratosis of the lateral border of the tongue from chronic biting habit. Courtesy of Catherine M. Flaitz, DDS and Alfredo Aguirre, DDS.
Oral frictional hyperkeratosis of the attached maxillary gingiva from inappropriate toothbrushing technique. Courtesy of Catherine M. Flaitz, DDS and Alfredo Aguirre, DDS.
Oral frictional hyperkeratosis of the retromolar pad is also referred to as a ridge callus. This lesion is caused by masticatory irritation. Courtesy of Catherine M. Flaitz, DDS and Alfredo Aguirre, DDS.
Low-power view of stratified squamous epithelium with marked hyperkeratinization, acanthosis, and a prominent granular cell layer. Courtesy of Catherine M. Flaitz, DDS and Alfredo Aguirre, DDS.
High-power view of the surface keratin layer and a prominent granular cell layer. Courtesy of Catherine M. Flaitz, DDS and Alfredo Aguirre, DDS.
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.