benign lesions of the oral mucosa Flashcards
are most congenital/hereditary or acquired?
some congenital/hereditary but majority are acquired
epithelial origin lesions
papilloma
drug-induced gingival overgrowth
lamina propria origins
traumatic fibroma pyogenic granuloma peripheral GC granuloma mucocele lipoma haemangioma
papilloma aetiology
neoformation epithelial origin
HPV
clinical papilloma
hairy like elongated lesion single/multiple white/pinkish pedunculated/sessile no malignant potential
tx papilloma
surgical - may recur
another name for traumatic fibroma
fibroepithelial polyp
location of traumatic fibroma
usually buccal mucosa, lips, tongue
NOT gingiva
traumatic fibroma aetiology
accidental biting
chronic irritation
trauma/infection
traumatic fibroma clinical presentation
dome-shaped soft same colour as surrounding mucosa, can be keratinised sessile/pedunculated can be ulcerated
what is a traumatic fibroma called if on gingivae?
epulis
traumatic fibroma tx if excessive dimension
surgically remove
traumatic fibroma histology
fibrous tissue
covered by keratinised SSE
- buccal mucosa NK: paler cells (store glycogen)
- to withstand trauma
- atrophic - thinner than normal epithelium
collagen fibres, fibroblasts, a few chronic inflammatory cells
- relatively acellular CT
drugs responsible for drug-induced gingival overgrowth
anticonvulsants - phenytoin
immunosuppressants - cyclosporin
Ca channel blockers - nifedipine, amlodipine
clinical presentation drug-induced gingival overgrowth
enlargement 1-3m of taking drug entire U and L gingiva more severe anterior regions starts from ID papilla may cover a portion or entire tooth crown
drug-induced gingival overgrowth consequences
may prevent OH
painful eating
disfigurement
impair QOL
drug-induced gingival overgrowth tx
liase w physician: discontinuation of drug and switch to another
professional OH and CHX rinse
gingivectomy
if med not stopped may recur
pyogenic granuloma aetiology
benign, vascular, reactive?
aetiology unknown
- seems constant insults may lead to rapid proliferation of capillaries w a friable and lobulated aspect
hormonal factors - associated with pregnancy
clinical presentation pyogenic granuloma
begins small red papule
then red pedunculated exophytic lesion
surface often friable and ulcers - bleeding
often gingival margin (vascular epulis) and tongue
pyogenic granuloma consequences
no malignant potential but complications - ulceration, bleeding, secondary infections
pyogenic granuloma tx
surgical (but may recur)
also to stop angiomatous proliferation or to rule out chancre, carcinoma or kaposi-sarcoma
peripheral giant cell granuloma/GC epulis aetiology
usually described as reaction to chronic local factors
- supra/subgingival dental biofilm
- ill fitting Rxs
- dentures
- associated to implants
unknown aetiology - seems to come from PDL, or periosteum, or persistence of cells from PDL after tooth ext
peripheral giant cell granuloma/GC epulis clinical
younger pts anterior exophytic smooth red/purple firm/elastic consistency freq asymptomatic except if surface ulcerated
peripheral giant cell granuloma/GC epulis radiographic
resorption alv bone
widening PDL space
rarely RR
peripheral giant cell granuloma/GC epulis histology
MN GCs with background of GT
mononuclear stromal cells and extravased rbcs, v cellular
sharply demarcated but no fibrous capsule surrounding
hyperlastic SSE - parakeratinised
red cell areas - haemorrhage
- haemosidrin - brown
GCs might be macrophages joined together
peripheral giant cell granuloma/GC epulis tx
conservative excision with PD therapy
but high chance of recurrence
exclude systemic disease
- raised PTH
- low vit D in diet
- malabsorption
- renal disease
CGCG (bony)
uncommon
found only in tooth bearing regions of jaws
most common in mandible 20-30yrs
may mimic malignant neoplasm
can erode through cortical bone - domed purplish mucosal swelling
may have haemosidrin due to new and old haemorrhages (v vascular)
mucocele aetiology
lesion caused by disruption of salivary flow from minor salivary glands origin
types of mucoceles
extravasation
- collection of saliva in CT following trauma to ducts
retention
- accumulation of saliva within ductal system due to obstruction of the salivary ducts
ranula
- from major salivary gland origin, occur on FOM
mucocele clinical
soft neoformations
usually L lip and buccal mucosa
colour from normal mucosa to light blue/white
tend to be larger and smaller periodically
- may want to wait 2-3m to see if it gets larger. Bursts and recurs
mucocele tx
surgical removal inc underlying minor salivary gland