White Sponge Nevus - Causes, Symptoms, Diagnosis and Treatment

Introduction

Have you ever wondered why you get those white patches on your inner cheeks inside your mouth? Well, it could be leukoplakia or candidal infections which is a common oral problem seen among adults. But not all white patches on the mucosa are leukoplakia or infections. Some patches, which do not cause any discomfort, could be seen since birth or since early childhood,, and this condition is called white sponge nevus.

What Is White Sponge Nevus?

White sponge nevus is a genetic condition that affects the mucosal lining of the mouth due to the mutation of a gene. This condition is often characterized by the formation of thick, velvety white layers of tissues in the mucosal lining of the oral cavity. In some cases, white, velvety dense tissue formations are also seen in the mucosal lining of the genital areas. This condition can be seen since birth or can be witnessed during the early childhood period. Each velvety white patch of tissue formation is called a “nevi” (nevus is the plural form of nevi).

What Causes White Sponge Nevus?

White sponge nevus is an autosomal dominant condition. It is caused due to the mutation of a gene, KRT4 or KRT13. These genes are responsible for the synthesis of a fibrous protein called keratin. This protein keratin strengthens the fibers of the mucosal linings of all the cavities of the body. When a mutation occurs in either of these genes, it leads to the formation of an abnormal fibrous protein that is weaker than keratin. This protein often gets damaged easily during everyday activities like chewing food or brushing the teeth. This condition might run in families.

What Are the Common Signs and Symptoms of White Sponge Nevus?

White sponge nevus is a very rare genetic autosomal dominant condition. That is, this condition is seen to affect less than one person in every 200000 people. This condition affects both men and women equally and is not found to affect any particular population. Some of the common signs and symptoms of white sponge nevus are,

• The nevus (white spongy tissue formation seen in the mucosal part of the oral cavity) is often symptomless. They are often painless.

• These white lesions are often found bilaterally on both sides of the mouth.

• The lesions are commonly seen in the buccal mucosa (inner cheek). However, they can also be seen in the gums, upper palate, the floor of the mouth, and tongue in some cases. Rarely, few people experience white sponge nevus in the mucosal lining of the genital areas.

• The signs are the formation of corrugated, thick lesions in the inner linings of the mouth. The texture of the lesions is velvety or spongy.

• The lesions are often seen since birth, or they can be more evident during early childhood.

• The lesions grow in size and are often seen when they reach a bigger size as they are often symptomless.

• The nevus itself does not cause any pain or discomfort. However, the thick corrugated surface of these lesions may favor the accumulation of bacteria, which can cause discomfort.

How to Diagnose White Sponge Nevus?

• The dentist or the general physician often clinically diagnoses the size, shape, and texture of the lesion.

• They usually rule out the presence of other conditions like leukoplakia and candidiasis before making the final diagnosis.

• A test called genetic testing registry (GTR) is done to find any abnormal mutations in the gene.

What Are the Other Conditions That Mimic White Sponge Nevus?

Few other standard conditions of the oral cavity resemble white sponge nevus. Therefore before starting any treatment or before making the final diagnosis, the presence of other conditions must be ruled out. Some of the common conditions that mimic white sponge nevus are,

• Candidiasis.

• Leukoplakia.

• Cheek biting habits.

• Lichen planus.

• Dental plaque.

What Are Other Names Used for White Sponge Nevus?

White sponge nevus (WSN) is called by different names such as,

1. Cannon’s disease.

2. Nevus of cannon.

3. Familial white folded mucosal dysplasia.

4. Hereditary oral keratosis.

5. White gingivo stomatitis.

6. White sponge nevus of cannon.

7. White sponge nevus of the mucosa.

8. Leukokeratosis of the oral mucosa.

9. Leukokeratosis, hereditary mucosal.

How to Treat White Sponge Nevus?

White sponge nevus is an autosomal dominant condition that does not cause any severe complications. Therefore, mostly there is no treatment needed for cure.

• In some cases, the corrugated surfaces of the white sponge nevus may lead to the formation of bacteria in the layers that could cause discomfort. In those situations, your dentist or your general physician might prescribe an antibiotic and antiseptics like Chlorhexidine which is known to be present in mouthwashes.

• Usage of Tetracycline for a few weeks is shown to give improvements.

Conclusion

White sponge nevus is a very rare genetic autosomal dominant condition that might lead to the formation of white spongy layers of tissues in the oral cavity. Though they resemble leukoplakia or lichen planus, they do not usually cause any discomfort or pain to the person having it. Therefore 90 percent of the persons affected do not seek treatment. However, further invasion of the white sponge nevus with bacteria can lead to discomfort and pain. These complications can be avoided by following a proper oral hygiene routine and using antiseptic mouthwashes with Chlorhexidine in them.