Mucosal Colour Changes Flashcards
Why might white lesions occur in the oral cavity?
Hereditary
Smoking/frictional- thickening of the mucosa
Lichen plans
Candidal leukoplakia
Carcinoma
Why do white lesions appear white?
Thickening of the mucosa by extra production of keratin.
Less blood in the tissues- vasoconstrictor.
What is leukoplakia?
A white patch that cannot be scraped off or attributed to any other cause.
It is a diagnosis of exclusion, where no other cause of the lesion can be identified.
What are fordyce’s spots?
Ectopic sebaceous glands.
Benign, normal structure.
What is frictional keratosis?
Excess keratin production via trauma- usually from a parafunctional habit.
What is smoker’s keratosis?
Thickening of the mucosa by excess keratin formation caused by irritation to the outer layer by the smoke.
Excessive melanin pigment formed as well.
Low malignant potentially of the leukoplakia lesion but higher overall oral cancer risk because of they are a smoker.
What is white sponge naevus?
White change in the mouth, in areas not associated with trauma.
Caused by fluid accumulation in between the epithelial cells.
Genetic.
If a patient presented with a white lesion, what would you want to ask/examine?
History
- How long has it been there for?
- Is it painful?
- Are you a smoker? Full smoking history.
Examination
- try to rub it off.
- Look to see if there are any erythematous margins.
- What does the underlying mucosa look like?
- Look for a potential traumatic cause?
What is pseudomembranous candidiasis?
Infection caused by fungal species, Candida albicans.
Usually found in the soft palate and uvula.
When would you refer a white lesion?
If the lesion is becoming raised and thickened.
Lesion is without cause and in at risk sights- lateral border of the tongue, floor of the mouth and soft palate area.
If the lesion has a red, inflamed outer layer.
Refer with a photo of the lesion.
Why are red lesions, red?
Blood flow increases- inflammation and dysplasia.
Reduced thickness of the epithelium.
What is erythroplakia?
A red patch which cannot be attributed to any other cause.
More of a concern that leukoplakia.
What might cause mucosal pigmentation?
Exogenous stains
- amalgam, tea, coffee, chlorhexidine, bacterial overgrowth.
- Smoking, drugs.
Intrinsic pigmentation-
- Systemic disease- addison’s disease- raised ACTH.
- Melanoma
- Melanocytic naevus
- Melanotic macule
- Reactive melanosis.
What questions might you ask yourself about mucosal pigmentation?
Can the pigmentation be easily explained?
Is it increasing in size, colour or quantity? Take photos.
Any new systemic problem?
DO I have an existing radiograph to show it is amalgam?
What would the lesion look like if it was melanoma?
Variable pigmentation- highly pigmented regions followed by low pigmented lesions.
Irregular outline.
Raised surface- variable thickness throughout.
Symptomatic- itch or bleed.
