Normal Oral Mucosa

Question 1

What stain is used for mucosa?

Answer 1

H&E
Haemotoxylin and eosin
Stains pink and purple

Question 2

What layers would you expect to see in normal mucosa?

Answer 2

Surface epithelium
Lamina propria
Sub-mucosa
Skeletal tissue

Question 3

What is the surface mucosa of normal lining mucosa?

Answer 3

Non-keratinised stratified squamous

Question 4

What is lamina propria?

Answer 4

Superficial connective tissue

Question 5

What is sub-mucosa made from?

Answer 5

Adipose tissue

Question 6

What is a good biopsy?

Answer 6

Deep biopsy - provides sufficient tissue depth for examination

Question 7

What mucosa is present in oral cavity?

Answer 7

Mucosa not consistant
Masticatory mucosa - gingiva HP
Lining mucosa - SP/ uvula
Gustatory (special mucosa) - tongue

Question 8

What is masticatory mucosa?

Answer 8

Firmly fixed to underlying bone - mucoperiosteum

Resist stress and strain - don’t want flexibility

Question 9

How does gingiva look?

Answer 9

Pale pink w/ fine stippling

Line of mucogingival junction separates masticatory and lining mucosa

Question 10

How does hard palate look?

Answer 10

Histoloigcally look same as masticatory mucosa of gingiva

If from anterior palate see rugae

Question 11

What would you see histologically on sample from hard palate - masticatory mucosa?

Answer 11

Layer of keratin on surface
Thinner epithelium
Less extensive lamina propria submucosa
Mucosal salivary gland tissue

Question 12

If sample from anterior palate what would you see instead of submucosa?

Answer 12

Subperiosteum

Question 13

Where find lining mucosa?

Answer 13

Soft palate
Ventral tongue
Floor mouth
Buccal mucosa

Question 14

What allows for flexibility and movement of lining mucosa?

Answer 14

Lose sub-mucosa w/ adipose

SS epithelium always non-keratinised

Question 15

Describe layers of SS epithelium?

Answer 15

Basal cell layer
Prickle cell layer
Granular layer

Question 16

What is the basal cell layer?

Answer 16

Sits on basmenet membrane
Rapidly proliferate and migrates up to replace epithelium cells
Eventually form keratin

Question 17

What is granular layer?

Answer 17

See as black dots

Only seen when keratin is being produced

Question 18

Example of specialised mucosa?

Answer 18

Mucosa of tongue w/ tastebuds

Question 19

What are the diff types of tastebuds?

Answer 19

Filiform - most numerous
Fungiform - larger, anterior 2/3
Foliate - lateral posterior aspect
Circumvalate - posterior 1/3 form V shape

Question 20

How do filiform papillae appear histologically?

Answer 20

On biopsy of anterior 2/3 tongue - will see small amount submucosa and large amount muscle
Pointy/ spikes projection of keratin

Question 21

How does leukoedema present?

Answer 21

Generalised opacification of buccal mucosa w/ classic appearance

Present symmetrically and asymptomatically
Typically on buccal mucosa
Milky-white translucent area w/ diffuse appearance
Can blend w/ adjacent mucosa w/o defined border

Question 22

What is defining feature of leukoedema?

Answer 22

If hold pt cheek and pull it will disappear?

Question 23

Who is leukoedema likely to affect?

Answer 23

More prevalent black individuals - esp African Americans

Question 24

What can leukoedema be associated w/?

Answer 24

Smoking

Question 25

What could be differential diagnosis of leukoema?

Answer 25

White sponge naveus - thicker folded and extensive white patch Chronic cheek biting - frictional keratosis Lichen planus - classic white reticulation/ Lacey pattern

Question 26

What is erythema migrans?

Answer 26

Geographic tongue | Well defined islands - red patch w/ white halo

Question 27

Where does erythema migrans affect?

Answer 27

Dorsum of tongue | Can extend ventral/ lateral aspect

Question 28

Is erythema migrans painful?

Answer 28

Asymptomatic or mild soreness | Can be aggravated - spicy/ acidic food

Question 29

Tx of geographic tongue?

Answer 29

No tx | If sore - difflam mouthwash - local acting analgesic and anti-inflammatory

Question 30

Differential diagnosis for geographic tongue?

Answer 30

If classic appearance - dx made clinically Lichen planus - have red/white (rarely affect dorm tongue) Frictional keratosis

Question 31

What are fordyce spots?

