Benign mucosal disease Flashcards
1
Q
What categories are in the surgical sieve?
A
- congenital
- traumatic
- autoimmune
- metabolic
- infective
- inflammatory
- idiopathic
2
Q
What is the surgical sieve used for?
A
to give a systematic approach to finding the aetiology of a problem
3
Q
What are the common congenital oral mucosal lesions?
A
- leukoedema
- fordyce spots
4
Q
What is leukoedema?
A
congenital
- white/grey discolouration of the mucosa generally
- asymptomatic
5
Q
What is fordyce spots?
A
congenital
- ectopic sebaceous glands
6
Q
Where on the oral mucosa does leukoedema affect?
A
most obvious on the buccal mucosa but can affect any area in the mouth
7
Q
What is leukodema due to?
A
a slight thickening of the orla mucosa
8
Q
What is the appearance of fordyce spots?
A
small cream coloured spots within the buccal mucosa
9
Q
What is this?
A
leukoedema
10
Q
What is this?
A
fordyce spots
11
Q
What are the common traumatic oral mucosal lesions?
A
- erosions/ulcers
- frictional keratosis
- polyps
- denture induced hyperplasia
- amalgam tattoos
- mucocoeles
12
Q
What are ulcers and erosions caused by?
A
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
13
Q
How are uclers treated?
A
irradiate the source of the trauma, if does not resolve within 14 days then investigate with biopsy
14
Q
What % of population are affected by aphthous ulcers?
A
20%
15
Q
What may caused aphthous ulcers?
A
- genetic element
- trauma
- food stuffs
- haematinic deficiency
- hormonal
16
Q
How do aphthous uclers resolve?
A
self resolving, usually within 14 days
17
Q
What kinds of trauma may cause ulcers?
A
- mechanical
- thermal
18
Q
When may a traumatic ulcer develop a keratotic margin around it?
A
when the trauma is chronic and low grade
19
Q
What is this?
A
traumatic ulcer - mechanical trauma
20
Q
What is this?
A
traumatic ulcer - thermal trauma
21
Q
What are these?
A
aphthous uclers
22
Q
What is morsicatio buccarum?
A
cheek biting
23
Q
What is this evidence of?
A
cheek biting
24
Q
What is this evidence of?
A
cheek biting
25
What is linea alba?
- white tissue line at the level of the occlusal plane
- asymptomatic
- associated with clenching, sucking habits
- biopsy if unusual appearance
26
What are polyps?
benign outgrowths from the oral mucosa
- normal overlying mucosa with fibrous centre
- asymptomatic unless traumatised
27
What is it called with a polyp has a small stalk?
pedunculated
28
What is it called with a polyp has a broad base?
sessile
29
What is this?
sessile polyp
30
How are polyps treated?
excision
31
What is an amalgam tattoo?
metal inclusions in the mucosa, dark coloured pigmented lesion
32
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
33
Why may a biopsy be taken to establish diagnosis of an amalgam tattoo?
looks similar to a mucosal melanoma
34
What is this?
amalgam tattoo
35
What caused denture induced hyperplasia?
ill fitting dentures worn 24/7
36
How is denture induced hyperplasia treated?
excision and new dentures
37
What is this?
denture induced hyperplasia
38
What is this?
extensive denture induced hyperplasia with superimposed candida
39
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
40
What is a mucocoele?
a minor salivary gland cyst / mucous extravasation cyst
41
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
42
How are mucocoeles treated?
excision of the mucocoele and the minor salivary gland
43
What is this?
mucocoele / mucous extravasation cyst
44
What are the (broad) infective causes of oral mucosa lesions?
- fungal
- viruses
45
What are the fungal causes of infective oral mucosal disease?
- acute pseudomembranous candidiasis
- candidal leukoplakia
46
What are the viral causes of infective oral mucosal disease?
- human papilloma virus
- herpes virus
47
What is acute pseudomembranous candidiasis commonly known as?
thrush
48
How does thrush clinically present?
white plaques that wipe free leaving a red base
49
What microorganism is the common cause of thrush?
candida albicans
50
How us oral thrush treated?
systemic antifungals
- can use topical but systemic generally works better
51
Why may oral thrush be a recurring problem?
underlying systemic issues/immunocompromised e.g. previously undiagnosed diabetes
52
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**
53
How is candidal leukoplakia treated?
generally advocate 2 weeks of systemic antifungals and then review, if no marked clinical improvement then biopsy required
54
What is this?
oral thrush/candidiasis
55
What is this?
candidal leukoplakia
56
What is a papilloma?
a human papilloma virus associated lesion
57
How may a papilloma present?
