Summary
- Benign/normal variant presenting as asymptomatic, symmetric white-gray translucent linear reticulations, most often on the buccal mucosa; may involve lip mucosa and ventral tongue; reticulations disappear on stretching (stretch test). (L9 Benign Epithelial Pathosis; Contemporary Oral Medicine white and red lesions of the oral Mucosa; 2. Physical and Chemical Injuries of the Oral Cavity)
- Likely related to mild local irritation (cigarette/marijuana smoking, toothpaste/mouth rinses, physical trauma such as sucking); other contributory factors include alcohol use and salivary alterations. (Contemporary Oral Medicine white and red lesions of the oral Mucosa; L9 Benign Epithelial Pathosis)
- Prevalence varies widely (≈0.96–90%); more apparent in dark-skinned individuals and highest prevalence reported in African-American males. (Contemporary Oral Medicine white and red lesions of the oral Mucosa; 2. Physical and Chemical Injuries of the Oral Cavity)
- Histology shows keratinocyte/intracellular edema with acanthosis/parakeratosis and thickened epithelium of swollen epithelial cells. (L9 Benign Epithelial Pathosis; 2. Physical and Chemical Injuries of the Oral Cavity)
- Management is reassurance; smoking cessation discussion when relevant; biopsy is rarely necessary but may be done if mistaken for lichen planus. (Contemporary Oral Medicine white and red lesions of the oral Mucosa)
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Etiology and Pathophysiology
- Considered a normal variant; the term refers to the clinical presentation, with the histopathologic correlate being keratinocyte edema. (L9 Benign Epithelial Pathosis; 2. Physical and Chemical Injuries of the Oral Cavity)
Contributory factors
- Mild local irritation including cigarette or marijuana smoking. (Contemporary Oral Medicine white and red lesions of the oral Mucosa)
- Use of some toothpastes and mouth rinses. (Contemporary Oral Medicine white and red lesions of the oral Mucosa)
- Physical trauma such as sucking. (Contemporary Oral Medicine white and red lesions of the oral Mucosa)
- Additional contributory factors may include alcohol use and salivary alterations. (L9 Benign Epithelial Pathosis)
Epidemiology
- Reported prevalence ranges from 0.96% to 90% of the population. (Contemporary Oral Medicine white and red lesions of the oral Mucosa)
- More readily discerned in dark-skinned individuals; highest prevalence reported in African-American males. (2. Physical and Chemical Injuries of the Oral Cavity; Contemporary Oral Medicine white and red lesions of the oral Mucosa)
Clinical Features
Location
- Most commonly affects the buccal mucosa; may also involve the lip mucosa and ventral tongue (nonkeratinized sites). (L9 Benign Epithelial Pathosis; Contemporary Oral Medicine white and red lesions of the oral Mucosa; 2. Physical and Chemical Injuries of the Oral Cavity)
Appearance
- Asymptomatic and usually an incidental finding with symmetric distribution. (L9 Benign Epithelial Pathosis)
- Delicate lacy, gray-white lines/reticulations or translucent linear reticulations. (2. Physical and Chemical Injuries of the Oral Cavity; Contemporary Oral Medicine white and red lesions of the oral Mucosa)
Demographics
- More apparent in non-white individuals. (L9 Benign Epithelial Pathosis)
Histological Features
- Epithelium exhibits parakeratosis and acanthosis. (L9 Benign Epithelial Pathosis)
- Keratinocyte/intracellular edema with swollen epithelial cells and thickened epithelium. (L9 Benign Epithelial Pathosis; 2. Physical and Chemical Injuries of the Oral Cavity)
Differential Diagnoses
- White sponge nevus. (L9 Benign Epithelial Pathosis)
- Frictional keratosis. (L9 Benign Epithelial Pathosis)
- Oral lichen planus. (L9 Benign Epithelial Pathosis)
Relevant Clinical Investigations
Stretch Test
- Pale reticulations usually disappear completely upon stretching the mucosa. (L9 Benign Epithelial Pathosis; Contemporary Oral Medicine white and red lesions of the oral Mucosa; 2. Physical and Chemical Injuries of the Oral Cavity)
Patient Management
- Reassure the patient regarding the benign nature of the condition. (Contemporary Oral Medicine white and red lesions of the oral Mucosa)
- If there is an associated smoking habit, use the opportunity to discuss cessation. (Contemporary Oral Medicine white and red lesions of the oral Mucosa)
- Biopsy is rarely necessary, though it may be done if mistaken for lichen planus. (Contemporary Oral Medicine white and red lesions of the oral Mucosa)