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5th Oral Disease -Histology Lectures > Normal Oral Mucosa > Flashcards

Normal Oral Mucosa Flashcards

1
Q

What stain is used for mucosa?

A

H&E
Haemotoxylin and eosin
Stains pink and purple

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2
Q

What layers would you expect to see in normal mucosa?

A

Surface epithelium
Lamina propria
Sub-mucosa
Skeletal tissue

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3
Q

What is the surface mucosa of normal lining mucosa?

A

Non-keratinised stratified squamous

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4
Q

What is lamina propria?

A

Superficial connective tissue

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5
Q

What is sub-mucosa made from?

A

Adipose tissue

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6
Q

What is a good biopsy?

A

Deep biopsy - provides sufficient tissue depth for examination

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7
Q

What mucosa is present in oral cavity?

A

Mucosa not consistant
Masticatory mucosa - gingiva HP
Lining mucosa - SP/ uvula
Gustatory (special mucosa) - tongue

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8
Q

What is masticatory mucosa?

A

Firmly fixed to underlying bone - mucoperiosteum

Resist stress and strain - don’t want flexibility

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9
Q

How does gingiva look?

A

Pale pink w/ fine stippling

Line of mucogingival junction separates masticatory and lining mucosa

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10
Q

How does hard palate look?

A

Histoloigcally look same as masticatory mucosa of gingiva

If from anterior palate see rugae

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11
Q

What would you see histologically on sample from hard palate - masticatory mucosa?

A

Layer of keratin on surface
Thinner epithelium
Less extensive lamina propria submucosa
Mucosal salivary gland tissue

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12
Q

If sample from anterior palate what would you see instead of submucosa?

A

Subperiosteum

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13
Q

Where find lining mucosa?

A

Soft palate
Ventral tongue
Floor mouth
Buccal mucosa

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14
Q

What allows for flexibility and movement of lining mucosa?

A

Lose sub-mucosa w/ adipose

SS epithelium always non-keratinised

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15
Q

Describe layers of SS epithelium?

A

Basal cell layer
Prickle cell layer
Granular layer

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16
Q

What is the basal cell layer?

A

Sits on basmenet membrane
Rapidly proliferate and migrates up to replace epithelium cells
Eventually form keratin

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17
Q

What is granular layer?

A

See as black dots

Only seen when keratin is being produced

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18
Q

Example of specialised mucosa?

A

Mucosa of tongue w/ tastebuds

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19
Q

What are the diff types of tastebuds?

A

Filiform - most numerous
Fungiform - larger, anterior 2/3
Foliate - lateral posterior aspect
Circumvalate - posterior 1/3 form V shape

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20
Q

How do filiform papillae appear histologically?

A

On biopsy of anterior 2/3 tongue - will see small amount submucosa and large amount muscle
Pointy/ spikes projection of keratin

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21
Q

How does leukoedema present?

A

Generalised opacification of buccal mucosa w/ classic appearance

Present symmetrically and asymptomatically
Typically on buccal mucosa
Milky-white translucent area w/ diffuse appearance
Can blend w/ adjacent mucosa w/o defined border

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22
Q

What is defining feature of leukoedema?

A

If hold pt cheek and pull it will disappear?

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23
Q

Who is leukoedema likely to affect?

A

More prevalent black individuals - esp African Americans

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24
Q

What can leukoedema be associated w/?

A

Smoking

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25
Q

What could be differential diagnosis of leukoema?

A

White sponge naveus - thicker folded and extensive white patch

Chronic cheek biting - frictional keratosis

Lichen planus - classic white reticulation/ Lacey pattern

26
Q

What is erythema migrans?

A

Geographic tongue

Well defined islands - red patch w/ white halo

27
Q

Where does erythema migrans affect?

A

Dorsum of tongue

Can extend ventral/ lateral aspect

28
Q

Is erythema migrans painful?

A

Asymptomatic or mild soreness

Can be aggravated - spicy/ acidic food

29
Q

Tx of geographic tongue?

A

No tx

If sore - difflam mouthwash - local acting analgesic and anti-inflammatory

30
Q

Differential diagnosis for geographic tongue?

A

If classic appearance - dx made clinically

Lichen planus - have red/white (rarely affect dorm tongue)
Frictional keratosis

31
Q

What are fordyce spots?

