Oral Mucosal Changes

Question 1

What are 5 causes of white lesions?

Answer 1

Hereditary
Smoking/Frictional
Lichen Plans
Candidal Leukoplakia
Carcinoma

Question 2

What is oral white sponge nevus?

Answer 2

This is a lesion that has genetic changes in cytokeratins in mouth resulting in white lesion

Question 3

What is a smoking/frictional white lesion?

Answer 3

This is where smoking chemicals/friction irritates the mucosal surface causing a thickening of keratin on surface of mucosa which obstructs BVs and CTs which is what provides mucosa with pink colour (less pink more white due to thickening of keratin)

Question 4

What can cause lichen plans?

Answer 4

Lupus
GVHD - there is acanthuses - thickening of ep layers which reduces visibility of BVs so reduced pinkness

Question 5

What is candid leukoplakia?

Answer 5

White lesions associated with candida organism and will case inflammation in epithelium and surrounding CT - the inflammation of ep allows thickness and fluid to accumulate which reduces visibility of blood flow and CT and therefore white lsion

Question 6

Why can a carcinoma produce a white lesion?

Answer 6

Thickness of cells as the proliferate increases - blood vessels less visible

Question 7

Why does oral mucosa have pink/red colour?

Answer 7

This is due to the underlying blood vessels in the connective tissue which can be seen through the opaque layers of the epithelium

the pink/red colour is seen less when there is thickening of the epitheliumm so we can’t see BVs as clear resulting in paler whiter mucosa

Question 8

Why are white lesions white? 2

Answer 8

This is due to thickening of the mucosa or increase in keratin production resulting in less visibility of BVS and blood flow

or if there is less blood in the tissues such as vasoconstriction caused by LA which slows blood flow down through CT and area becomes white or pale

Question 9

Why do tissues blanch when using LA?

Answer 9

LA causes vasoconstriction so there is less blood flow through th CT and the area as a result becomes whiter

Question 10

What is leukoplakia?

Answer 10

White patch/lesion that cant be explained - there is no histopathological explanation and no malignancy

IT IS A CLINICAL DESCRIPTION

Question 11

Can leukoplakia be rubbed off?

Answer 11

No its a white patch lesion with an unknown cause and no histological reason or malignancy
it can’t be rubbed off or attributed to any cause

Question 12

How many leukoplakia become malignant?

Answer 12

1-5% - not all leukoplakia become malignant - it is a white patch with no other cause

1% is acceptable value

Question 13

How can we describe leukoplakia as a dx?

Answer 13

Dx of exclusion

Question 14

Can leukoplakia be sued to describe white lesion due to hyperkeratosis?

Answer 14

NO - as leukoplakia is dx of exclusion - theres no known cause for it

Question 15

What are fordyces spots?

Answer 15

These are ectopic sebaceous glands that are seen mostly on buccal mucosa and lips - there are benign oral structures with no malignant potential

Question 16

What is frictional keratosis?

Answer 16

This is white lesion due to traumatic source such as parafuntional clencher

Question 17

What can parafucntional habits such as clenching lead to?

Answer 17

frictional keratosis - this is where pt clench teeth, pulls cheeks in and cusp edges rub against buccal mucosa causing a thickening of mucosa - keratin thinking resulting in less visibility of BVs in CT so white appearance

Question 18

What is a smokers keratosis?

Answer 18

This is when there is trauma from the thermal gases in smoking which causes a reactive change known as keratosis (thickening of keratin) making BVs in CT harder to see

Thick layer of keratin forms on palate

Mucosa can appear normal besides some melanin pigment from irritation to prs mucosa (melanocytes over produce melanin)

Question 19

How are melanin and trauma related?

Answer 19

IN trauma melanocytes can repeatedly produce melanin resulting in melanin pigment on the mucosa known as melanosis

Question 20

IS smokers keratosis a high risk lesion?

Answer 20

White lesion in general is low risk but pt is high risk due to smoking

The area of white change is low risk for cancer but oral mucosa in general is high risk

Question 21

What is hereditary keratosis?

Answer 21

This is a non traumatic keratosis where there is a white lesion in area that isn’t subject to trauma (for example in the sulcus with intact dentition)

It often begins posterior and spreads anterior to buccal mucosa up and down the sulcus and is seen in familie

Question 22

What is a hereditary keratosis known as?

