Medical Care
The most important management protocol includes the following:
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Establish a diagnosis.
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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.
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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.
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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.
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.
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.
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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.
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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.
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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.
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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.
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Anterior rough surface area at the occlusal plane of the teeth. Courtesy of Catherine M. Flaitz, DDS and Alfredo Aguirre, DDS.
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Oral frictional hyperkeratosis of the lateral border of the tongue from chronic biting habit. Courtesy of Catherine M. Flaitz, DDS and Alfredo Aguirre, DDS.
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Oral frictional hyperkeratosis of the attached maxillary gingiva from inappropriate toothbrushing technique. Courtesy of Catherine M. Flaitz, DDS and Alfredo Aguirre, DDS.
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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.
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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.
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High-power view of the surface keratin layer and a prominent granular cell layer. Courtesy of Catherine M. Flaitz, DDS and Alfredo Aguirre, DDS.
