Benign mucosal disease Flashcards
What categories are in the surgical sieve?
- congenital
- traumatic
- autoimmune
- metabolic
- infective
- inflammatory
- idiopathic
What is the surgical sieve used for?
to give a systematic approach to finding the aetiology of a problem
What are the common congenital oral mucosal lesions?
- leukoedema
- fordyce spots
What is leukoedema?
congenital
- white/grey discolouration of the mucosa generally
- asymptomatic
What is fordyce spots?
congenital
- ectopic sebaceous glands
Where on the oral mucosa does leukoedema affect?
most obvious on the buccal mucosa but can affect any area in the mouth
What is leukodema due to?
a slight thickening of the orla mucosa
What is the appearance of fordyce spots?
small cream coloured spots within the buccal mucosa
What is this?
leukoedema
What is this?
fordyce spots
What are the common traumatic oral mucosal lesions?
- erosions/ulcers
- frictional keratosis
- polyps
- denture induced hyperplasia
- amalgam tattoos
- mucocoeles
What are ulcers and erosions caused by?
acute trauma which caused loss of the superficial epithelial layer e.g. dentures, restorations, direct trauma
loss of just the more superficial layer = erosion
loss of full thickness of epithelial layer = ulcer
How are uclers treated?
irradiate the source of the trauma, if does not resolve within 14 days then investigate with biopsy
What % of population are affected by aphthous ulcers?
20%
What may caused aphthous ulcers?
- genetic element
- trauma
- food stuffs
- haematinic deficiency
- hormonal
How do aphthous uclers resolve?
self resolving, usually within 14 days
What kinds of trauma may cause ulcers?
- mechanical
- thermal
When may a traumatic ulcer develop a keratotic margin around it?
when the trauma is chronic and low grade
What is this?
traumatic ulcer - mechanical trauma
What is this?
traumatic ulcer - thermal trauma
What are these?
aphthous uclers
What is morsicatio buccarum?
cheek biting
What is this evidence of?
cheek biting
What is this evidence of?
cheek biting
What is linea alba?
- white tissue line at the level of the occlusal plane
- asymptomatic
- associated with clenching, sucking habits
- biopsy if unusual appearance
What are polyps?
benign outgrowths from the oral mucosa
- normal overlying mucosa with fibrous centre
- asymptomatic unless traumatised
What is it called with a polyp has a small stalk?
pedunculated
What is it called with a polyp has a broad base?
sessile
What is this?
sessile polyp
How are polyps treated?
excision
What is an amalgam tattoo?
metal inclusions in the mucosa, dark coloured pigmented lesion
What generally caused an amalgam tattoo?
when an amalgam restoration is replaced or restored in some way where a small amount of the amalgam gets relates into the tissues at high speed
- introduction of metal into the mucosa which is then taken up by macrophages, causing a tattoo
Why may a biopsy be taken to establish diagnosis of an amalgam tattoo?
looks similar to a mucosal melanoma
What is this?
amalgam tattoo
What caused denture induced hyperplasia?
ill fitting dentures worn 24/7
How is denture induced hyperplasia treated?
excision and new dentures
What is this?
denture induced hyperplasia
What is this?
extensive denture induced hyperplasia with superimposed candida
What is this treatment for this?
(extensive denture induced hyperplasia with superimposed candida)
excision of excess tissue and systemic treatment of the candida, and new dentures
What is a mucocoele?
a minor salivary gland cyst / mucous extravasation cyst
What causes a mucocoele?
usually as a result of trauma to the lip (usually lower lip)
- saliva escapes from the damaged duct into the surrounding lip and causes a swelling
How are mucocoeles treated?
excision of the mucocoele and the minor salivary gland
What is this?
mucocoele / mucous extravasation cyst
What are the (broad) infective causes of oral mucosa lesions?
- fungal
- viruses
What are the fungal causes of infective oral mucosal disease?
- acute pseudomembranous candidiasis
- candidal leukoplakia
What are the viral causes of infective oral mucosal disease?
- human papilloma virus
- herpes virus
What is acute pseudomembranous candidiasis commonly known as?
thrush
How does thrush clinically present?
white plaques that wipe free leaving a red base
What microorganism is the common cause of thrush?
candida albicans
How us oral thrush treated?
systemic antifungals
- can use topical but systemic generally works better
Why may oral thrush be a recurring problem?
underlying systemic issues/immunocompromised e.g. previously undiagnosed diabetes
How does candidal leukoplakia present?
inside of the commissures, presents as a white/red or speckled lesion, may be unilateral or bilateral
leukoplakia = white patch that does not wipe off
How is candidal leukoplakia treated?
generally advocate 2 weeks of systemic antifungals and then review, if no marked clinical improvement then biopsy required
What is this?
oral thrush/candidiasis
What is this?
candidal leukoplakia
What is a papilloma?
a human papilloma virus associated lesion
How may a papilloma present?
