Oral mucosa

Question 1

What are the layers of the buccal (lining) mucosa?

Answer 1

No keratin
Stratified squamous epithelium 
Prickel cell layer and basal cell layer
- Lamina dura
- Sub-mucosa - fat
- Skeletal muscle e.g. buccinator from cheek

Question 2

Gingiva and hard palate mucosa type?

Answer 2

Masticatory mucosa

- pale pink mucosa

Question 3

Uvula, floor of mouth, buccal mucosa and soft palate mucosa type?

Answer 3

Lining mucosa

Question 4

Tongue mucosa type?

Answer 4

Gustatory or specialised mucosa

Question 5

What are the two mucosas above the teeth?

Answer 5

junction of masticatory (pale mucosa) and lining mucosa (darker gingivae) = mucogingival junction

Question 6

What are the layers of masticatory mucosa - hard palate?

Answer 6

Pink band on top = orthokeratin (no nuclei on the surface) or parakeratin (nuclei)
Epithelium is narrower (thinner)
Granular layer - prickle cell layer and then basal cell layer below
Lamina propria
Not much submucosa

Question 7

Masticatory mucosa features?

Answer 7

Firmly fixed to underlying bone = mucoperiosteum

Resists stresses and strains

Question 8

Lining mucosa features and locations?

Answer 8

Loose submucosa for movement

Lingual, FOM, buccal mucosa

Question 9

Specialised mucosa - where is it?

Answer 9

Dorsal tongue

Question 10

What are the types of papillae

Answer 10

Papilla types:

• Filiform = tongue feels rough
• Fungiform
• Foliate = posterior lateral tongue
• Circumvalate = posterior border of tongue

Question 11

Layers of specialised mucosa epi?

Answer 11

SS epi with spikes of keratin = filiform papillae
Lamina propria
Muscle

Question 12

What is the function of specialised mucosa?

Answer 12

Taste buds - foliate, fungiform, circumvalate

Abrasion - filiform (used in mastication)

Question 13

What are the types of variations in the appearance of normal mucosa that do not need any tx?

Answer 13

Leukoedema
Georgraphic tongue
Fordyce spots

Question 14

Leukodema appearance?

Answer 14

More common in afro-americans
Milky white areas, typically in buccal mucosa, often bilateral
If you stretch the cheek it will disappear

Question 15

What does leukodema show histologically?

Answer 15

Oedema

Question 16

Differential diagnosis for leukodema?

Answer 16

White sponge naevus = white patches are thicker
Chronic cheek biting (frictional keratosis)
Lichen planus

Question 17

Geographic tongue (erythema migrans)

Answer 17

May have symptoms with acidic or spicy foods - can prescribe difflam m/w
Affects dorsal/lingual tongue
Islands of erythema (redness) with white halo of keratin around them - can move around

Question 18

Geographic tongue differential diagnosis?

Answer 18

Lichen planus

Frictional keratosis - doesnt usually affect dorsal tongue

Question 19

Fordyce spots features?

Answer 19

White or yellow speckling
Asymptomatic 
Ectopic sebaceous glands 
Common and easily diagnosed 
Get more prominent when older

Question 20

White sponge naevus features?

Answer 20

Hereditary - Autosomal dominant
Family history but may skip generations
Point mutation in keratin 4/or 13 genes

Bilateral 
Cheeks and floor of mouth
Thick white folds, wrinkles, ebbing tide
Does not disappear on stretching
Life long 
May affect other mucosal sites - eyes, genitals

Question 21

Why be more vary with red and white patches in the floor of the mouth?

Answer 21

Common site for dysplasia and oral squamous cell carcinoma

Question 22

What does white sponge naevus look like histologically?

Answer 22

Parakeratin
Acanthosis - increased thickness prickle cell layer
Uninflamed

Question 23

Differential diagnosis for white sponge naevus?

Answer 23

Lichen planus - usually symptomatic, burning sensation
Lichenoid drug rxns - has pt started new drug? Usually have redness
Chronic cheek biting - buccal mucosa
Luekodema

Question 24

Age changes in oral mucosa?

Answer 24

Thinner and smoother, atrophic
Decrease in elasticity
Prominence of fordyce spots
Varicosities ventral surface tongue = prominent veins in tongue

Question 25

Mechanical trauma to oral mucosa?

Answer 25

From dentures, teeth, ortho appliances, surgical wounds

Question 26

Chemical trauma to oral mucosa?

Answer 26

Burns e.g. allergic response to dental materials, aspirin

Question 27

Physical trauma to oral mucosa?

Answer 27

Hot and cold, irradiation

Question 28

Histological response of oral mucosa to changes - epithelial changes?

Answer 28

Epi changes - Ulceration = loss of epithelium, fibrin on top, then granulation tissue (endothelium cells forming new BVs and fibroblasts forming collagen to help healing) - Keratosis (if was non keratinised at first), hyperkeratosis (if keratin thickens), hyperplasia (epi can become thicker) - Atrophy = epi becomes thinner due to loss of cells

Question 29

Causes of traumatic ulceration?

Answer 29

``` Dentures Teeth Chem burns Irradiation for malignancy Vit deficiencies Chrone's disease ```

Question 30

Histological response of oral mucosa to changes - CT changes?

Answer 30

Hyperplasia - overgrowth of CT - full of collagen e.g. polyps

Question 31

Examples of trauma affecting the oral mucosa?

Answer 31

Frictional keratosis Stomatitis nicotina Papillary hyperplasia of palate Chemical burns

Question 32

Frictional keratosis features?

Answer 32

White patches caused by continual trauma Usually along the occlusal line or opposite sharp cusps, orthodontic wires or dentures Hyperkaratosis, acanthosis, uninflamed

Question 33

Diagnosis of frictional keratosis?

Answer 33

Demonstrate lesion caused by trauma Remove cause and lesion should regress If not then must consider other white lesions in differential diagnosis Important that it is not a laukoplakia - increased risk of malignant change Management - incisional to establish diagnosis

Question 34

Stomatitis nicotina features? Tx?

Answer 34

Palate in pipe and cigar smokers - red dots = irritated salivary glands Not a pre-malignant lesion Positive correlation between intensity of smoking and severity Tx - Stop/reduce smoking - Lesions may disappear - Regular review

Question 35

Papillary hyperplasia of the palate? Tx?

Answer 35

Caused by ill fitting dentures - bumpy hard palate Symptomless, erythematous overgrowth of mucosa Corresponds to outline of denture Tx: New denture Excision of papillary projections for advanced cases NOT pre-malignant

Question 36

What factors influence healing?

Answer 36

Primary or secondary intention - wounds closely opposed heal faster than those separated Foreign body - acts as a focus of infection and delays healing (e.g. bone/fractured root after extraction) Vascular supply - reduced blood supply reduces healing capacity Nutritional deficiencies - vitamin C Irradiation - reduces blood supply Malignancy - failure to heal e.g. non-healing tooth socket Infection - reduces healing capacity Poor immune response - leukaemia, diabetes, immunosuppression

Question 37

Primary and secondary intention?

Answer 37

Primary - Incisional biopsy - Big biopsy will heal just as quickly as small biopsy Secondary - e.g. Gingivectomy - e.g. Tooth extraction socket healing