reactive and benign lesions

Question 1

what is a fibro-epithelial polyp

Answer 1

• localised hyperplastic lesion
• overproduction of granulation and fibrous tissue in responce to damage or trauma

Question 2

clinical features of fibre-epithelial polyp

Answer 2

• commonly presents in buccal mucosa
• often in areas of trauma
• may be pedunculated or sessile
• firm or soft
• pink appearance
• painless
• can be ulcerated and easily traumatised
• may have associated frictional keratosis
• usually an isolated lesion

Question 3

histology of fibro-epithelial polyp

Answer 3

• fibrous tissue in core
• thick interlacing collagen fibres
• adjacent normal tissue
• covered with squamous epithelium
• may have hyperkeratosis
• little inflammatory infiltrate

Question 4

management of fibro-epitheial polyp

Answer 4

• photos
• identify and if appropriate correct traumatic cause
• consider excisional biopsy

Question 5

benefits and risk of biopsy in fibro-epitheial polyp

Answer 5

benefits
- can confirm diagnoses - useful if the diagnossis isnt certain or patient has SCC risk factors
- can remove lesion

risks
- surgical risks
- altered sensations - can be permanent
- recurrance or incomplete excision

Question 6

what is this

Answer 6

fibro-epithelial polyps

Question 7

what is denture associated hyperplasia

Answer 7

• response to denture trauma
• poor denture fit
  -leaf fibroma
  -denture/papillary hyperplasia
  -can make denture fit worse

Question 8

management of denture hyperplasia

Answer 8

• excision of lesion
• denture hygiene
• candida management
• consider fabrication of new prosthesis

Question 9

what is an epulis

Answer 9

• refers to reactive hyperplastic lesion on the gingivae

Question 10

what is fibrous epulis

Answer 10

• a fibro-epiithelial polyp presenting on gingivae
• same coloour as gingiva
• may be ulcerated
• histologically similar to polyps but more likely to have varying amounts of inflammatory infiltrates

Question 11

what is giant cell epulis

Answer 11

• peripheral giant cell granuloma
• red/purple appearance
  -sessile or predunculated
• children
• idential histopathological features as a central giant cell lesion and hyperparathyroidism (browns tumour)
  
  • multinucleated osteoclast giant cells
  • vascular stroma
  • fibrous tissue

Question 12

management of peripheral giant cell granuloma

Answer 12

• excisional biopsy
• bone profile
• OPT +/- CBCT
• parathyroid hormone assay

Question 13

what is this

Question 14

what is vascular epulis

Answer 14

• same as pyohenic granuloma
• if presents in pregnancy termed pregnancy epulis
• increase in size due to hormone change
• soft bright red appearance
• gradual increase in size
• may resolve following birth
• if removed following birth, inflammation may decrease and resemble a fibrous epulis
• may recur if removed during pregnancy

Question 15

how does vascular epulis appear histologically

Answer 15

• vascular appearance
• variable amounts of inflammatory infiltrate

Question 16

management of vascular epulis

Answer 16

• keep under observation
• excisional biopsy
• keep under observation with a view to excise following birth

Question 17

what is this

Answer 17

vascular epulis

Question 18

what drugs induce gingival overgrowth

Answer 18

• calcium channel blockers
• ciclosporin
• phenytoin

Question 19

management of gingival overgrowth

Answer 19

• gingivoplasty may be indicated - but will likely bleed due to vascular nature
• ask GP to consider alternative medications
• plaque control
• are there risk factors for other diseases
• consider referral to oral med to exclude other causes

Question 20

what is squamous cell papilloma

Answer 20

• benign growth (tumour) - can describe as wart
• any aspect of oral mucosa
• pedunculated or sessile
• cauliflower appearance
• often keratinised surface
• result from viral - typically HPV infection (HPV-2,3,6,11 and 40)
• not associated with malignant transformation
• signle or multiple lesions
• may present in immunocompromised

Question 21

management of squamous cell papilloma

Answer 21

• excisional biopsy
• observation - if no red flags , signs or symptoms , or OSCC risk factors

Question 22

histology of squamous cell papilloma

Answer 22

• histological examination shows fingers - like processes of hyperplastic squamous epithelium
• thin cores of vascular connective tissue

Question 23

what is pyogenic granuloma

Answer 23

• reactive vascular lesion
• gingiva most common site - but any oral mucosal tissue can be affected
• typically a responce to locla irritation/trauma

Question 24

histology of pyogenic granuloma

Answer 24

• vascular proliferation
• oedematous fibrous stroma
• variable inflammatory infiltrate

Question 25

management of pyogenic granuloma

Answer 25

- remove irritant - plaque/overhanf/denture/other traumatic cause - excisional biopsy

Question 26

pathophysiology of black hairy tongue

Answer 26

- hyperplasia of filiform papillae - build up of commensal bacteria , food debris - pigment inducing fungi and bacteria

Question 27

cause of black hairy tongue

Answer 27

- smoking - antibiotics - chlorhexidine - poor OH

Question 28

management of black hairy tongue

Answer 28

- reassure - stop smoking - stay hydrated - lightly brush tongue - exfoliate tongue surface - peach stones - eating fresh pineapple - other causative factor? - not caused by fungal infection

Question 29

what can happen in lingual tonsil

Answer 29

- lymphoid tissue - postero-lateral aspect of tongue - may become enlarged following trauma or infection - can mimic malignancy and is in high risk site. - no treatment necessary - referral may be inficated if diagnosis is unclear

Question 30

what are varices

Answer 30

- blood vessels - become more prominent with age - may be more prominant in - smokers - those with cariodvascular disease

Question 31

what is hemanginoma

Answer 31

- common, bengin growth made of a collection of small blood vessels that form a lump under the skin - two histological subtypes - capillary - smaller capillary vessels - cavernous - large thin walled vessels

Question 32

what is vascular malformation

Answer 32

- congenital lesion due to abnormal blood vessel development - associated with larger arteries and veins - present at birth but present at different times of life - can be challenging to manage - may need extensive secision and free-flap reconstruction - complications - trauma/aesthetics/spontaneous bleeding - sturge-weber syndrome

Question 33

management of vascular malformation and haemanginoma

Answer 33

- pulsility assessment - no treatment/monitoring - most lesions - if asymptomatic and no asthetic concerns - cryotherapy - ultrasound - electro-cautery - CO2 laser excision - mri +/- angiogram for large lesions