- sessile or pedunculated
- asymptomatic
- can become traumatised
How are papillomas treated?
excision
What is this?
papilloma
What is secondary herpes?
reactivation of latent herpes virus in the trigeminal system
- reactivated during times of stress, immunocompromise, UV light exposure, hormonal problems
virus travels down the trigeminal division and presents as a blistering lesion in the lip
How does secondary herpes present clinically?
tingling sensation before vesicles develop which eventually rupture and form a crusting lesion - transmissable while crusting
How is secondary herpes treated?
cold sore treated with topical antivirals
What is this?
secondary herpes/cold sore
What inflammatory conditions can affect the oral mucosa?
- geographic tongue
- lichenoid reactions
- epulis
What is geographic tongue?
patterned appearance on the dorsum of the tongue, concentric white lines and red lines
What caused geographic tongue?
abnormality in the turnover of the dorsum of the tongue, red areas are atrophy, white are keratosis
How common is geographic tongue?
2-3%, often runs in families
What other things is geographic tongue sometimes associated with?
fissured tongue, psoriasis, sometimes an underlying vitamin B problem which predisposed pt to developing it
If geographic tongue is symptomatic what may be used to treat it?
local anaesthetic mouthwash
but generally it is asymptomatic
What is this?
geographic tongue
What can cause a lichenoid lesion?
- reaction to metal (contact lesions)
- medication
- antihypertensives
- hypoglycaemics
- NSAIDs
Are lichenoid lesions symptomatic?
- usually asymptomatic
- patches may have erosions or ulcerations which will be symptomatic and require symptomatic management
What is needed to establish the diagnosis of a lichenoid lesion?
biopsy due to potential cellular atypia, need to ensure it is benign
What is an epulis?
a growth on the gum
What are the types of epulis?
- fibrous epilus
- pyogenic granuloma
What is a fribrous epulis associated with?
the gingival margin of the teeth (usually at the papilla)
What is a fibrous epulis usually caused by?
chronic irritation which stimulates a granulation response
e.g. irregularly in surface enamel, a restoration, a carious lesion
What is the clinical presentation of a fibrous epulis?
normal overlying mucosa with a fibrous centre
What issues may a fibrous epulis cause?
issues with maintaining hygiene, bleeding when trying to clean interdentally
What is the treatment for an epulis?
excision
What is a pyogenic granuloma?
same site as a fibrous epulis but is a more vascular lesion
What are pyogenic granulomas associated with?
tend to have a hormonal association, tend to be found during pregnancy
What metabolic disease may cause a benign oral mucosal lesion?
Addison’s disease
What is Addison’s disease?
primary adrenal deficiency - cortisol and aldosterone
What is the oral manifestation of Addison’s disease?
oral mucosal pigmentation, in addition to skin pigmentation
Why does oral pigmentation caused by Addison’s disease usually require biopsy?
to rule out anything more sinister e.g. melanoma
What is this?
lichenoid lesion
What is this?
fibrous epulis
What is this?
pyogenic granuloma
What is this?
oral mucosal pigmentation due to Addison’s disease
What is a melanotic macule?
round or oval brown or black pigmented area on the lip or any mucosal surface
What is the aetiology of a melanotic macule?
trauma usually, or idiopathic
What group of people are melanotic macules usually found in?
develops in the 50+ age group
What si the treatment for a melanotic macule?
usually biopsy for diagnosis, may be excised for aesthetics if on the lip
What is this?
melanotic macule
What autoimmune conditions can cause benign mucosal lesions?
- lichen planus
- vesiculobullous conditions
What is lichen planus and who does it affect?
- autoimmune inflammatory condition
- 1-2% of the population, F>M
How does lichen planus present in the mouth?
various forms and symptoms, bilateral or unilateral
What is done to diagnose lichen planus?
- biopsy to determine diagnosis
- potentially malignant so must be monitored
What are vesticulobullous conditions?
autoimmune inflammatory conditions that cause painful blisters that rupture into erosions and uclers
How are oral presentations of vesiculobullous conditions diagnosed/treated?
biopsy to determine diagnosis, then treated by oral med
What is this?
lichen planus (reticular)
What are idiopathic lesions?
lesions of unknown aetiology e.g. lipoma
What is a lipoma?
a benign mesenchymal neoplasm which can develop in any part of the oral mucosa, idiopathic cause
What is a lipoma made of?
make up of fat cells surrounded by a thin fibrous capsule
How are lipomas treated?
excision
What is this?
lipoma
