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Module 6 - Oral Surgery > Benign Mucosal Lesions > Flashcards

Benign Mucosal Lesions Flashcards

1
Q

what are the 7 categories that an oral/mucosa lesion can be according to the SURGICAL SIEVE APPROACH?

A
  • Congenital.
  • Traumatic.
  • Autoimmune.
  • Metabolic.
  • Infective.
  • Inflammatory.
  • Idiopathic.
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2
Q

Two types of congenital oral/mucosal lesions?

A
  • Leukodema
  • Fordyce spots
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3
Q

What is Leukodema? Where is it often located? What causes it? What does it look like?

A
  • White/grey discoloration.
  • Outwith the area that would normally be traumatized by the teeth.
  • Caused by THICKENING of the mucosa.
  • Often there is a FH.
  • Asymptomatic.
  • Benign.
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4
Q

What are fordyce spots? Where are they often located?

A
  • Ectopic sebaceous glands.
  • Within the BUCCAL MUCOSA or LIPS.
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5
Q

What causes erosions and ulcers? What is the difference between the two?

A

LOSS OF THE SUPERFICIAL EPITHELIAL LAYER DUE TO TRAUMA

  • Ulcers: full thickness of epithelium.
  • Erosions: only upper epithelial lost.
    thus depends on HOW ACUTE THE TRAUMA IS.
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6
Q

Name 3 things that can cause ulcers?

A
  • Dentures.
  • Restorations.
  • Direct trauma.
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7
Q

What is the treatment for ulcers?

A

Irradicate the source and review resolution. Must have resolution within 14 days.

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8
Q

5 factors to aphthous ulcers?

A
  1. Genetic.
  2. Hormonal.
  3. Trauma.
  4. Hematinic deficiency (ferritin, B12, Follate).
  5. Food stuffs.
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9
Q

What % of the population experiences aphthous ulcers?

A

20%

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10
Q

What is the white patch around an ulcer called? What does it do?

A

Keratosis.
- The body’s attempt to form a barrier.

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10
Q

What is the treatment for aphthous ulcers?

A
  • Self resolving thus treatment is SYMPTOMATIC (analgesia).
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11
Q

What is habitual chewing of the inside of the cheek called?

A

Morsicatio buccarum

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11
Q

What is meant if you see a white patch following trauma? What if an ulcer forms?

A
  • JUST WHITE PATCH: Often occurs when the trauma is CHRONIC and LOW-GRADE.
  • ULCER FORMATION: More ACUTE trauma.
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12
Q

How can you differentiate between morsicatio buccarum Vs leukodema?

A

Not as extensive as would be seen in leukodema - limited to around the occlusal plane.

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13
Q

What is linea alba?

A

White line at the level of the occlusal plane on the buccal mucosa.
- Bilateral.
- May also see scalloped lateral tongue (from patient pushing tongue against teeth when clenching).

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14
Q

What causes linea alba?

A
  • Associated with clenching.
  • Sucking habits.
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15
Q

What are polyps?

A

Benign growths of mucosa with fibrous centre.
- Mucosa appears healthy.

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16
Q

What are the 2 types of polyps?

A
  • Pedunculated: have a small stock.
  • Sessile: broad based.
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17
Q

What causes polyp formation?

A
  • An episode of trauma, ex. cheek biting habit.
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18
Q

What is the treatment for polyps?

A
  • Excision of the lesion under LA.
  • Only done because they may get so large that the patient keeps on biting on them, causing bother.
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19
Q

What is an amalgam tattoo?

A
  • Metal inclusion in the mucosa (taken up by macrophages).
  • Usually benign.
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20
Q

What may cause an amalgam tattoo?

A
  • When an amalgam restoration is replaced/ restore and a small amount of amalgam is released into the tissues at high speed.
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21
Q

Do we need to take biopsy of amalgam tattoos?

A
  • Must undertake BIOPSY to establish diagnosis as amalgam tattoos look similar to MUCOSAL MELANOMAS.
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22
Q

What causes denture induced hyperplasia?

A
  • Ill-fitting dentures.
  • Wear their dentures 24/7
  • Dentures are very old.
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23
Q

What is denture induced hyperplasia?

A
  • Overgrowths of tissue that grow around the flange of an ill-fitting denture.
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24
Q

What is the treatment for denture induced hyperplasia?

A
  • Excision of the lesion.
  • New dentures.
  • Systemic antifungals (if superimposed candidal infection).
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25
Q

What may be superimposed with denture induced hyperplasia?

