Oral Mucosal Disease Flashcards
(44 cards)
1
Q
When should referral of an oral mucosal lesion to oral medicine be made?
A
- any symptomatic lesion that has not responded to standard treatment
- must meet hospital referral criteria
- follow SDCEP guidance
- any benign lesion that the patient can’t be persuaded isn’t cancer
2
Q
When should referral of an oral mucosal lesion to maxillofacial specialists be made?
A
- anything the dentist thinks might be cancer or dysplasia
- 2 week cancer referral pathway for malignancies
3
Q
What kind of epithelium is the oral mucosa?
A
stratified squamous
4
Q
What are the 3 gross types of oral mucosa?
A
- lining
- masticatory
- gustatory
5
Q
What are the microscopic categories of oral mucosa?
A
- non keratinised
- keratinised
- orthokeratosis
- parakeratosis
6
Q
Where is keratin visible histologically for buccal mucosa?
A
thin keratin layer on the surface of stratified squamous epithelium
7
Q
Where is keratin visible histologically for buccal mucosa?
A
thick layer of keratin on surface
8
Q
What are the 5 strata and compartments that make up keratinised epithelium?
A
- stratum corneum
- granulosum
- spinousum
- basal
- lamina propria
9
Q
What 3 categories make up the keratinised layer of oral mucosa?
A
- cornified
- maturation
- progenitor
10
Q
What type of cells are present in the basement membrane?
A
- epithelial progenitor cells
- mature and progress up epithelium
11
Q
Why does keratin stain purple?
A
- loss of organelles
- cell wall left behind
- keratin layer stains purple
12
Q
Where does mitosis occur in keratinised epithelium and what does mitosis outwit this region indicate?
A
- occurs in the basal and suprabasal layers
- in higher layers could indicate dysplasia
- may be basement membrane from adjacent mucosa
- serial sections required
13
Q
What are 3 reactive changes that can be seen in oral epithelium?
A
- keratosis
- non-keratinised site
- parakeratosis
- usually due to trauma
- increased surface protection
- acanthosis
- hyperplasia of stratum spinous
- thickening of epithelium
- trauma, immune change, reaction to disease
- elongated rete ridges
- hyperplasia of basal cells
14
Q
What is atrophy?
A
reduction in viable layers
15
Q
What is erosion?
A
partial thickness loss
16
Q
What is ulceration?
A
loss of epithelial covering with fibrin exudate on top of connective tissue
17
Q
What is oedema?
A
- swelling
- intracellular
- cells appear bigger
- intercellular
- spongiosis
18
Q
What is a blister?
A
- vesicle or bulla
- depends on size of lesion
19
Q
What mucosal changes are commonly seen associated with age?
A
- progressive mucosal atrophy
- appearance should still be normal
20
Q
What mucosal changes are commonly seen wiyj nutritional deficiencies?
A
- iron or B group vitamins
- atrophy
- predisposed to infection
- loss of tongue papillae
- easier for microbes to penetrate mucosa
- atrophy
21
Q
What is the prevalence of geographic tongue?
A
- 1-2% of population
- less common in children
22
Q
Provide 3 examples of benign tongue lesions
A
- geographic tongue
- black hairy tongue
- fissured tongue
23
Q
What is geographic tongue?
A
- desquamation of mucosa
- varied pattern and timing
- alteration to maturation and replacement
- entire areas of epithelial surface replaced on single occasion
- replication halted
- epithelial layer thins
- tongue appears more red
- replication restarts
- new cells produced
- thickness increases
- appearance returns to normal
- replication halted
24
Q
What are the symptoms of geographic tongue?
A
- usually asymptomatic
- patient may be concerned about appearance
- intermittent tissue sensitivity
- nerve has less protection
- avoid spicy and strong flavoured foods
- more likely in children
- usually for around a week
- can be up to a month before next
25
What are the two ways in which geographic tongue can present?
