mucosal disease and colour changes Flashcards
Reactive changes of oral epithelium
eg if you traumatise the surface at a low level, surface will react
it will increase thickness of the epithelium, to increase surface protection- keratosis of the non-keratinized site
acanthosis - thickening of the epithelium as a reactive change or immunological damage (hyperplasia od stratum spinosum)
rete ridges become elongated (hyperplasia of basal cells)
this can happen for example in lichen planus
Age factor in oral mucosa changes
Progressive mucosa atrophy happens with age, so older person will have thinner mucosa just as they have thinner skin, but this should not account for changes in the appearance
Eg if tongue which appears to have lost the normal papillae, this is not simply age related change
This is due to some disease within the epithelium and it should be investigated
These kind of smooth changes can be caused by nutritional deficiencies such as iron or vit B
This kind of change may make it easier for cancer and other infections to get into the tissues
atrophy
opposite of acanthosis
reduction in viable layers
geographic tongue
benign mucosa changes
1-2% of population, less in children
Desquamation - varied pattern and timing
Alteration to the maturation and replacement of the normal epithelial surface
Normally desquamation happens in random areas of the tongue, therefore is never noticed as the epithelium is replaced
In g. tongue whole areas of epithelial surface are replaced at a single occasion. It starts with epithelial replication being stopped, so the epithelial layer will continuously loose cells and will make the tongue appear redder (less barrier from the eye, to the blood vessels and CT underneath)
These areas can be sensitive, as they are closer to the nerve, pt may complain about sensitivity to spicy and acidic food
After few days epithelial production restarts, thickness starts to increase and gradually appearance returns to normal.
2 common ways of presentation of G. t
Crescent shaped areas where the changes take place, can be on dorsum and lateral border - semicircular white and red areas, more focal
Large areas of change happening, more patchy pattern, active erythematous areas, areas of normal mucosa
It is not a disease but disorder of maturation, requires no treatment
Many people are completely asymptomatic, but if pt becomes aware, they may be concerned. Make sure to reassure this is a benign condition, does not require treatment.
Can start at any age, the more sensitive the tongue is, the more likely problems with the tongue, so children that present with g.t often have much more sensitivity. If so, allow the child to eat things that make it comfortable.
Intermittent problem, tends to be worse in younger patients
Seeing g.t does not mean pts symptoms are caused by it. There may be other reasons why pt experiences problem with tongue, eg vit B12, iron or folic acid (B9) deficiency, trauma causing damage to tip of the tongue, oral dysaesthesia (abnormal unpleasant sensation). So it is important to investigate this patients and check their bloods at least.
Black hairy tongue
Benign condition
Elongated papillae
Which then collects pigment from food/drink like tea and coffee
Happens in pt on soft diet, where the tongue is not abraded by hard food
Non invasive treatment to remove elongated papilla, can consist of eating a peach and then keeping peach stone for about an hour per day
Added benefit of vitamins from eating the peach
blisters
Collections of fluid, either within or below epithelium
Either vesicle or bulla, depending on size of the lesion
dry mouth treatments
Offer no pharmacological benefit, only lubrication
Medical device
Salivix pastilles
Saliva orthana
Biotene oral balance
Artificial saliva dpf
Glandosane
erosion
partial thickness loss
fissured tongue
Reasons not known
Not painful
Fissures may become deep and collect food debris, so risk of local inflammation
Soft brush can be used to clean the fissures and remove the debris
There may be another disease present like lichen planus or candida, not caused by the fissures themselves, but it may be what’s causing the pt pain
If pt concerned, the analogy of fissured tire can be used
foliate papilla
Benign mucosal structures at the back of the lateral surface of the tongue
Made up of lingual lymphoid tissue
glossitis
Tongue inflammation
Further investigation rq- haematinics, fungal cultures
Leukoplakia - what is it characterised by and why is it important clinically to distinguish it from any other white lesion?
Leukoplakia - a white patch that cannot be scraped off, cannot be contributed to any other cause
It is associated with an increased risk of malignant transformation - close surveillance is required
Mucosal atrophy - manifestation and histological features
Manifests as red appearance of mucosa
Overall thinning of stratified epithelium, but all the layers of epithelium are viable and intact
Reduction in viable layers
Mucosal erosion- manifestation and histological features
Manifests as red appearance of the mucosa
Loss of superficial layers of the stratified epithelium
Partial thickness loss
Oedema
Swelling within the epithelium
Abnormal accumulation of fluid
Intracellular - each cell is slightly bigger and slightly more filled with fluid
Intercellular - spongiosis - fluid between the cells