Answer 22

White sponge navus

Question 23

Why is the mucosa white in hereditary keratosis?

Answer 23

This is because fluid accumulates between epithelial cells making it harder to visualise underlying BVs so lesion appears white

Question 24

If a white lesion was likely malignant what would we see?

Answer 24

Inflammatory process surrounding lesion - erythematous halo

Question 25

What is a sign a white lesion is less worrying?

Answer 25

Clearly defined margins, regular, normal mucosal covering

Question 26

What is idiopathic keratosis?

Answer 26

This is a white lesion with no obvious cause for keratosis but under microscope there is keratin increase

Question 27

What are some provisional dx for white lesions on the gingival margin?

Answer 27

Idiopathic - unknown cause Trauma Nail biting habit or toothbrush onto lesion

Question 28

What can a chemical burn of mucosa present as?

Answer 28

Can present as white erosive lesion - often due to acidic substance held in contact with mucosa aspirin - held in mucosa alendrotnic acid - if pt doesn't swallow properly or holds in mouth leading to chemical change

Question 29

What do acids do to mucosa?

Answer 29

They cause coagulation of proteins which damage the epithelial surface

Question 30

What type of white lesions can we see on tongue?

Answer 30

Traumatic keratosis - from incisal edge of teeth rubbing simple idiopathic keratosis - keratin but no obvious cause for lesion hairy leukoplakia

Question 31

What is hairy leukoplakia?

Answer 31

Elongation of tongue paella on lateral border and thinking of surface due to EBV that causes cells to reproduce at a faster rate and produce more keratin

Question 32

What is an infective reason for white lesion?

Answer 32

Infectiev candidiasis

Question 33

what are the four types of oral candidiasis?

Answer 33

Acute pseudomembranous candidiasis (THRUSH) Acute erythematous candidiasis Chronic hyperplastic candidiosis Chronic denture stomatitis ITS A COMMON OPPORTNISTIC INFECTION IN THE ORAL CAVITY CAUSED BY OVERGROWTH OF CANDIDA SPECIES (C.Albicans)

Question 34

What is thrush also known as?

Answer 34

Acute pseudomembranous candidiasis

Question 35

What are 3 features of acute pseudomembranous candidiasis?

Answer 35

Produces white lesions all over the soft palate and uvula Can be scraped/wiped off as its pseudomembranous (doesn't firmly adhere to mucosa) Can be removed with swab leaving inflammatory change - red, inflamed, bleeding area

Question 36

Presidposing factors for acute pseudomembranous candidiasis?

Answer 36

HIV diabetes inhaler user

Question 37

What is acute erythematous candidiasis?

Answer 37

This is when there is red appearance, pt often has burning feeling on mouth or tongue (can be seen in pts with steroid inhaler use and no rinse)

Question 38

What is chronic hyperplastic candidosis?

Answer 38

White patch that can't be rubbed off -, can occur in angle of mouth

Question 39

WHat is chronic denture stomatitis known as?

Answer 39

Chronic atrophic candidiasis - common in pts who wear dentures have poor OH and can see outline of denture (red raw)

Question 40

What is angular chelitis?

Answer 40

This is fissuring at oral commissures often due to intra oral candida infection - can be due to decreased OVD in denture pts

Question 41

Why can herpes simplex virus produce white lesions?

Answer 41

In primary herpes virus lesions begin as white intra-oral epithelial vesicles which eventually burst resulting in breach of ep and CT exposure - no longer white appear as ulcerations

Question 42

What is the overall rule for white lesions?

Answer 42

Most are benign - 1% become malignant - if theres no obvious need for referral dont refer

Question 43

When might we consider referral for white lesion?

Answer 43

IF lesion is both white and red - focus on red area if lesion is raised and thickening if theres an inflammatory margin if theres no known cause of lesion - lateral border of tongue with no parafucntional habit, anterior floor of mouth and no trauma or soft palate

Question 44

What is the importance of an inflammatory margin in white lesions?

Answer 44

If there is an inflammaoty margin be more inclined to refer as there is process occurring leading to inflammation surrounding lesion

Question 45

What areas might we refer if we see white lesion?

Answer 45

Borders of tongue with no parafunctonal habits FOM - no obvious trama Soft palate area