Mucosal Lesions Flashcards
Appearance regarding georgraphic tongue
Two types
1. Areas of depopulation surrounded by white area- turn over of cells does not match , irregular smooth red areas, usually wavy, white lines next to the red patch
2. Cresent chapped fissures-
Cause and key features of geographic tongue
Unnown cause
Irregular turnover of epithelium
Red patches -tin, raw, sore on acidic food
Can be inherited or have allergic component, associated with anaemia
Diagnosis made by appearance
No cure
Treatment - anaesthetic mouthwashes
Oral pain relievers
Topical steroids
Back hairy tongue
Benign, thickening of filiform papillae. Can get discoloured -giving the appearance
Defective shredding of cells of filiform papillae
No symptoms
Contributing factors- soft diet, poor OH, smoking , alcohol, antibiotics,
Treatment - increased hydration, stop smoking, using tongue scraper, tongue brushing, scraping with peach stone,
Epulis
Long term inflamed hyperplasia
Types-fibrous epulis-same colour as other gum, pyogenic/vascular- reddish swellings, usually ulcerated, may bleed, denture etc
Caused by trauma or long term irritation or friction
Fibro-epithelial polyp
Firm painless swelling. It is reactive localised- scarring due to trauma or irritation
Can have narrow stalk or sessile, shouldn’t grow, surface may become white if there is frictional keratosis
Hyperplastic swellings caused by low grade infection
Salivary mucocole
Fluid fill cyst, anywhere in the mouth where we have minor salivary glands, usually due to trauma, quite common, usually no larger than 1cm in size
Types
Extravasation-due to trauma causing rapture of the salivary duct. Area becomes inflamed, and fills with mucus. Cyst can rapture and appears blueish, 70% occur on lower lip. Histology -pools of mucin (mucin with no epithelial lining-not a cyst!, There are macrophages), capillaries and fibroblast growing in area forming granulation tissue and surface of the lip shows as squamous epithelium; mucin is irritant to tissue so granulation tissue tries to get rid of mucin so macrophages can clean the mucin, more in young adults
It is cyst like lesion (be careful if you see epithelium because it is coming from the lip, NOT cyst)
Retention mucocele -pooling of mucus due to blockage of salivary duct (could be by food debris)0 often found in FOM, more in adults. Histology -dilated duct, true cyst as it is lined by epithelium, mucin inside of the cyst. Can either enlarge or burst (making them combination with extravasation)
Example is ranula-occurs in large salivary gland ,if bulges into the neck-plunging ranula
Oral candidiasis
Yeast
Opportunistic-change in oral ecology or due to immunosuppression
Symptoms -local discomfort, altered taste sensation, dysphagia (due to overgrowth in oesophagus) causing poor nutrition and slow recovery.
Sign- white/yellow patches/plaque that can be rubbed off leaving red/erythematous surface
Diagnosis-rinse, swab, culture
Treatment -anti fungals (miconazole, Nystatin…)
Pt at risk-immunocompromised (leukaemia, HIV, other malignancy), on inhaled corticosteroids, cytotoxic drugs, broad spectrum antibacterials, diabetic, nutritional deficiency)
Denture stomatitis
Chronic erythematous candidiasis
Not associated with allergy but denture wearing
Red/erythema beneath the denture
More in RPD than CD
Superficial fungal infection
Multifactorial aetiology
Treatment -of oral tissues and the denture by local measures or adjunct with antifungals or chlorhexidine
(Brushing daily, cleaning denture and soaking in hypochlorite, leaving denture out as much as possible, making new denture if that is the issue)
Angular cheilitis
Due to candida in denture wearers
In non denture wearers- streptococcus or staphilococcus
Miconazole cream effective treatment (not if taking warfarin or statins)
If bacterial infection-sodium fusidate (ointment-on dry)
Median rhomboid glossitis
Erythematous candidiasis unique to midline posterior tongue, just Infront of sulcus terminalis.
Single area of redness that does not migrate
More in male, mid old age
Associated with smoking
Treatment-fuconazole
Associated with HIV if in young person
Geographic tongue
Areas of depapulation/atrophy on dorsum of the tongue surrounded by thickened areas which are hyperplastic
Associated with psoriasis
Two types
Crescent fissures or
Patches
No treatment, only reassurance
Nicotinic stomatitis
In the palate
Usually asymptomatic
White spots surrounded by redness-swollen minor salivary gland orifices
Mechanism of action- heat irritation acting as local irritant stimulating reactive process
Reverses on smoking stopped
Causes.of atrophy and erosion
Atophy- candida, haematinic deficiency, geographic tongue, lichen planus
Erosion- trauma, lichen planus, candida
Other than keratosis, what other change can cause white appearance
Subepithelial hypovascularisation- vasoconstriction, fibrosis
Leukoplakia and malignamcy
Leukoplakia is associated with an increased risk of malignant transformation - close surveillance is required
