Oral mucosal peeling | British Dental Journal

Oral mucosal peeling

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• Published: 26 April 2013

• Y. Hassona¹ &
• C. Scully² 

British Dental Journal
volume 214, page 374 (2013)Cite this article

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Sir, peeling of the oral mucosa is rarely encountered in clinical practice and consequently it can cause diagnostic confusion for unfamiliar practitioners. Therefore, we would like to share an interesting case of oral mucosal peeling that we have recently encountered.

An 80-year-old Caucasian woman presented with a three-month history of asymptomatic peeling of her oral mucosa. The medical history was unremarkable and there was no history of mechanical and chemical trauma, nor any recent changes in her usual oral hygiene practices. Clinical examination showed only grey-white strips of oral epithelium sloughing from the buccal mucosae and dorsal tongue (Fig. 1, arrows). These epithelial layers sloughed spontaneously or could be peeled off easily leaving a normal tissue base with no bleeding or erosions. A clinical diagnosis of oral mucosal peeling (epitheliolysis) was made and the patient reassured and discharged.

Figure 1

Grey-white strips of oral epithelium sloughing from the buccal mucosae and dorsal tongue

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Oral epitheliolysis (also known as shedding oral mucosa or oral mucosal peeling) is a rarely described and often unrecognised superficial desquamation of oral mucosa that may be caused by sodium lauryl sulphate (SLS) containing oral hygiene products, though some cases appear idiopathic. The condition has no significant clinical consequences and usually resolves spontaneously or upon discontinuation of any implicated toothpastes or mouthwashes.^1,2,3

References

1. Zegarelli D J, Silvers D N . Shedding oral mucosa. Cutis 1994; 54: 323–326.

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2. Herlofson B B, Barkvoll P . Oral mucosal desquamation caused by two toothpaste detergents in an experimental model. Eur J Oral Sci 1996; 104: 21–26.

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3. Plonait D R, Reichart P A . Epitheliolysis of the mouth mucosa (mucosal peeling) as a side effect of toothpaste. Mund Kiefer Gesichtschir 1999; 3: 78–81.

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1. Bristol, Jordan

   Y. Hassona

2. Bristol

   C. Scully

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1. Y. Hassona

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• Frictional Keratosis, Contact Keratosis and Smokeless Tobacco Keratosis: Features of Reactive White Lesions of the Oral Mucosa

  • Susan Müller

  Head and Neck Pathology (2019)

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Oral Leukoedema with Mucosal Desquamation Caused by Toothpaste Containing Sodium Lauryl Sulfate

Case Letter

By

James B. MacDonald, MD

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References

1. Shafer WG, Hine MK, Levy BM. A Textbook of Oral Pathology. Philadelphia, PA: WB Saunders; 1983.
2. Zegarelli DJ, Silvers DN. Shedding oral mucosa. Cutis. 1994;54:323-326.
3. Archard HO, Carlson KP, Stanley HR. Leukoedema of the human oral mucosa. Oral Surg Oral Med Oral Pathol. 1971;25:717-728.
4. Herlofson BB, Barkvoll P. Desquamative effect of sodium lauryl sulfate on oral mucosa. a preliminary study. Acta Odontol Scand. 1993;51:39-43.
5. Skaare A, Eide G, Herlofson B, et al. The effect of toothpaste containing triclosan on oral mucosal desquamation. a model study. J Clin Periodontology. 1996;23:1100-1103.

To the Editor:

A 34-year-old woman presented for evaluation of dry mouth and painless peeling of the oral mucosa of 2 months’ duration. She denied any other skin eruptions, dry eyes, vulvar or vaginal pain, or recent hair loss. A recent antinuclear antibodies test was negative. The patient’s medical history was otherwise unremarkable and her current medications included multivitamins only.

Oral examination revealed peeling gray-white tissue on the buccal mucosa and mouth floor (Figure 1). After the tissue was manually removed with a tongue blade, the mucosal base was normal in color and texture. The patient denied bruxism, biting of the mucosa or other oral trauma, or use of tobacco or nonsteroidal anti-inflammatory drugs.

Figure 1. Oral examination revealed peeling gray-white tissue on the buccal mucosa and mouth floor.

Biopsies from the buccal mucosa were performed to rule out erosive lichen planus and autoimmune blistering disorders. Microscopy revealed parakeratosis and intracellular edema of the mucosa. An intraepithelial cleft at the parakeratotic surface also was present (Figure 2). Minimal inflammation was noted. Fungal staining and direct immunofluorescence were negative.

Figure 2. Intraepithelial linear cleft in the parakeratotic surface with intracellular edema present in the upper one-third to one-half of the stratum spinosum (H&E, original magnification ×20).

The gray-white clinical appearance of the oral mucosa resembled leukoedema, but the peeling phenomenon was uncharacteristic. Histologically, leukoedema typically has a parakeratotic and acanthotic epithelium with marked intracellular edema of the spinous layer.^1,2 Our patient demonstrated intracellular edema with the additional finding of a superficial intraepithelial cleft. These features were consistent with the observed mucosal sloughing and normal tissue base and led to our diagnosis of leukoedema with mucosal desquamation. This clinical and histologic picture was previously described in another report, but a causative agent could not be identified.²

Because leukoedema can be secondary to chemical or mechanical trauma,³ we hypothesized that the patient’s toothpaste may be the causative agent. After discontinuing use of her regular toothpaste and keeping the rest of her oral hygiene routine unchanged, the patient’s condition resolved within 2 days. The patient could not identify how long she had been using the toothpaste before symptoms began.

