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BDS4 Oral Medicine > Oral Mucosal Colour Changes > Flashcards

Oral Mucosal Colour Changes Flashcards

1
Q

What are the causes of white oral lesions?

A

 Hereditary- oral white sponge Naevus (genetic changes to cytokeratins)
 Frictional- thickening of keratin layer, obstructs view to blood vessels giving more white appearance
 Lichen planus- acanthosis (reduces visibility of vessels)
 Candidal leukoplakia- inflammation within epithelium and connective tissue, thickness and fluid builds up reducing visibility of vessel
 Carcinoma- thickening of cells

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2
Q

What conditions is lichen planus associated with

A

Lupus erythematosus

Graft versus host disease

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3
Q

What causes lesions to appear white?

A

Thickening of the mucosa or keratin
-> Less visibility of blood/vessels

Less blood in the tissues
-> vasoconstrictor effect- slowing of blood passage through connective tissue

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4
Q

What is leukoplakia?

A

A white patch which cannot be scraped off or attributed to any other cause

-> descriptor/diagnosis of exclusion

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5
Q

What is the risk of leukoplakia becoming malignant?

A

1-5%

-> risk is based on aetiology of white patch

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6
Q

What are fordyce’s spots?

A

Ectopic sebaceous glands
-> Benign and normal

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7
Q

What habit is associated with frictional keratosis?

A

Parafunctional clenching- pulling buccal mucosa in which rubs against cusps of teeth causing keratotic thickening and lack of view of blood flow (white appearance)

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8
Q

What causes smokers keratosis, what are its features?

A

Trauma caused by thermal gases
 Thickening of tissues
 mucosa remains normal but sometimes as a result of trauma, melanocytes over produce melanin (pigmentation changed- melanosis)
 Malignant conversion potential is low (but general risk is higher due to smoking)

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9
Q

What are the features of White Sponge Naevus?

A

 Starts in childhood in posterior of mouth then spreads forward
 Familial
 Not caused by trauma

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10
Q

What causes the appearance of WSN?

A

Fluid accumulates between epithelial cells in the superficial layers- increases opacity of tissue and disrupts visualisation of blood vessels

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11
Q

What would be the general features of a non-worrying oral lesion?

A

White lesions

Well defined (no inflammation surrounding)

Covering normal mucosa

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12
Q

What is idiopathic keratosis?

A

Occurs without obvious cause (genetic programming switches to produce more keratin)

-> still biopsy to confirm

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13
Q

How does desquamative gingivitis present?

A

Lichen planus areas- white, with areas of thinning- red vascular appearance

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14
Q

Why is biopsy of the gingival margin an issue?

A

Difficult- chance of ischaemia and tissue death (done by specialist)

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15
Q

What occurs as a result of a chemical burn in the oral cavity?

A

Coagulation of protein and damage to epithelial surface

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16
Q

What medications are associated with causing chemical burns?

A

Can happen with aspirin or alendronic acid (can be seen if patient has reduced cognitive function and does not swallow tablets)

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17
Q

Which habit is associated with traumatic keratosis?

A

Tongue thrusting

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18
Q

What happens as a result of hairy leukoplakia, what causes this?

A

Elongation on papillae on side of tongue and thickening of surface
-> Due to incorporation of Epstein bar virus into genetic code of the cell causing them to reproduce at faster rate and produce more keratin rich appearance

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19
Q

What are the types of lesions associated with candida?

A

Pseudomembranous Acute (thrush)

Denture Associated - Chronic due to prolonged contact (erythematous)

20
Q

What does pseudomebraneous mean?

A

Not part of or adhering to mucosa (can be rubbed off)

21
Q

How do lesions caused by HSV present in the mouth?

A

As intra-epithelial vesicles (disrupt view of BVs)
-> Loses white appearance on bursting

22
Q

When should a white lesion be referred by a dentist?

A

If RED and WHITE- concentrate on the RED part

If the lesion is becoming more raised and thickened

If the lesion is ‘without cause’- esp in lateral tongue, anterior floor of mouth, soft palate area

-> most are benign and kept under review by dentist only

23
Q

What are the caused of the red appearance of some lesions?

