Mucosal Changes Flashcards
What is the cancer referral pathway and when should this be used?
Anything that the dentist thinks might be cancer/ dysplasia
2 week pathway for malignancies
When should a lesion be referred to oral medicine?
If symptomatic and hasn’t responded to standard treatment or any benign lesion that a pt cant be persuaded isn’t cancer.
What are the layers of the oral mucosa?
Stratified squamous epithelium with underlying lamina propia (contains blood vessels)
Stratum corneum
Granulosum
Spinosum
Basal
What are the reactive changes of the oral epithelium?
Keratosis (non-keratinised sites)
Acanthosis (hyperplasia of stratum spinosum) - thickening
Elongated rete ridges (hyperplasia of basal cells)
What are mucosal changes?
Atrophy - reduction in viable layers
Erosion - partial thickness loss
Ulceration - fibrin on surface
Oedema - Intracellular/ intercellular (spongiosis)
Blister - vesicle or bulla
What is geographic tongue?
Disordered maturation and replacement of epithelial surface of tongue (benign condition)
Random areas are rep[laced at one time randomly, in geographic tongue, whole areas of epithelium are replaced at once, causing thinning and red appearance.
Can be sensitive at first (especially to spicy/ citrus foods)
May be due to haemantinics deficiency, parafunctional trauma, dysaesthesia
What is black hairy tongue?
Elongation of surface papillae which become stained
Can be from soft/ liquid diet
Remove elongated papilla with tongue scraper
What is fissured tongue
Has unknown cause
Can be due to dry mouth
Can be painful if becomes deep (food gets stuck, hard to clean)
May be associated with candida/ lichen planus
What is glossitis?
Atrophy, smooth, red appearance of the tongue
Investigate - haemantinics, fungal cultures
When should swellings in the mouth be referred?
If symptomatic
Abnormal overlying and surrounding mucosa
Increase in size
Rubber consistency
Trauma from teeth
What type of intra oral swellings should not be referred?
Tori (bony swelling in lingual of mandible/ midline palate)
Small polyps
Mucoceles
What is a fibrous polyp?
Caused by minor trauma or irritation
Benign tumour
Can get ‘leaf fibroma’ from polyp being squashed under denture
What is a pyogenic granuloma?
Granulation tissue (mixed inflammatory infiltrate on fibro vascular background)
Can occur on any mucosal site, response to trauma
No epithelial surface
What are reasons for white lesions in the mouth?
Hereditary
Smoking/ frictional keratosis
Lichen planus
Candida leukoplakia
Carcinoma
Why are white lesions white?
Increased thickness of epithelium, increases the opacity (making it less pink, less visibility of blood)
what is leukoplakia
A white patch which cannot be rubbed off or attributed to any other cause
<1% malignancy risk
What is smokers keratosis?
Trauma from the thermal gases resulting in white patches (on hard palate)
Melanin over production
Low malignant risk of the lesion, but higher cancer risk overall
What is white sponge naevus?
Hereditary white patches
Starts in childhood, FH
No traumatic
Why are red lesions red?
Inflammation
Dysplasia
(Reduced thickness of epithelium)
What is erythroplakia?
Unexplained red change
Cannot be attributed to any other cause
More of a malignant concern than leukoplakia
What causes blue lesions?
Fluid in connective tissue
Dark blue - slow moving blood
Light blue - clear fluid eg saliva (mucocele), lymph
Name 3 local and 3 general causes of pigmentation?
Local - malignant melanoma, melanocytic neavus, amalgam tattoo, haemangioma
General - racial pigmentation, addisons disease, smoking
How does addisons disease affect the oral mucosa?
Hyperpigmentation resulting in brown appearance of gingiva/ mucosa/ tongue/ lips
What are the two types of haemangioma?
Capillary and cavernous
What is a capillary haemangioma?
Haemangioma filled with thin walled capillaries
What is a cavernous haemangioma?
Encapsulated haemangioma with dilated vascular spaces.
What are the 6 types of candida?
Pseudomembranous
Denture induced
Erythematous
Hyper plastic
Angular cheilitis
Median rhomboid glossitis
What are the virulence factors of S mutans?
ASAP
Adhesins
Sugar modifier enzyme
Acidic tolerance and adaption
Polysaccharide binding protein
What are the virulence factors of Candida albicans?
GAMES
Germ tube formation
Adhesins
Metabolites (acidic)
Extra cellular enzymes
Switching mechanisms
What are the tests for candida?
Swab, biopsy, oral rinse
What are contraindications for -Azoles
Warfarin
Statins
What is median rhomboid glossitis?
For sum of the tongue from anterior to sulcus terminalis
Candida hyphae infiltration and elongated rete ridges
Hyper plastic rete ridges
What is the histology stain used for candida?
PAS
Periodic acidic Schiff stain
