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BDS4 Oral Medicine > Oral Mucosal Disease > Flashcards

Oral Mucosal Disease Flashcards

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
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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
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3
Q

What kind of epithelium is the oral mucosa?

A

stratified squamous

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4
Q

What are the 3 gross types of oral mucosa?

A
  • lining
  • masticatory
  • gustatory
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5
Q

What are the microscopic categories of oral mucosa?

A
  • non keratinised
  • keratinised
    • orthokeratosis
    • parakeratosis
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6
Q

Where is keratin visible histologically for buccal mucosa?

A

thin keratin layer on the surface of stratified squamous epithelium

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7
Q

Where is keratin visible histologically for buccal mucosa?

A

thick layer of keratin on surface

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8
Q

What are the 5 strata and compartments that make up keratinised epithelium?

A
  • stratum corneum
  • granulosum
  • spinousum
  • basal
  • lamina propria
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9
Q

What 3 categories make up the keratinised layer of oral mucosa?

A
  • cornified
  • maturation
  • progenitor
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10
Q

What type of cells are present in the basement membrane?

A
  • epithelial progenitor cells
    • mature and progress up epithelium
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11
Q

Why does keratin stain purple?

A
  • loss of organelles
  • cell wall left behind
  • keratin layer stains purple
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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
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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
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14
Q

What is atrophy?

A

reduction in viable layers

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15
Q

What is erosion?

A

partial thickness loss

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16
Q

What is ulceration?

A

loss of epithelial covering with fibrin exudate on top of connective tissue

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17
Q

What is oedema?

A
  • swelling
  • intracellular
    • cells appear bigger
  • intercellular
    • spongiosis
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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
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
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
Q

What are the two ways in which geographic tongue can present?

A
  • 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
Q

Can any other tissues be affected by geographic tongue?

A
  • buccal mucosa and palate
    • rare
27
Q

How is geographic tongue treated?

A
  • disorder of maturation, not disease
    • no treatment required
28
Q

How can it be determined if geographic tongue is symptomatic and what are the other possible causes?

A
  • 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
Q

What is brown/black hairy tongue?

A
  • 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
Q

How can black/brown hairy tongue be managed?

A
  • removal of elongated papillae
    • tongue scraper
    • peach stone
      • suck for 1 hour daily
31
Q

What is fissured tongue?

A
  • tongue has normal appearance then fissure pattern appears
    • not constantly present
  • aetiology unconfirmed
32
Q

What are the symptoms of fissured tongue?

A
  • 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
Q

What is glossitis?

A
  • smooth red appearance of tongue
    • atrophy of mucosa
34
Q

What are the possible causes of glossitis?

A
  • haematinic deficiency
    • check for angular cheilitis
  • lichen planus
35
Q

What investigations should be carried out when a patient presents with suspected glossitis?

A
  • haematinics
  • fungal cultures
  • biopsy
36
Q

When should swellings be referred?

A
  • 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
Q

What kind of swellings are not usually referred?

A
  • 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
Q

What is a leaf fibroma and how should it be managed?

A
  • fibrous polyp squashed under denture
    • thin and elongated
  • should be removed and allowed to heal
    • can then construct new denture
39
Q

What are fibroepithelial polyps and how should they be managed?

A
  • 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
Q

How are polyps formed parafunctionally and how can they be managed?

A
  • formed by parafunctional habit
    • sticking tongue through diastema
    • polyp on tongue edge
  • managed by closing gap or blocking diastema
41
Q

What are mucoceles and how can they be managed?

A
  • 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
Q

What are tori and what are the management options?

A
  • 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
Q

What types of medications are a risk factor for tori and why?

A
  • bisphosphonates
    • increased risk of avascular necrosis
      • affecting mucosal covering
      • blood supply reduced as from bone
  • consider risk for bisphosphonate patients
44
Q

What is a pyogenic granuloma?

A
  • 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

BDS4 Oral Medicine (3 decks)

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