A
  • Patients may also have an ORAL CANDIDA INFECTION due to poor OH.
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26
Q

What is the treatment for oral candida infection underneath dentures?

A
  • Systemic antifungals.
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27
Q

Treatment for mucocoele?

A

Excision of the mucocoele AND the minor salivary gland.

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28
Q

What is a mucocoele?

A
  • Mucous EXTRAVASATION cyst of a MINOR salivary gland.
  • usually PAINLESS.
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29
Q

What causes a mucocoele?

A

Trauma to the lip (usually lower), causing a “blister” to form in the lower lip.

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30
Q

What is the physiological process of mucocoele formation?

A

Saliva escapes from the damaged duct into the surrounding lip and causes a swelling

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31
Q

What happens once a mucocoele bursts?

A

Clear fluid is released and it goes down in size. however, as the broken duct is still present the mucocoele will reform. It will now be FIBROSED and more established.

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32
Q

3 types of FUNGAL infections of the mouth?

A
  • Denture induced.
  • Acute pseudomembranous candidiasis.
  • Candidal leukoplakia.
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33
Q

2 types of VIRAL infections of the mouth?

A
  • Human papilloma virus.
  • Herpes virus.
34
Q

What is the common name for oral acute pseudomembranous candidiasis?

A

Thrush

35
Q

What is the clinical presentation of thrust?

A
  • White plaques that wipe free, leaving a red base.
36
Q

What is the treatment for thrush?

A
  • Systemic antifungals
    (can use topical but not as effective).
37
Q

What could recurrent acute pseudomembranous candidiasis suggest?

A
  • Underlying IMMUNOCOMPROMISE
  • Ex. undiagnosed diabetes etc.
38
Q

What is the oral presentation of candidal leukoplakia?

A
  • White/red/ speckled lesion on the inside of the commisure - can be unilateral or bilateral.
  • Does NOT wipe off.
39
Q

What is leukoplakia?

A

A white patch that does NOT wipe off and cannot be attributed to any other cause.

40
Q

What is the treatment for oral candidal leukoplakia?

A
  • 2 week systemic antifungals.
  • If not improvement, biopsy is mandatory as the lesion could be potentially or frankly malignant lesion.
41
Q

What causes papillomas?

A
  • Associated with the LOW RISK HPV.
42
Q

What is the clinical presentation of oral papillomas?

A
  • Sessile or pedunculated.
  • Asymptomatic.
  • Can become traumatised.
43
Q

What is the treatment for papillomas?

A

Excision.

44
Q

What factors can cause reactivation of herpes (4)?

A
  • Stress.
  • Immunocompromise.
  • Sun exposure.
  • Hormonal problems.
45
Q

What causes secondary herpes?

A

Reactivation of latent virus in the trigeminal system.

46
Q

What is the clinical presentation of secondary herpes?

A
  • Tingling sensation before vesicles develop on the lip.
  • When vesicles rupture and crust, they are transmissible.
47
Q

What is the treatment for cold sores?

A

Topical antivirals.

48
Q

3 types of oral INFLAMMATORY lesions?

A
  • Geographic tongue.
  • Lichenoid reactions.
  • Epulis.
49
Q

What is the physiological cause behind geographic tongue?

A
  • abnormality of the turning over of the epithelium of the dorsum of the tongue.
  • Usually ASYMPTOMATIC.
  • Red: areas of atrophy.
  • White: areas of hyperkeratosis.
50
Q

What is another name for geographic tongue?

A

Benign migratory glossitis

51
Q

What can be used to treat symptomatic geographic tongue (2)?

A
  • Local anesthetic mouthwash.
  • Steroid mouthwash (if very severe).
52
Q

4 things that are sometime associated with geographic tongue?

A
  • Runs in families.
  • Psoriasis.
  • Fissured tongue.
  • Vitamin B deficiency.
53
Q

What are 2 causes of lichenoid reaction?

A
  • Reaction to METAL (due to chronic low grade irritation OR genuine allergy to metal).
  • Reaction to MEDICATION
54
Q

How can a lichenoid lesion present in the mouth (3)?

A

Can present as:
- White plaques.
- Red components.
- Erosions or ulcerations.
- Often ASYMPTOMATIC.

55
Q

3 types of drugs that can induce a lichenoid lesion?

A
  • Antihypertensives.
  • hypoglycaemics.
  • NSAIDs.
56
Q

What is the difference in oral presentation of lichenoid reaction induced by medications VS reaction to metal?

A
  • Reaction to metal: limited to CONTACT lesions and thus often unilateral.
  • Reaction to medication: Usually SYMMETRICAL presentation.
57
Q

Do we need biopsy of lichenoid lesions?

