Oral Mucosal Disease Flashcards
What to refer to OM for an opinion?
- anything that a dentist thinks might be cancer/ dysplasia
- send photographs
1. use 2 week cancer referral pathway for actual malignancy
2. NICE and SIGN H&N cancer guidelines - any symptomatic lesion that has not responded to standard tx
1. hospital referral criteria
2. SDCEP - any benign lesion that pt can’t be persuaded is not cancer
Oral mucosa labelling
- stratified squamous epithelium
- lamina propria
- gross types: lining, masticatory, gustatory
- microscopic: non- keratinised, keratinised
Keratinised
- parakeratosis
- orthokeratosis
Keratinised vs Non- keratinised
non- keratinised
- normally moist
- do not contain keratin
- buccal mucosa
keratinised
- palate
- gingiva
Strata and compartments
Reactive changes of oral epithelium
- keratosis: non- keratinised site (parakeratosis)
- acanthosis: hyperplasia of stratum spinosum; thickening of epithelium
- elongated rete ridges: hyperplasia of basal cells
Mucosal reactions
Atrophy
- reduction in viable layers
Erosion
- partial thickness loss
Ulceration
- fibrin on surface
Oedema/ swelling
- intracellular (more filled with fluid)
- intercellular (spongiosis)
Blister: within/ below epithelium
- vesicle/ bulla
Age and Nutrition
Age
- progressive mucosal atrophy
Nutritional deficiency
- iron/ B group vitamins
- atrophy
- predisposing to infection
Tongue lesions (benign)
Geographic tongue
- 1-2% of population
- less in children
- desquamation
Black hairy tongue
- hyperplasia of papillae
- bacterial pigment
Fissured tongue
- scrotal tongue
Geographic tongue symptoms
- when there is an alteration tot he maturation and replacement of normal epithelial surface
- sensitive with acidic/ spicy foods
- intermittent
- much worse in young children as more sensitive
- requires no tx, will settle after a while
- may symptomatic for a week and settled in a few weeks
Causes of geographic tongue
- haematinic deficicency (B12, Folate, Ferritin)
- parafunctional trauma, causing damage to tongue tip
- dysaesthesia
- need to have haematinics assessed
Brown/ Black hairy tongue
- can be due to bacterial colonisation
- simply elongation of surface papillae which is then stained with pigments from food
- can be removed with a peach stone/ tongue scraper
- may get additional vitamins when sucking peach stone
- association with smoking
Fissured tongue
- asymptomatic
- pt may think it looks strange
- normally an appearance issue
- if fissure is too deep, may cause food being trapped in fissures and cause inflammation
- use soft brush to clean fissures of tongue
- explain the pt it is like a car tire
Glossitis
- means pt has a tongue that doesnt look normal and requires further investigations
- may be medical issues involved
- may be case of anemia/ deficiency of Vit B12
- to describe smooth looking red tongue
- investigate haematinics and biopsy to look at the mucosa itself
- easier for fungus to colonise
- investigate fungal culture
When should swellings be referred?
- symptomatic
- pain is usually a fecture of SG malignancy
- abnormal overlying and surrounding mucosa
- increasing in size
- rubbery consistency
- trauma from teeth
- unsightly
Don’t refer these swellings
- tori: bony swellings, usually in lingual aspect of mandible/ midline of palate
- small mucosal polyps
- mucoceles: removing may cause more damage
- swellings in palate
- multiple fibrous enlargements caused by ill- fitting denture
- papillary hyperplasia of palate
Fibrous polyps
- should be removed before new dentures are made
- if not dentures may rub it and cause it to increase in size
Simple fibre epithelial polyp
- mucosal covering is the same as surrounding mucosa
- no inflammation which can cause cancer
Mucocele on palate
Mucocele filled with saliva
- remove both extravasated mucus and associated gland
Tori/ bony swelling
- may present with TMD pain
- pts taking bisphosphonates more likely to get avascular necrosis in tori than other parts of mandible
- due to blood supply for mucosa largely being derived from bone and periosteum rather than from arterial supplies in head and neck
Pyogenic granuloma
- inflammed granulation tissue with no patchy epithelial covering
- fibronous yellow appearance
