Oral Mucosal Disease

Question 1

When may an oral mucosal lesion be referred for an opinion in OM?

Answer 1

Anything potentially cancerous/dysplastic
-> 2 week referral pathway

Any symptomatic lesion which has not responded to treatment

Any benign lesion a patient cannot be convinced is not cancer

Question 2

Which type of epithelium is the oral mucosa?

Answer 2

Stratified squamous epithelium
 Masticatory- keratinised
 Gustatory cells
 Lining- Non- Keratinised

Question 3

In which region is Ortho-keratinised tissue present
?

Answer 3

Gingiva and hard palate

-> trauma expected in these areas

Question 4

What is parakeratinised tissue?

Answer 4

Present when there are alterations to standard mucosal type
-> Lichen planus

Question 5

What is the lamina propria?

Answer 5

Thin layer of connective tissue containing BV

Question 6

What are the epithelial layers?

Answer 6

Stratum Basal- basement membrane containing epithelial progenitor cells

Stratum Spinsoum (Maturation)

Stratum granulosum (M)

Stratum corneum (Cornified)

Question 7

What happens to cells as you move to epithelial surface from BM?

Answer 7

As you move toward surface organelles are lost from cells until just the cell wall remains, these become flattened and keratinised on the surface

Question 8

What does mitosis closer to epithelial surface suggest?

Answer 8

Dysplasia

-> serial sections may be required to see changes in 3D

Question 9

What reactive changes occur in the oral epithelium to protect it from trauma and immunological damage?

Answer 9

Keratosis in nonkeratinised site (parakeratosis)

Acanthosis- hyperplasia of stratum spinosum

Elongated rete ridges- hyperplasia of basal cells

Question 10

What are the types of mucosal reactions?

Answer 10

Atrophy- loss of viable layers

Erosion- partial loss in thickness

Ulceration- epithelium lost completely and fibrin exudate sits on connective tissue

Blisters- collections of fluid in vesicles or bulla

Oedema- intra/intercellular

Question 11

What can occur in mucosa as a result of age?

Answer 11

Slight thinning-would only be seen on biopsy, not in practice

-> investigate further if noticeable clinically

Question 12

What can occur to the tongue as a result of iron/vit B deficiency?

Answer 12

Becomes smooth (atrophic)

-> more likely to get infection

Question 13

When does geographic tongue appear as a result of?

Answer 13

Alteration to maturation and replacement of normal epithelial surface

-> Whole areas of epithelial surface are replaced at once (stop and starting of epithelial production) resulting in thinning of epithelial layer (red appearance- BV are closer to surface)

Question 14

Why do some people with geographic tongue experience sensitivity?

Answer 14

Nerves are closer to the surface due to loss of tissue

-> can be worse with acidic and spicy foods

Question 15

What are the features of Geographic tongue?

Answer 15

 Can be on dorsum of tongue or lateral borders (can occur on buccal mucosa and palate)- semi-circular white areas surrounded by red
 No treatment required- asymptomatic mostly
 Can happen at any age- worse in children (difficult to manage sensitivity but is not worrisome)
 Intermittent- symptomatic for a week, then settles for months (then process repeats)

Question 16

If geographic tongue becomes symptomatic, what are the likely underlying causes?

Answer 16

Haematinic deficiency (B12, Folate, Ferritin)

Parafunctional trauma

Dysaesthesia

Question 17

What causes black hairy tongue?

Answer 17

 Can be due to bacteria
 Mostly caused by elongated tongue papillae which have been stained with pigments from food etc

-> benign condition, mostly an appearance issue

Question 18

How is black hairy tongue treated?

Answer 18

Use of tongue scraper or peach stone?

Question 19

What are the features of Fissure Tongue?

Answer 19

 intermittent
 Often asymptomatic
 Usually aesthetic issue- “grips hold of food better”
 Fissures can become deep and trap food and debris- leading to local inflammation

 Candida or lichen planus within fissures can cause pain

Question 20

What can be done to prevent inflammation in fissured tongue?

Answer 20

Fissures can be cleaned using soft brush

Question 21

What is glossitis?

Answer 21

Inflammation of the tongue:
 Usually appears as smoothing and reddening (atrophy)
 Can be caused by disease process or nutritional deficiency
 Can occur along with angular cheilitis- esp in iron deficient anaemia

Question 22

What investigations may be done for glossitis?

Answer 22

Hamatinic check

Fungal culturing

Biopsy- Lichen Planus

Question 23

When should a swelling be referred to OM for removal?

Answer 23

Symptomatic (pain is a feature of salivary gland malignancy!)

Abnormal overlying and surrounding mucosa

Increasing in size

‘rubbery’ consistency

Trauma from teeth

Unsightly

Question 24

What swellings should not be referred to OM for removal?

Answer 24

Tori
Small polyps
Mucoceles – unless they become fixed as they are difficult to see

-> This is due to risk of iatrogenic damage on removal

Question 25

What is the cause of Papillary hyperplasia of the palate? How is it fixed?

Answer 25

By denture
-> Modify denture to fix issue

Question 26

What causes a leaf fibroma (fibrous polyp)? How is it treated?

Answer 26

Squashing of polyp underneath denture as it grows

-> Should be removed and allowed to heal (or it will grow) and then construct a new denture

Question 27

How do fibro-epithelial polyps appear?

Answer 27

Very similar to surrounding mucosa
-> not usually concerning in oral cavity

Question 28

What is the issue with a burst mucocele?

Answer 28

It is impossible to find where lesion was

Question 29

What are tori and their features?

Answer 29

Bony swellings (benign)
 Seen in parafunctional habits- may report TMD
 Covered by NK mucosa

Question 30

What is the issue with tori and bisphosponates?

Answer 30

People on bisphosphonates are more likely to get vascular necrosis of the mucosa over tori due to blood supply being derived from bone and periosteum rather than directly from arterial supply

Question 31

What are the features of a pyogenic granuloma?

Answer 31

 does not have epithelial surface (or has patches)
 granulation tissue- mixed inflammatory infiltrate on fibro-vascular tissue
 Fibrinous yellow or red appearance
 Occurs on any mucosal site
 Not a granuloma or pyogenic

Question 32

What are the other names for pyogenic granuloma?

Answer 32

Gingiva (most frequent site)- vascular epulis

Gingiva during pregnancy- Pregnancy epulis