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Oral Frictional Hyperkeratosis

Practice Essentials

Oral hyperkeratinization is defined as the excessive formation of tenaciously attached keratin in the mouth, which can result from friction. (See the image below.) The diagnosis of oral frictional hyperkeratosisis is typically based on a detailed clinical examination and the finding of an oral habit or some other agent that has produced chronic, low-grade irritation of the mucosa. Treatment consists of removal of the frictional irritant.

The white line observed on the cheek is level with

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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Signs and symptoms

Most patients with frictional keratosis have no symptoms, with the exception of those with aggressive cheek and lip biting habits. In some individuals who repeatedly traumatize the tissues, tenderness, swelling, and a burning sensation may be present.

Typically, the lesions of frictional keratosis appear as distinct, focal, and translucent-to-opaque white asymptomatic patches with sharply delineated borders. One of the more common presentations is the linea alba (white line).

See Presentation for more detail.

Diagnosis

The first step in the identification of white patches suspected of being associated with physical trauma is to use a 2 × 2-inch sterile gauze to wipe off the lesion or lesions. If the patch is not easily wiped off, this finding suggests hyperkeratinization. If any doubt exists about a particular lesion or if residual keratotic foci persist despite the removal of the causative factor, then a biopsy is indicated.

See Workup for more detail.

Treatment

Any frictional irritant should be 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.

See Treatment for more detail.

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