oral mucosal disease

Question 1

When should a mucosal lesion be referred to oral medicine?

Answer 1

Anything the dentist thinks might be cancer or dysplasia
Any symptomatic lesion that has not responded to standard treatment
Any benign lesion that the patient can’t be persuaded is not cancer

Question 2

What are the strata layers of the epithelium?

Answer 2

Stratum corneum - most superficial
Stratum granulosum
Stratum spinosum
Stratum basale

Question 3

Where does cell division occur in the strata?

Answer 3

Suprabasal cells only

Question 4

What is acanthosis?

Answer 4

Hyperplasia of the stratum spinosum

Question 5

What are elongated rete ridges?

Answer 5

Hyperplasia of basal cells

Question 6

What is atrophy?

Answer 6

Reduction in viable layers

Question 7

What is erosion?

Answer 7

Partial thickness loss of epithelium

Question 8

What is ulceration?

Answer 8

Complete loss of epithelium with fibrin on the surface

Question 9

What is oedema and what are the 2 types?

Answer 9

Swelling
Intracellular - each cell is slightly bigger
Intercellular (spongiosis) - fluid between epithelial cells

Question 10

What is a blister?

Answer 10

Collection of fluid within or just below the epithelium
Called vesicle or bulla depending on size

Question 11

How does the mucosa change with age?

Answer 11

Progressive mucosal atrophy

Question 12

How does the mucosa change with nutritional deficiency?

Answer 12

Iron or B vitamins - predisposes to infection

Question 13

Give 3 examples of benign mucosal conditions

Answer 13

Geographic tongue
Black hairy tongue
Fissured tongue

Question 14

What is geographic tongue and what is the prevalence?

Answer 14

Alteration in maturation and replacement of normal epithelial surface
Affects 1-2% of population, less in children

Question 15

What are the symptoms of geographic tongue?

Answer 15

Sensitive with acidic/spicy foods - intermittent
Much worse in young children
Most patients have no symptoms

Question 16

What other things may cause geographic tongue?

Answer 16

Haematinic deficiency
Parafunctional trauma
Dysaesthesia

Question 17

How is geographic tongue managed?

Answer 17

Benign condition managed by eating foods that don’t cause irritation during episodes

Question 18

What is brown/black hairy tongue?

Answer 18

Hyperplasia of papillae
Stains caused by bacterial pigment from foods

Question 19

How is black hairy tongue treated?

Answer 19

Remove elongated surface from tongue:
- tongue scraper
- natural scraper like peach or nectarine stone

Question 20

What is fissured tongue?

Answer 20

Occasionally fissures become deep and trap foods causing inflammation
May be another disease present such as candida or lichen planus

Question 21

What causes fissured tongue?

Answer 21

No answer as to what causes it

Question 22

How is fissured tongue treated?

Answer 22

Clean with a soft bristled brush

Question 23

What is glossitis?

Answer 23

Inflammation of the tongue

Question 24

What investigations are needed for glossitis?

Answer 24

Haematinics
Fungal culture

Question 25

When should swellings be referred to oral medicine?

Answer 25

Symptomatic - pain is a feature of salivary gland malignancy
Abnormal overlying and surrounding mucosa
Increasing in size
Rubbery consistency
Trauma from teeth
Unsightly

Question 26

What is papillary hyperplasia and how is it treated?

Answer 26

Multiple small swellings caused by an ill fitting denture
No treatment

Question 27

What is a pyogenic granuloma?

Answer 27

Granulation tissue with no epithelial surface
A response to trauma
Can be found on any mucosal site

Question 28

What are other names for a pyogenic granuloma?

Answer 28

If on gingiva - a vascular epulis
If on gingiva during pregnancy - a pregnancy epulis

Question 29

How should potential malignancies be referred?

Answer 29

2 week cancer referral pathway