8 - Oral mucosal disease Flashcards
Who do you refer to for a potential malignancy?
MFOS
Who do you refer to for symptomatic lesions?
When symptomatic lesions do not respond to standard treatment referral to OM specialist
What are the different types of oral mucosa?
- lining
- masticatory (keratinised)
- gustatory
Define orthokeratosis.
Keratinised epithelium in areas that experience regular trauma (ie gingiva and palate)
What are the layers of the epithelium?
- stratum corneum
- granulosum
- spinosum
- basal
- lamina propria
What is keratosis?
Parakeratinisation of nonkeratinised epithelium
What is acanthosis?
Thickening of the epithelium by hyperplasia of stratum spinosum (due to trauma or immunological reasons)
What are elongated rete ridges?
Caused by hyperplasia of basal cells
Define atrophy.
Reduction in viable layers
Define erosion.
Partial thickness loss
Define ulceration.
Epithelium lost, fibrin on surface
Define intracellular oedema.
Fluid accumulation within cells
Define intercellular oedema.
- spongiosis
- fluid accumulation between cells
Define a blister.
- vesicle (small) or bulla (large)
- can be within or under epithelium
What affect does age have on oral mucosa?
- progressive mucosal atrophy (not visible on examination)
- should not be given as reason for visible mucosal atrophy
What are common causes of mucosal atrophy?
- iron deficiency
- vit B deficiency
- folate deficiency
What are the symptoms of geographic tongue?
- often asymptomatic
- sensitivity to acid/spicy foods
- intermittent (often sensitive for a week then remits for a period)
- affects children more
What are the symptoms of a fissured tongue?
- often asymptomatic
- deep fissures can gather plaque/food debris and cause infection
What is the clinical appearance of glossitis?
Smooth red tongue, atrophied
What investigations are required for glossitis?
- haematinics
- fungal cultures
- biopsy (?)
What symptoms indicate you should refer a swelling?
6
- symptomatic
- abnormal overlying or surrounding mucosa
- increasing in size
- rubbery consistency
- trauma from teeth
- unsightly
What types of swelling do not require referral?
- tori
- small polyps
- mucoceles (unless fixed in size)
Describe papillary hyperplasia.
- multiple fibrous enlargements under normal mucosa
- caused by ill fitting denture
- no direct treatment, just alteration of denture
Describe a fibrous polyp.
- can be known as a leaf polyp
- covered in normal mucosa
- caused by an ill fitting denture, can grow in size
- requires removal
Describe a fibroepithelial polyp.
- round swelling/growth covered in normal mucosa
- no inflammation at base
- only requires removal if large and interfering with function/being traumatised
Describe a small mucocele.
Small clear swelling that develops over a minor salivary gland
Describe a fixed mucocele.
- large swelling that turns blue, increases in size
- requires surgical removal of gland
Describe tori.
- 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
Describe a pyogenic granuloma.
- 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