- sessile or pedunculated
- asymptomatic
- can become traumatised
58
How are papillomas treated?
excision
59
What is this?
papilloma
60
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
61
How does secondary herpes present clinically?
tingling sensation before vesicles develop which eventually rupture and form a crusting lesion - transmissable while crusting
62
How is secondary herpes treated?
cold sore treated with topical antivirals
63
What is this?
secondary herpes/cold sore
64
What inflammatory conditions can affect the oral mucosa?
- geographic tongue
- lichenoid reactions
- epulis
65
What is geographic tongue?
patterned appearance on the dorsum of the tongue, concentric white lines and red lines
66
What caused geographic tongue?
abnormality in the turnover of the dorsum of the tongue, red areas are atrophy, white are keratosis
67
How common is geographic tongue?
2-3%, often runs in families
68
What other things is geographic tongue sometimes associated with?
fissured tongue, psoriasis, sometimes an underlying vitamin B problem which predisposed pt to developing it
69
If geographic tongue is symptomatic what may be used to treat it?
local anaesthetic mouthwash
but generally it is asymptomatic
70
What is this?
geographic tongue
71
What can cause a lichenoid lesion?
- reaction to metal (contact lesions)
- medication
- antihypertensives
- hypoglycaemics
- NSAIDs
72
Are lichenoid lesions symptomatic?
- usually asymptomatic
- patches may have erosions or ulcerations which will be symptomatic and require symptomatic management
73
What is needed to establish the diagnosis of a lichenoid lesion?
biopsy due to potential cellular atypia, need to ensure it is benign
74
What is an epulis?
a growth on the gum
75
What are the types of epulis?
- fibrous epilus
- pyogenic granuloma
76
What is a fribrous epulis associated with?
the gingival margin of the teeth (usually at the papilla)
77
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
78
What is the clinical presentation of a fibrous epulis?
normal overlying mucosa with a fibrous centre
79
What issues may a fibrous epulis cause?
issues with maintaining hygiene, bleeding when trying to clean interdentally
80
What is the treatment for an epulis?
excision
81
What is a pyogenic granuloma?
same site as a fibrous epulis but is a more vascular lesion
82
What are pyogenic granulomas associated with?
tend to have a hormonal association, tend to be found during pregnancy
83
What metabolic disease may cause a benign oral mucosal lesion?
Addison’s disease
84
What is Addison’s disease?
primary adrenal deficiency - cortisol and aldosterone
85
What is the oral manifestation of Addison’s disease?
oral mucosal pigmentation, in addition to skin pigmentation
86
Why does oral pigmentation caused by Addison’s disease usually require biopsy?
to rule out anything more sinister e.g. melanoma
87
What is this?
lichenoid lesion
88
What is this?
fibrous epulis
89
What is this?
pyogenic granuloma
90
What is this?
oral mucosal pigmentation due to Addison’s disease
91
What is a melanotic macule?
round or oval brown or black pigmented area on the lip or any mucosal surface
92
What is the aetiology of a melanotic macule?
trauma usually, or idiopathic
93
What group of people are melanotic macules usually found in?
develops in the 50+ age group
94
What si the treatment for a melanotic macule?
usually biopsy for diagnosis, may be excised for aesthetics if on the lip
95
What is this?
melanotic macule
96
What autoimmune conditions can cause benign mucosal lesions?
- lichen planus
- vesiculobullous conditions
97
What is lichen planus and who does it affect?
- autoimmune inflammatory condition
- 1-2% of the population, F>M
98
How does lichen planus present in the mouth?
various forms and symptoms, bilateral or unilateral
99
What is done to diagnose lichen planus?
- biopsy to determine diagnosis
- potentially malignant so must be monitored
100
What are vesticulobullous conditions?
autoimmune inflammatory conditions that cause painful blisters that rupture into erosions and uclers
101
How are oral presentations of vesiculobullous conditions diagnosed/treated?
biopsy to determine diagnosis, then treated by oral med
102
What is this?
lichen planus (reticular)
103
What are idiopathic lesions?
lesions of unknown aetiology e.g. lipoma
104
What is a lipoma?
a benign mesenchymal neoplasm which can develop in any part of the oral mucosa, idiopathic cause
105
What is a lipoma made of?
make up of fat cells surrounded by a thin fibrous capsule
106
How are lipomas treated?
excision
107
What is this?
lipoma