A

Blood flow increases
-> Inflammation
-> Dysplasia causing increased vascularity (can become malignant)

Reduced thickness of the epithelium

24
Q

What are the features of geographic tongue?

A

White margins with areas of erythema
-> Changes in a few weeks or may resolve

25
Q

What causes red lesions to present under dentures?

A

If candida present due to poor denture hygiene

-> Can appear in certain areas only in older dentures if bone has resorbed in certain sections meaning only certain parts of mucosa are in contact

26
Q

What is erythroplakia?

A

A red patch which cannot be attributed to any other cause
-> Atrophic or non-keratotic end of the spectrum
-> More of a concern for malignancy than leukoplakia

27
Q

What are the causes of red/blue lesions?

A

Fluid in the connective tissue:

Dark – slow moving blood in large vessels
-> varicosities, veins or cavernous haemangioma

Light Blue – clear fluid
-> presence of saliva (mucocele)/lymph (Lymphangioma) within

28
Q

How do normal haemangiomas look?

A

More red due to presence of more capillaries

29
Q

How can vascular lesions be distinguished from malignancy?

A

Vascular- tend to fluctuate in size

Malignancy- only increases

30
Q

What cause lymphangioma?

A

Proliferation of fluid filled spaces

-> common in tongue

-> most are cavernous and appear like cavernous haemagiomas

31
Q

What does vasculitis cause?

A

Alteration of blood flow to tissues

32
Q

What are the different types of vasculitic disease?

A

Large vessel Disease:
Giant cell (temporal) arteritis

Medium Vessel Disease:
Polyarteritis nodosa
Kawasaki disease

Small vessel Disease:
Granulomatosis with Polyangiitis

33
Q

What are the causes of pigmented lesions?

A

Exogenous-
-> Stain from tea, coffee, chlorhexidine
-> Bacterial overgrowth

Intrinsic Pigmentation
-> Reactive Melanosis/melanotic macule- freckles
-> Melanocytic naevus
-> Melanoma
-> Effect of systemic disease, paraneoplastic phenomenon

Intrinsic foreign body
-> metals – amalgam, arsenic

34
Q

What is melanoma?

A

Malignant change within melanocyte
-> can be pigment free
-> may be on face, hands or neck rather than the mouth

35
Q

What are the causes of localised black/brown lesions?

A

Amalgam tattoos

Melanotic Macule

Melanotic naevus

Malignant Melanoma

Peutz-Jehger’s syndrome

Pigmentary incontinence

Kaposi’s sarcoma

36
Q

What are the causes of localised black/brown lesions?

A

Racial/familial

Smoking

Drugs- Contraceptive pill/tetracycline/newer biologics

Addison’s disease
-> Raised ACTH conditions

37
Q

What does ACTH do to cause generalised black/brown lesions?

A

More stimulation of melanocytes, more melanin and pigmentation of skin and mucosa

38
Q

What should be done if patient suspected to have raised ACTH as result of Addison’s?

A

Check BP and electrolytes

39
Q

When should oral pigmentation be referred?

A

If increasing in size, colour or quantity

If related to new systemic disorder

40
Q

What are the signs of Melanoma?

A

Variable pigmentation

Irregular outline

Raised surface

Symptomatic- Itch/bleed

41
Q

What are the causes of mucosal inflammation

A

trauma- physical or chemical

infection- viral, bacterial or fungal

immunological

42
Q

What are biopsies used for?

A

Identifying/excluding malignancy

Identifying dysplasia

Identify other disease- lichen planus

-> All unexplained white, red, pigmented patches

43
Q

What cases should be referred to oral med?

A

Patients with abnormal and/or unexplained changes to the oral mucosa
-> Practitioner threshold will vary with experience

If there is concern about dysplasia risk:
Appearance of lesion
Risk site
Risk behavior
Family history

44
Q

What should not be referred to OM?

A

Asymptomatic VARIATIONS of NORMAL mucosa

Benign conditions the practitioner has diagnosed that:
Are asymptomatic
Do not have potentially malignant risk
For which there is no treatment

45
Q

What should you do if you are unsure whether to refer to OM?

A

Monitor area until next check up

Send photos to OM and discuss with specialist

BDS4 Oral Medicine (28 decks)

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