Normal and Hyperplastic Oral Mucosa

Question 1

The lamina propria contains:

Answer 1

FCT which contains:

• Fibroblasts
• ECM with-
• Collagens
• Proteoglycans
• Glycoproteins
• Elastin

Question 2

The epithelium and lamina propria are together known as the oral mucosa. Where is the basement membrane located?

Answer 2

Between them.

Question 3

The epithelium and lamina propria are together known as the oral mucosa. Below this is the sub mucosa, which contains:

Answer 3

• FCT
• Fat
• Blood vessels
• Minor salivary glands

Depending on the site, there may be muscle or bone beneath the submucosa.

Question 4

What parts of the mouth have no submucosa?

Answer 4

Gingiva, hard palate - oral mucosa is attached directly to periosteum

Question 5

List the compartments of the epithelium of the oral mucosa

Answer 5

• Basal compartment
• Maturation compartment
• Keratin compartment (usually)

Question 6

Cells found in the basal layer of the SSE

Answer 6

• Stem cells
• Melanocytes
• Langehans cells

Question 7

What is the maturation layer of the SSE also called?

Answer 7

Prickle ell layer

Flatten as they rise and lose nuclei

Question 8

Example of a place in the mouth there is no keratin

Answer 8

Floor of mouth

Question 9

Proteins in Desmosomes:

Answer 9

• Plakoglobulin
• Desmoplakin
• Desmogleins

Question 10

Epithelial cells are attached to the basement membrane via:

Answer 10

Hemi-desmosomes.

Question 11

Proteins in hemi-desmosomes -

Answer 11

BP-230, BP-180

Question 12

4 factors which influence the colour of the mucosa

Answer 12

• Vascularity of underlying CT
• Melanin pigmentation
• Thickness of the maturation compartment
• Thickness of keratin compartment

Question 13

1 example of epithelial hyperplasia:

Answer 13

• Frictional keratosis

Question 14

7 examples of mucosal hyperplasia

Answer 14

• Pyogenic granuloma
• Pregnancy epulis
• Fibrous epulis
• Fibro-epithelial polyp
• Denture-induced hyperplastic tissue
• Papillary hyperplastia of the palate
• Giant cell epulis (peripheral giant cell granuloma)

Question 15

Soft reddish swelling on the interdental papilla, usually with an ulcerated surface which may be covered by a yellowish slough. Relatively painless

Answer 15

Pyogenic granuloma.

Inflammatory vascular lesion usually on gingivae.

Question 16

Management of pyogenic granuloma:

Answer 16

Excisional biopsy. Removal of local factors.

Question 17

Pyogenic granulomas may mature to form a:

Answer 17

Fibrous epulis

Question 18

Pyogenic granuloma occuring in a pregnant female:

Answer 18

Pregnancy epulis

Question 19

Management of pregnancy epulis:

Answer 19

Unless causing significant problems tx of a pregnancy epulis should be deferred until after birth when it will likely decrease and resolve.

Question 20

Common fibrous mass occurring in the gingival margin. Pedunculated or sessile mass, which feels firm and is of similar colour to the adjacent gingivae.

Usually painless.

Answer 20

Fibrous epulis.

Question 21

Btoh pyogenic granulomas and fibrous epulis may be ulcerated and covered in a yellowish slough

True or false

Answer 21

True

Question 22

Management of fibrous epulis:

Answer 22

Excisional biopsy and remove local factors eg overhangs, rough restos.

Question 23

What is the difference between a fibrous epulis and a fibro-epithelial polyp?

Answer 23

Fibro-epithelial polyp used for solitary nodules occurring in sites other than the gingiva.

Question 24

Where do fibro-epithalial polyps usually occur?

Answer 24

Occlusal line of the buccal mucosa or lateral margin of tongue.

Question 25

What is denture induced hyperplastic tissue

Answer 25

Folds of hyperplastic tissue which develop at the periphery of an ill-fitting denture. Shoudl reduce if denture adjusted or removed, but if extensive might need to be surgically removed to allow provision of new dentures.

Question 26

Relatively common lesion which presents as a bluish or purple gingival mass. Thought to be a form of hyperplasia with proliferation of multi-nucleated cells.

Answer 26

Giant cell epulis (or peripheral giant cell granuloma)

Question 27

Why are radiographs necessary before management of a peripheral giant cell granuloma?

Answer 27

To ensure no intra-bony pathology (exclude a central giant cell granuloma).

Lesion is then excised in total.

Question 28

For multiple peipheral giant cell granulomas or any central giant cell granulomas, what condition should be excluded:

Answer 28

Hyperparathyroidism

Question 30

How often does the epithelium turnover?

Answer 30

every 50-70 days

Question 31

functions of the oral mucosa:

Answer 31

• Barrier (trauma, microbes, toxins)
• Sensory (touch, temp, taste)
• Secretory (IgA)

Question 32

What age changes occur in the oral mucosa:

Answer 32

• Reduction in epithelial thickness
• Loss of elasticity
• Loss of innervation and blood supply
• Salivary gland atrophy and fibrosis