OM - oral mucosal diseases

Question 1

List the cells present in the oral mucosa. (4)

Answer 1

1. stratified squamous epithelium
2. lamina propria: connective tissue of the mucous membranes
3. Different epithelial linings dependant on the function of the tissue;
   - Masticatory with keratinisation
   - Non-keratinised squamous epithelium
   - gustatory
4. microscopic
   - non-keratinised
   - keratinised
   orthokeratosis (gingivae or palate) or parakeratosis (alterations to the standard mucosal type i.e. lichen planus)

Question 2

List the layers of the strata and compartments. (4)

Answer 2

at top - stratum corneum
granulosum
spinosum
basal

Question 3

Where does cell division occur in the mucosa?

Answer 3

the basal and supra basal cells

Question 4

What region of the mucosa contains blood vessels?

Answer 4

lamina propria

Question 5

What region of the mucosa are epithelial progenitor cells (stem cells) found?

Answer 5

basement membrane

Question 6

What can mitosis or further division that occurs beyond the basal layer suggest?

Answer 6

Dysplastic changes

Question 7

What is keratosis ?

Answer 7

• Reactive change in non-keratinised site

Question 8

What is acanthosis?

Answer 8

Hyperplasia/ reactive change of stratum spinosum

Question 9

What is elongation of the rate ridges?

Answer 9

hyperplasia/reactive change of basal cells

Question 10

Define atrophy.

Answer 10

reduction in viable layers

Question 11

Define erosion.

Answer 11

partial thickness loss (from disease)

Question 12

Define ulceration.

Answer 12

lost epithelium centrally (??) with fibrin on surface

Question 13

Define oedema.

Answer 13

watery fluid collecting either intracellular: within epithelium or intercellular: between cells (spongiosis)

Question 14

Define blistering.

Answer 14

A vesicle or bulla

Collections of fluid within or just below the epithelial cells

Question 15

What nutritional deficiencies can cause loss of papillae on the tongue (smooth tongue)?

Answer 15

iron or B group vitamins

Question 16

What are the effects of age on the mucosa?

Answer 16

Progressive mucosal atrophy;
Mucosa should appear as normal clinically, however be thinner when viewed microscopically
If there are abnormalities seen clinically, these should be investigated as normal

Question 17

What are the effects of nutritional deficiency? (2)

Answer 17

• Atrophy = loss of papillae
• predisposes to infections such as candida etc

Question 18

What is geographic tongue?

Answer 18

Disorder of maturation: Alteration to the maturation and replacement of normal epithelial surface

Question 19

Describe what occurs in geographic tongue. (begin mucosal condition)

Answer 19

Starts with replication being stopped temporarily = thinning of this area and redness from the blood vessels showing through and then replication restarts and the appearance returns to normal.

Question 20

What are the symptoms of geographic tongue? (benign mucosal condition) (4)

Answer 20

• Sensitive with acidic/spicy foods
• Intermittent flare ups (Lasts about 1 week and then gets better)
• Much worse in young children
• None

Question 21

What other disorders can cause the same symptoms as geographic tongue?(3)

Answer 21

• Haematinic deficiency (B12, Folate, Ferritin)
• Parafunctional trauma
• Dysaesthesia

Question 22

What is the treatment for geographic tongue? (benign mucosal condition)

Answer 22

None – simply management

Problems occur with the sensitivity & not the disorder itself;
- Advise patients to eat what makes them comfortable during these flareups until it settles

Question 23

What is black hairy tongue? (benign mucosal condition)

Answer 23

Hyperplasia of the papillae of the tongue which stains from food/drink/CHX)
Staining can also be caused by bacteria (black pigment) but not always

Question 24

How do we manage black hairy tongue? (benign mucosal condition) (1)

Answer 24

Manage the appearance problems with;
- Remove elongated tissue from the surface of the tongue via a tongue scraper or a peach/nectarine stone (suck for an hour a day to remove the surface material)

Question 25

What causes a fissured tongue?

Answer 25

No specific reasons

Question 26

What are the symptoms of a fissured tongue? (benign mucosal condition) (3)

Answer 26

• Usually Asymptomatic
  However;
• Very deep fissures can trap food debris etc and cause local inflammation
• If px has symptoms consider if there is another disease process ongoing e.g. lichen planus or candida within the fissures

Question 27

What is glossitis? (benign mucosal condition)

Answer 27

Atrophy of the surface of the tongue

Question 28

What special investigations are required for glossitis? (benign mucosal condition) (3)

Answer 28

• Haematinics
• Fungal cultures
• biopsy?

Question 29

When do we refer swellings? (6)

Answer 29

• Symptomatic
• Abnormal overlying and surrounding mucosa
• Increasing in size (rapidly)
• ‘rubbery’ consistency
• Trauma from teeth
• Unsightly

Question 30

What swellings do we not refer? (3)

Answer 30

• Tori (mandible – lingual, maxilla – midline of palate)
• Small polyps
• Mucoceles – unless they become fixed in size

Question 31

When is a mucocele referred for intervention? (2)

Answer 31

When it is;
fixed
growing in size

Question 32

What habits are tori associated with?

Answer 32

Parafucntional clenching habits - commonly present in those with TMD symptoms

Question 33

When would mandibular tori be considered a risk factor and why? (2)

Answer 33

Those starting/on bisphosphonates

• more likely to have avascular necrosis of the mucosa over the tori than in other areas of the mandible (blood supply to the mucosa from bone and periosteum rather than the blood supply for head and neck)

Question 34

What is a pyogenic granuloma?

Answer 34

Granulation tissue – mixed inflammatory infiltrate on fibro-vascular background

No epithelial surface.

Question 35

What causes pyogenic granulomas?

Answer 35

response to trauma