- many areas of change
- red and white margins
- often crescent shaped areas
- dorsal and lateral margin most common
- large area of change
- central area of normal epithelium
- erythematous margin
26
Can any other tissues be affected by geographic tongue?
- buccal mucosa and palate
- rare
27
How is geographic tongue treated?
- disorder of maturation, not disease
- no treatment required
28
How can it be determined if geographic tongue is symptomatic and what are the other possible causes?
- determine whether symptoms occur during change of appearance of all the time
- take photos when symptomatic
- other causes
- haematinic deficiencies
- B12
- folate
- ferritin
- parafunctional trauma
- trauma to tip of tongue
- dysaesthesia
29
What is brown/black hairy tongue?
- aesthetic problem
- tongue looks dirty/unhygienic
- bacterial colonisation
- possible cause
- elongation of surface papillae
- stained by food stuffs/tobacco
- tea
- coffee
- soft/liquid diet thickens papillae
30
How can black/brown hairy tongue be managed?
- removal of elongated papillae
- tongue scraper
- peach stone
- suck for 1 hour daily
31
What is fissured tongue?
- tongue has normal appearance then fissure pattern appears
- not constantly present
- aetiology unconfirmed
32
What are the symptoms of fissured tongue?
- often asymptomatic
- localised inflammation
- deep fissures can trap food/debris
- soft bristle brush to clean fissures
- other disease processes may cause symptoms
- candida
- lichen planus
33
What is glossitis?
- smooth red appearance of tongue
- atrophy of mucosa
34
What are the possible causes of glossitis?
- haematinic deficiency
- check for angular cheilitis
- lichen planus
35
What investigations should be carried out when a patient presents with suspected glossitis?
- haematinics
- fungal cultures
- biopsy
36
When should swellings be referred?
- symptomatic
- possibly underlying disease process
- pain may be salivary gland malignancy
- abnormal overlying or surrounding mucosa
- increasing in size
- rubbery consistency
- trauma from teeth
- removal of entire swelling
- removal of edge of swelling
- unsightly
37
What kind of swellings are not usually referred?
- tori
- bony swellings
- lingual aspect of mandible
- palate
- small polyps
- causes more damage to remove
- mucoceles
- extraversion of mucus into tissues
- from minor salivary glands
- difficult to find surgically
- causes more damage to remove
- if fixed in size should refer
38
What is a leaf fibroma and how should it be managed?
- fibrous polyp squashed under denture
- thin and elongated
- should be removed and allowed to heal
- can then construct new denture
39
What are fibroepithelial polyps and how should they be managed?
- polyp with same mucosal covering as surrounding tissue
- no inflammation at base of lesion
- can be removed
- size may be causing catching between teeth
- trauma causes enlargement
- only remove if causing problems
40
How are polyps formed parafunctionally and how can they be managed?
- formed by parafunctional habit
- sticking tongue through diastema
- polyp on tongue edge
- managed by closing gap or blocking diastema
41
What are mucoceles and how can they be managed?
- clear swelling associated with minor salivary gland
- surgical removal
- if fixed and remains filled with saliva
- possible to remove mucus and gland
- if small and bursts
- impossible to tell where swelling is
- surgical removal close to impossible
42
What are tori and what are the management options?
- benign bony protrusions
- mandibular tori
- thin, non-keratinised mucosal covering
- palatal tori
- keratinised mucosal covering
- associated with parafunctional clenching habits
- may present with TMJ problems
- removal is not recommended
- only in unusual circumstances
43
What types of medications are a risk factor for tori and why?
- bisphosphonates
- increased risk of avascular necrosis
- affecting mucosal covering
- blood supply reduced as from bone
- consider risk for bisphosphonate patients
44
What is a pyogenic granuloma?
- granulation tissue
- mixed inflammatory infiltrate
- fibro-vascular background
- no epithelial surface
- fibrinous yellow or red appearance
- can be present on any mucosal site
- response to trauma
- other names
- vascular epulis
- pregnancy epulis