Our case as well as a report in the literature suggest that leukoedema with mucosal desquamation may be the result of contact mucositis to dental hygiene products.³ Reports in the dental literature suggest that a possible cause for oral mucosal desquamation is sensitivity to sodium lauryl sulfate (SLS),^1,4 an ingredient used in some toothpastes, including the one used by our patient. The patient has since switched to a non–SLS-containing toothpaste and has remained asymptomatic. She was unwilling to reintroduce an SLS-containing product for further evaluation.

Sodium lauryl sulfate is a strong anionic detergent that is commonly used as a foaming agent in dentifrices.⁴ In products with higher concentrations of SLS, the incidence of oral epithelial desquamation increases. Triclosan has been shown to protect against this irritant phenomenon.⁵ Interestingly, the SLS-containing toothpaste used by our patient did not contain triclosan.

Although leukoedema and mucosal desquamation induced by oral care products are well-described in the dental literature, it is important for dermatologists to be aware of this phenomenon, as the differential diagnosis includes autoimmune blistering disorders and erosive lichen planus, for which dermatology referral may be requested. Further studies of SLS and other toothpaste ingredients are needed to establish if sloughing of the oral mucosa is primarily caused by SLS or another ingredient.

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How to get rid of wrinkles around the mouth – article

Shallow creases in the nasolabial triangle appear at a young age. Purse-string vertical above the upper lip and puppet wrinkles that run from the corners of the lips to the chin do not paint anyone. They change facial expressions and give age. How to deal with them will help the advice of cosmetologists.

Ways to correct wrinkles

Since the circular muscle is attached to the epidermis, it stretches the skin with each contraction. Due to the activity of the circular muscle, facial expressions, articulation, the absence of sebaceous glands and fat, lines of future creases are already visible at 25+. The main causes of purse-string wrinkles are smoking and sipping cocktails through a straw. Constant squeezing of the cigarette with the lips stretches them into a tube and forms longitudinal lines that deepen with age. Savoring drinks gives them the shape of a bow and forms a fine network of wrinkles around the mouth. There are corrective ways to make them invisible. To start:

• give up bad habits;
• constantly apply moisturizing creams and masks to your face;
• when going outside, use protective creams with a high UV index;
• do special exercises to contract the circular muscle.

Effective masks

To nourish and saturate the skin with moisture, use cottage cheese. Mix the fatty product with sour cream and honey 1:1. Add a pharmacy vitamin A capsule, apply the composition to the area of ​​​​the nasolabial triangle of the face for 20 minutes. For prevention, make a mask a couple of times a week.

White clay

The fine powder is ideal for women with oily epidermis. Dilute it in warm water or herbal decoction, enrich with oily vitamin E. Apply with a sponge near the mouth and massage to exfoliate dead skin cells. The mixture smoothes and dries pimples, removes inflammation, narrows pores. Leave on for 15 minutes, rinse and moisturize with any warm carrier oil.

Lip Gymnastics

With daily exercise, tighten and reduce the depth of even age-related wrinkles in 10 days, protect yourself from gravitational ptosis.

1. Press your lips inwards. Hold the corners of your mouth with your index fingers. Overcoming resistance, retract to the teeth 30 times.
2. Take a mouthful of air and puff out your cheeks. Roll it left and right until muscle fatigue.
3. Open your mouth and round your lips, avoiding cheek lines. Put your index fingers in the corners and smile. Feel the tension in all the muscles of the lower third of the face.
4. With your mouth wide open, pronounce vowels with precise articulation.

After each exercise, relax the circular muscle with the vibration emanating from the sound “whoa”. Massage immediately. It relaxes the facial muscles, removes moisture from the tissues, increases elasticity.

How to get rid of creases with fillers?

Older women are more likely to turn to injection cosmetology. From cassette and labio-chin wrinkles, lowering the corners of the mouth, contour plastic helps. The essence of the method is the introduction of gel-like hyaluronic acid under the skin in the form of a gel. When it swells, it:

• compensates for the lack of volume and decomposes the epidermis;
• accelerates metabolic processes in tissues;
• intensively moisturizes;
• enhances the production of collagen and elastin fibers that increase turgor.

Hyaluronic acid breaks down into carbon dioxide and water and is excreted from the tissues in 6-10 months.

Botox shots

Due to the risk of getting “frozen lips”, this procedure is not decided so often. This effect occurs with incorrect dosage of the drug and careless administration. The method is contraindicated for people with edematous-deformed type of face. Botox mixes with water in the tissues and spreads.

Medium chemical peel

For the treatment of wrinkles on oily epidermis, use peels. Exposure to the deep layers of compounds with AHA and BHA acids causes a controlled burn of the skin and exfoliates the keratinized epithelium. During regeneration, the cells are renewed, the depth and size of the grooves are reduced, and the face is rejuvenated. Since the method increases photosensitivity, carry out the procedure in winter. Use mesotherapy in summer. The technology provides for the introduction of cocktails with hyaluronic acid, amino acids, vitamins. For those suffering from bags and edema, the method is not suitable to get rid of folds in the nasolabial zone.

Laser method

In hardware cosmetology for women 35+, rejuvenation is effective with generated rays that erase wrinkles like an eraser.