A
  • YES.
  • Lichenoid lesions can have CELLULAR ATYPIA and can thus be POTENTIALLY MALIGNANT LESIONS.
  • Biopsy to determine whether they have cellular atypia.
58
Q

What does the term epulis mean?

A
  • Growth on the gum.
59
Q

What are 2 types of epulis?

A
  • Fibrous epulis.
  • Pyogenic granuloma.
60
Q

What is the clinical presentation of fibrous epulis? What causes a fibrous epulis?

A
  • Associated with the GINGIVAL MARGIN of teeth.
  • Normal overlying mucosa and fibrous centre.
  • Difficult to clean around and can bleed when attempting to clean around it.
  • Caused by CHRONIC IRRITATION - stimulates a chronic granulation response (ex. rough enamel, restoration margin, caries).
61
Q

What is the clinical presentation of pyogenic granuloma? What causes it?

A
  • Appears on the gum but is a MORE VASCULAR LESION.
  • Associated with females during PREGNANCY so may have a HORMONAL ASSOCIATION.
  • VERY prone to bleeding.
62
Q

What is the treatment for epulis?

A
  • Can be EXCISED.
  • Pyogenic granuloma can resolve after childbirth.
63
Q

What is a metabolic disease that can have oral manifestations?

A
  • ADDISON’S DISEASE
64
Q

What causes addison’s disease?

A
  • Primary ADRENAL insufficiency.
  • Causes deficiency of CORTISOL AND ALDOSTERONE.
65
Q

What is the clinical presentation of Addison’s disease?

A
  • Widespread SYMMETRICAL SKIN PIGMENTATION.
  • Can cause SYMMETRICAL ORAL MUCOSAL PIGMENTATION.
66
Q

Do we need biopsy of oral pigmentation caused by addison’s disease?

A

YES - to rule out anything more sinister like melanoma.

67
Q

What is the clinical presentation of melanotic macule?

A
  • Round or oval, brown or black pigmented area on the LIP or ANY MUCOSAL SURFACE.
  • ASYMPTOMATIC.
  • BENIGN.
68
Q

What causes melanotic macule? Who is more likely to have it?

A
  • Aetiology: trauma (common) or idiopathic.
  • Common in the 50+ age group, more common in F.
69
Q

What is the treatment for melanotic macule?

A
  • Biopsy for diagnosis
  • Excision for aesthetics
70
Q

2 autoimmune conditions that can affect the oral mucosa?

A
  • Lichen planus.
  • Vesiculobullous conditions.
71
Q

3 ways lichen planus can present in the mouth?

A
  • Erosions.
  • Plaques.
  • Reticular (lace-like).
  • Can be either BILATERAL or UNILATERAL.
72
Q

Why is a known lichen planus diagnosis important?

A
  • Lichen planus is known as a POTENTIALLY MALIGNANT CONDITION hence these patients must be monitored in case they undergo malignant transformation.
73
Q

What is lichen planus? How widespread is it?

A
  • Autoimmune inflammatory conditions.
  • 1-2% population.
  • F>M.
74
Q

Do we need to take a biopsy of a lichen planus lesion?

A

YES to determine the diagnosis.
- These lesions can look like potentially malignant lesions + lichen planus is a known potentially malignant condition so these patients must be monitored in case they undergo malignant transformation.

75
Q

What are vesiculobullous conditions?

A
  • Autoimmune inflammatory conditions.
76
Q

What is the oral presentation of vesiculobullous conditions?

A

Painful blisters that rupture into erosions and ulcers

77
Q

What is the management of vesiculobullous conditions?

A

Biopsy to determine diagnosis

78
Q

What is an example of an idiopathic oral lesion?

A

Lipoma

79
Q

What is a lipoma?

A
  • Benign mesenchymal neoplasm.
  • Made up of fat cells surrounded by a thin fibrous capsule.
80
Q

What causes lipomas?

A

cause unknown

81
Q

What is the clinical presentation of lipomas?

A
  • yellow lump.
  • can be penduculated or cessile.
  • asymptomatic until large enough to become traumatised.
82
Q

What is the treatment for lipomas?

A

If large enough that they are becoming traumatised, treatment is EXCISION.

83
Q

6 oral lesions that can be caused due to trauma?

A
  • Erosions/ ulcers.
  • Frictional keratosis.
  • Polyps.
  • Denture induced hyperplasia.
  • Amalgam tattoos.
  • Mucoceles

Module 6 - Oral Surgery (11 decks)

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