OM - Mucosal Colour Change Flashcards
What causes oral white lesions? (5)
- Hereditary
- Oral white sponge naevus
- Smoking/frictional
- Lichen planus
- Candidal leukoplakia
- Carcinoma
Describe why white lesions appear white. (2)
Red colour comes from the connective tissue where the vibrancy of the BV are diluted by the epithelial layers,
therefore if there is;
- Thickening of the mucosa or increased keratin deposition on the surface = less visibility of blood vessels in the CT beneath
- Less blood in the tissues (from vasoconstriction) = less visibility on the surface of the mucosa as blood flow is slowed
What is leukoplakia?
A white patch which cannot be scraped off or attributed to any other cause
No histopathological connotation - it is simply a clinical description not yet attributed to any other cause
Once biopsied and we have a diagnosis it is no longer a leukoplakia
How do we diagnose leukoplakia?
Via exclusion
What are fordyce spots?
ectopic sebaceous glands
Where are common sites for fordyce spots? (2)
Lips
Buccal mucosa
Do fordyce spots have malignant potential?
No
What is frictional keratosis?
Reactive thickening of the mucosa from a traumatic source – keratotic thickening leads to loss in visibility of blood vessels in CT
What is frictional keratosis usually associated with? (1)
an obvious traumatic source i.e. parafunctional clenching
What is smokers keratosis?
Trauma from thermal gases causes reactive keratotic changes and thickening of the mucosa leading to loss in visibility of blood vessels in CT.
Describe the appearance of smokers keratosis histologically.
Increased keratin deposition however the mucosa has no other changes except an increase in melanin pigment from the irritation (melanocytes over produce melanin)
Describe the malignant potential of smokers keratosis.
- Low malignant potential of the lesion but patient has a higher oral cancer risk in general
What is hereditary keratosis also known as?
White sponge naevus
What Is hereditary Keratosis (white sponge naevus)?
White appearance is from fluid accumulation (spongiosis) between the superficial layers of the epithelium. This increased the opacity of the tissues and reduces visibility of BV beneath.
How do we establish that the white lesion is hereditary keratosis and not frictional keratosis? (4)
lesions present in the sulcus - this area is hard to traumatise
Starts in
childhood and occurs initially in the posteriorly mouth
- Moves anteriorly and into the sulcus over time
Characteristically seen within multiple family members
What is idiopathic keratosis?
A biopsied Keratosis with a defined margin, a non-concerning appearance and with no obvious aetiological cause
What causes idiopathic keratosis?
When genetic programming within cells switches to overproduce keratin (more than what cells in this area would normally produce)
Describe hairy leukoplakia?
What causes this?
Elongation of the papillae on the tongue and thickening of the surface from the incorporation of the Epstein bar virus into the genetic code of the cells which causes them to reproduce at a faster rate and to reproduce with more keratin.