8 - Oral mucosal disease

Question 1

Who do you refer to for a potential malignancy?

Answer 1

MFOS

Question 2

Who do you refer to for symptomatic lesions?

Answer 2

When symptomatic lesions do not respond to standard treatment referral to OM specialist

Question 3

What are the different types of oral mucosa?

Answer 3

• lining
• masticatory (keratinised)
• gustatory

Question 4

Define orthokeratosis.

Answer 4

Keratinised epithelium in areas that experience regular trauma (ie gingiva and palate)

Question 5

What are the layers of the epithelium?

Answer 5

• stratum corneum
• granulosum
• spinosum
• basal
• lamina propria

Question 6

What is keratosis?

Answer 6

Parakeratinisation of nonkeratinised epithelium

Question 7

What is acanthosis?

Answer 7

Thickening of the epithelium by hyperplasia of stratum spinosum (due to trauma or immunological reasons)

Question 8

What are elongated rete ridges?

Answer 8

Caused by hyperplasia of basal cells

Question 9

Define atrophy.

Answer 9

Reduction in viable layers

Question 10

Define erosion.

Answer 10

Partial thickness loss

Question 11

Define ulceration.

Answer 11

Epithelium lost, fibrin on surface

Question 12

Define intracellular oedema.

Answer 12

Fluid accumulation within cells

Question 13

Define intercellular oedema.

Answer 13

• spongiosis
• fluid accumulation between cells

Question 14

Define a blister.

Answer 14

• vesicle (small) or bulla (large)
• can be within or under epithelium

Question 15

What affect does age have on oral mucosa?

Answer 15

• progressive mucosal atrophy (not visible on examination)
• should not be given as reason for visible mucosal atrophy

Question 16

What are common causes of mucosal atrophy?

Answer 16

• iron deficiency
• vit B deficiency
• folate deficiency

Question 17

What are the symptoms of geographic tongue?

Answer 17

• often asymptomatic
• sensitivity to acid/spicy foods
• intermittent (often sensitive for a week then remits for a period)
• affects children more

Question 18

What are the symptoms of a fissured tongue?

Answer 18

• often asymptomatic
• deep fissures can gather plaque/food debris and cause infection

Question 19

What is the clinical appearance of glossitis?

Answer 19

Smooth red tongue, atrophied

Question 20

What investigations are required for glossitis?

Answer 20

• haematinics
• fungal cultures
• biopsy (?)

Question 21

What symptoms indicate you should refer a swelling?

6

Answer 21

• symptomatic
• abnormal overlying or surrounding mucosa
• increasing in size
• rubbery consistency
• trauma from teeth
• unsightly

Question 22

What types of swelling do not require referral?

Answer 22

• tori
• small polyps
• mucoceles (unless fixed in size)

Question 23

Describe papillary hyperplasia.

Answer 23

• multiple fibrous enlargements under normal mucosa
• caused by ill fitting denture
• no direct treatment, just alteration of denture

Question 24

Describe a fibrous polyp.

Answer 24

• can be known as a leaf polyp
• covered in normal mucosa
• caused by an ill fitting denture, can grow in size
• requires removal

Question 25

Describe a fibroepithelial polyp.

Answer 25

• round swelling/growth covered in normal mucosa
• no inflammation at base
• only requires removal if large and interfering with function/being traumatised

Question 26

Describe a small mucocele.

Answer 26

Small clear swelling that develops over a minor salivary gland

Question 27

Describe a fixed mucocele.

Answer 27

• large swelling that turns blue, increases in size
• requires surgical removal of gland

Question 28

Describe tori.

Answer 28

• bengin bony growths that can occur in the palate or mandible
• sometimes associated with parafunctional habits
• can be a risk factor for necrosis of overlying mucosa if patient is on bisphosphonates, this should be considered when beginning medication

Question 29

Describe a pyogenic granuloma.

Answer 29

• no epithelial surface
• made up of granulation tissue (mixed inflammatory infiltrate with fibro-vascular background)
• can be found on any mucosal site
• response to trauma
• also known as vascular epulis (gingiva) or pregnancy epulis