Answer 31

White or yellow speckling caused ectopic sebaceous glands Common and easily diagnosed

Question 32

Where are fordyce spots found?

Answer 32

Often buccal mucosa Often in elderly - buccal mucosa become atrophic - glands become more prominent

Question 33

What would histology be of fordyce spot?

Answer 33

Normal mucosa w/ sebaceous glands

Question 34

What is white sponge naevus?

Answer 34

Hereditary condition - autosomal dominat due to point mutation in keratin 4 or 13

Question 35

Clinical appearance of white sponge naevus?

Answer 35

Bilateral and symmetrical Affect: cheek and floor of mouth Appear as thick white folds, wrinkled, ebbing tides Doesn't disappear on stretching/ rubbing

Question 36

When does white sponge naevus appear?

Answer 36

Life long - appears in child hood

Question 37

What would see in biopsy of white sponge naeuvs?

Answer 37

Hyperplasitic epithelial Acanthosis - increased prickle cell layer No inflammatory component Epithelium - pink cytoplasm due to abnormal keratin formation

Question 38

Differential diagnosis of white sponge naeuvs?

Answer 38

Lichen planus Lichenoid drug reaction Chronic cheek biting Leukoedema

Question 39

What changes do you see in ageing mucosa?

Answer 39

Mucosa atrophic and smoother Decrease in elasticity Prominence fordyce spots Varicosities ventral surface tongue

Question 40

Common cause of trauma to mucosa?

Answer 40

Mechanical - denture, teeth, ortho Chemical - burns e.g aspirin, materials Physical - temp, irradiation

Question 41

What is an ulcer?

Answer 41

Full thickness breach of epithelium | Epithelium lost exposing underlying CT (sore)

Question 42

What are the components of an ulcer?

Answer 42

Thick pink part = fibrinopurulent slough Granulation tissue below Epithelium grows beneath slough

Question 43

What is slough of ulcer made from?

Answer 43

Fibrous tissue and neutrophils

Question 44

What is purpose of granulation tissue in ulcer?

Answer 44

Healing Fibroblast lay collagen Endothelial cells make blood vessels

Question 45

What is difference between keratosis and hyperkeratosis?

Answer 45

Keratosis = epithelium not typically keratinised Hyperkeratosis = epithelium normally keratinised

Question 46

What is atrophy of epithelium?

Answer 46

Reduction in thickness of epithelium due to loss of cells

Question 47

What is hyperplasia of CT and give example

Answer 47

Overgrowth of CT - increased collagen production Example: fibre-epithelial polyp

Question 48

Give examples of specific trauma to the oral mucosa?

Answer 48

Frictional keratosis Stomatitis nicotina Papillary hyperplasia of palat

Question 49

What is frictional keratosis?

Answer 49

White patch caused by continuous trauma | Usually along occlusal line/ opposed sharp cusp/ denture etc

Question 50

Classic appearance of frictional keratosis?

Answer 50

Classic crenelation where mucosa pinched - mucosa becomes keratin and hyperplastic = thick white band

Question 51

How to diagnose frictional keratosis?

Answer 51

Must be able to demonstrate lesions caused by trauma (if remove cause lesion will regress)

Question 52

What is stomatitis nicotina?

Answer 52

White bumps w/ red centre (duct orifice to minor saliva gland) on palate Damage to underlying duct = inflammation of duct w/ surrounding area of keratosis

Question 53

Who is stomatitis nicotina seen in?

Answer 53

Seen in pipe and cigar smokers | Correlation between intensity of smoking and severity

Question 54

What is papillary hyperplasia of the palate?

Answer 54

Erythematous overgrowth of mucosa - appear nodular

Question 55

Who do you see papillary hyperplasia in?

Answer 55

Denture wearer | Caused by ill-fitting denture, lesion will follow outline of denture

Question 56

What is the redness seen in papillary hyperplasia of the palate?

Answer 56

Superimposed candida infection

Question 57

Management of papillary hyperplasia of palate?

Answer 57

New denture | Excision of papillary projection in advanced cases

Question 58

Is stomatitis nictonina pre-malignant?

Answer 58

No

Question 59

Is papillary hyperplasia of palate pre-malignant?

Answer 59

No

Question 60

What factors influence healing?

Answer 60

``` Wound closure - primary/ secondary Foreign bodies Vascular supply Nutritional deficiency (vit C) Irradiation (reduce blood supply) Malignancy (fail heal) Infection Immune response ```