Oral mucosa: normal, hereditary conditions, ageing and response to trauma

Question 1

What are the different layers of the normal mucosa?

Answer 1

Stratisfied squamous epithelium
Lamina propria
Sub-mucosa = fat/adipose tissue
Skeletal muscle

Question 2

What type of mucosa is the gingivae?

Answer 2

Masticatory

Question 3

What is the mucogingival junction?

Answer 3

Line between masticatory and lining mucosa

Question 4

Does parakeratin have nuclei?

Answer 4

Yes

Question 5

Does ortho keratin have nuclei?

Answer 5

No

Question 6

What is the role of basal cells?

Answer 6

Differentiate to form the cells above (cells in prickle cell layer)

Question 7

What are the qualities of masticatory mucosa?

Answer 7

Firmly fixed to underlying bone
Mucoperiosteum
Resists stressed and strains (when eating)

Question 8

What are examples of lining mucosa?

Answer 8

Soft palate

Buccal mucosa

Question 9

What is the difference between buccal mucosa and hard palate?

Answer 9

Buccal mucosa has no keratin, thicker epithelium
No granular layer as not forming keratin
Significant submucosa

Question 10

What is an example of special mucosa?

Answer 10

Dorsum of tongue

Question 11

What are the 4 types of papillae?

Answer 11

Filiform - most numerous
Fungiform - larger
Foliate - posterior lateral of tongue - can get caught by molars and molars and become hyperplastic
circumvalate

Question 12

What are the functions of specialised mucosa?

Answer 12

Taste buds: foliate, fungiform, circum

Abrasion - filiform

Question 13

Who is leukoedema most commonly found in?

Answer 13

Afro-carribean

Question 14

How can you differentiate leukoedema clinically?

Answer 14

If stretch the cheek it will disappear

Question 15

Differentials for leukoedema?

Answer 15

White sponge naevus - thicker and present from birth
Chronic cheek biting (frictional keratosis)
Lichen planus - sore and lacey white lines

Question 16

What is the halo formed of in geographic tongue?

Answer 16

Keratin

Question 17

Differentials for geographic tongue?

Answer 17

Lichen planus

Frictional keratosis

Question 18

What is geographic tongue?

Answer 18

islands of erythema with white borders
Asymptomatic or mild soreness
Aggravating factors

Question 19

What are fordyce spots?

Answer 19

White or yellows speckling
Asymptomatic
Ectopic sebaceous glands
As get older, become more prominent

Question 20

What is the aetiology of white sponge naevus

Answer 20

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

Question 21

What is the clincal presentation of white sponge naevus

Answer 21

Bilateral
Cheeka and floor of mouth
Thick white folds, wrinkled 'ebbing tide' 
Grooves and variation in thickness
presents in childhood

Question 22

What is the histological presentation white sponge naevus?

Answer 22

Acanthosis - increased thickness of the prickle cell layer
Parakeratin (with nuclei)
Un-inflamed

Question 23

Differential diagnosis for white sponge naevus

Answer 23

Lichen planus - causes burning with acidic food
Lichenoid drug reactions - new drug
Chronic cheek biting - only buccal mucosa
Leukoedema

Question 24

Age changes in oral mucosa

Answer 24

Mucosa may appear atrophic and smoother
Decrease in elasticity
Prominence of Fordyce spots - buccal mucosa
Varicosities ventral surface tongue
Mucosa thinned - veins more prominent with age

Question 25

What are examples of mechanical, chemical and physical examples of trauma to oral mucosa

Answer 25

mechanical - from dentures, teeth, ortho appliances, surgical wounds Chemical - burns: aspirin, allergic response to dental materials Physical - extremes of hot and cold; irradiation

Question 26

What are the responses to oral mucosa trauma?

Answer 26

Epithelial changes | Connective tissue changes

Question 27

What are the causes of traumatic ulceration?

Answer 27

Trauma from dentures Teeth Chemical burns Irradiation for malignancy

Question 28

What is atrophy?

Answer 28

A reduction in thickness of epithelium due to loss of cells

Question 29

What is hyperplasia?

Answer 29

Overgrowth of connective tissue

Question 30

What are specific examples of trauma affecting the oral mucosa?

Answer 30

Frictional keratosis Stomatitis nicotine Papillary hyperplasia of palate Chemical burns

Question 31

What is frictional keratosis caused by?

Answer 31

continual trauma

Question 32

How would you diagnose frictional keratosis?

Answer 32

must be able to demonstrate lesion caused by trauma. When remove the cause the lesion should regress If not then consider other white lesions in differential

Question 33

What is a differential for frictional keratosis and why is it important?

Answer 33

Leukoplakia - white patch of unknown cause, increased risk of malignant change

Question 34

How would you manage the white patch if dont know the cause?

Answer 34

Biopsy - incisional to establish diagnosis

Question 35

Where is stomatitis nicotine found?

Answer 35

palate in pipe and cigar smokers Epithelium responds to chemical and heat from cigars Salivary glands become inflamed

Question 36

What is papillary hyperplasia of the palate?

Answer 36

Symptomless erythematous overgrowth of mucosa | Corresponds to outline of the denture

Question 37

What is the management for papillary hyperplasia of the palate?

Answer 37

Excision of papillary projections for advanced cases | Not pre-malignant

Question 38

What are the factors influencing healing?

Answer 38

Primary or secondary intention - wounds closely opposed heal faster Foreign Body - acts as a focus for infection and delays healing Vascular supply Nutritional deficiencies - vit C Irradiation - reduces blood supply, osteomyelitis/osteoradionecrosis Malignancy - failure of something to heal Infection - reduces healing capacity Poor immune response - leukaemia, diabetes, immunosuppression - steroids

Question 39

Primary intention

Answer 39

Incisional biopsy Big biopsy or small biopsy will heal just as quickly Put together with suture

Question 40

Secondary intention

Answer 40

Gingivectomy Tooth extraction socket Blood clot heals the socket

Question 41

Example of a foreign body affecting healing

Answer 41

bone left in after tooth taken out Need to irrigate socket or will frustrate healing Get lots of neutrophils =pus and bigger cells = osteoclasts Need to remove the bone causing the problem