A

White or yellow speckling caused ectopic sebaceous glands

Common and easily diagnosed

32
Q

Where are fordyce spots found?

A

Often buccal mucosa

Often in elderly - buccal mucosa become atrophic - glands become more prominent

33
Q

What would histology be of fordyce spot?

A

Normal mucosa w/ sebaceous glands

34
Q

What is white sponge naevus?

A

Hereditary condition - autosomal dominat due to point mutation in keratin 4 or 13

35
Q

Clinical appearance of white sponge naevus?

A

Bilateral and symmetrical
Affect: cheek and floor of mouth
Appear as thick white folds, wrinkled, ebbing tides

Doesn’t disappear on stretching/ rubbing

36
Q

When does white sponge naevus appear?

A

Life long - appears in child hood

37
Q

What would see in biopsy of white sponge naeuvs?

A

Hyperplasitic epithelial
Acanthosis - increased prickle cell layer
No inflammatory component
Epithelium - pink cytoplasm due to abnormal keratin formation

38
Q

Differential diagnosis of white sponge naeuvs?

A

Lichen planus
Lichenoid drug reaction
Chronic cheek biting
Leukoedema

39
Q

What changes do you see in ageing mucosa?

A

Mucosa atrophic and smoother
Decrease in elasticity
Prominence fordyce spots
Varicosities ventral surface tongue

40
Q

Common cause of trauma to mucosa?

A

Mechanical - denture, teeth, ortho
Chemical - burns e.g aspirin, materials
Physical - temp, irradiation

41
Q

What is an ulcer?

A

Full thickness breach of epithelium

Epithelium lost exposing underlying CT (sore)

42
Q

What are the components of an ulcer?

A

Thick pink part = fibrinopurulent slough
Granulation tissue below
Epithelium grows beneath slough

43
Q

What is slough of ulcer made from?

A

Fibrous tissue and neutrophils

44
Q

What is purpose of granulation tissue in ulcer?

A

Healing
Fibroblast lay collagen
Endothelial cells make blood vessels

45
Q

What is difference between keratosis and hyperkeratosis?

A

Keratosis = epithelium not typically keratinised

Hyperkeratosis = epithelium normally keratinised

46
Q

What is atrophy of epithelium?

A

Reduction in thickness of epithelium due to loss of cells

47
Q

What is hyperplasia of CT and give example

A

Overgrowth of CT - increased collagen production

Example: fibre-epithelial polyp

48
Q

Give examples of specific trauma to the oral mucosa?

A

Frictional keratosis
Stomatitis nicotina
Papillary hyperplasia of palat

49
Q

What is frictional keratosis?

A

White patch caused by continuous trauma

Usually along occlusal line/ opposed sharp cusp/ denture etc

50
Q

Classic appearance of frictional keratosis?

A

Classic crenelation where mucosa pinched - mucosa becomes keratin and hyperplastic = thick white band

51
Q

How to diagnose frictional keratosis?

A

Must be able to demonstrate lesions caused by trauma (if remove cause lesion will regress)

52
Q

What is stomatitis nicotina?

A

White bumps w/ red centre (duct orifice to minor saliva gland) on palate
Damage to underlying duct = inflammation of duct w/ surrounding area of keratosis

53
Q

Who is stomatitis nicotina seen in?

A

Seen in pipe and cigar smokers

Correlation between intensity of smoking and severity

54
Q

What is papillary hyperplasia of the palate?

A

Erythematous overgrowth of mucosa - appear nodular

55
Q

Who do you see papillary hyperplasia in?

A

Denture wearer

Caused by ill-fitting denture, lesion will follow outline of denture

56
Q

What is the redness seen in papillary hyperplasia of the palate?

A

Superimposed candida infection

57
Q

Management of papillary hyperplasia of palate?

A

New denture

Excision of papillary projection in advanced cases

58
Q

Is stomatitis nictonina pre-malignant?

A

No

59
Q

Is papillary hyperplasia of palate pre-malignant?

A

No

60
Q

What factors influence healing?

A 
Wound closure - primary/ secondary
Foreign bodies
Vascular supply
Nutritional deficiency (vit C)
Irradiation (reduce blood supply)
Malignancy (fail heal)
Infection
Immune response

5th Oral Disease -Histology Lectures (11 decks)

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