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Oral Disease > Oral mucosa > Flashcards

Oral mucosa Flashcards

1
Q

What are the layers of the buccal (lining) mucosa?

A 
No keratin
Stratified squamous epithelium 
Prickel cell layer and basal cell layer
- Lamina dura
- Sub-mucosa - fat
- Skeletal muscle e.g. buccinator from cheek
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2
Q

Gingiva and hard palate mucosa type?

A

Masticatory mucosa

- pale pink mucosa

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3
Q

Uvula, floor of mouth, buccal mucosa and soft palate mucosa type?

A

Lining mucosa

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4
Q

Tongue mucosa type?

A

Gustatory or specialised mucosa

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5
Q

What are the two mucosas above the teeth?

A

junction of masticatory (pale mucosa) and lining mucosa (darker gingivae) = mucogingival junction

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6
Q

What are the layers of masticatory mucosa - hard palate?

A

Pink band on top = orthokeratin (no nuclei on the surface) or parakeratin (nuclei)
Epithelium is narrower (thinner)
Granular layer - prickle cell layer and then basal cell layer below
Lamina propria
Not much submucosa

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7
Q

Masticatory mucosa features?

A

Firmly fixed to underlying bone = mucoperiosteum

Resists stresses and strains

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8
Q

Lining mucosa features and locations?

A

Loose submucosa for movement

Lingual, FOM, buccal mucosa

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9
Q

Specialised mucosa - where is it?

A

Dorsal tongue

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10
Q

What are the types of papillae

A

Papilla types:

  • Filiform = tongue feels rough
  • Fungiform
  • Foliate = posterior lateral tongue
  • Circumvalate = posterior border of tongue
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11
Q

Layers of specialised mucosa epi?

A

SS epi with spikes of keratin = filiform papillae
Lamina propria
Muscle

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12
Q

What is the function of specialised mucosa?

A

Taste buds - foliate, fungiform, circumvalate

Abrasion - filiform (used in mastication)

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13
Q

What are the types of variations in the appearance of normal mucosa that do not need any tx?

A

Leukoedema
Georgraphic tongue
Fordyce spots

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14
Q

Leukodema appearance?

A

More common in afro-americans
Milky white areas, typically in buccal mucosa, often bilateral
If you stretch the cheek it will disappear

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15
Q

What does leukodema show histologically?

A

Oedema

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16
Q

Differential diagnosis for leukodema?

A

White sponge naevus = white patches are thicker
Chronic cheek biting (frictional keratosis)
Lichen planus

17
Q

Geographic tongue (erythema migrans)

A

May have symptoms with acidic or spicy foods - can prescribe difflam m/w
Affects dorsal/lingual tongue
Islands of erythema (redness) with white halo of keratin around them - can move around

18
Q

Geographic tongue differential diagnosis?

A

Lichen planus

Frictional keratosis - doesnt usually affect dorsal tongue

19
Q

Fordyce spots features?

A 
White or yellow speckling
Asymptomatic 
Ectopic sebaceous glands 
Common and easily diagnosed 
Get more prominent when older
20
Q

White sponge naevus features?

A

Hereditary - Autosomal dominant
Family history but may skip generations
Point mutation in keratin 4/or 13 genes

Bilateral 
Cheeks and floor of mouth
Thick white folds, wrinkles, ebbing tide
Does not disappear on stretching
Life long 
May affect other mucosal sites - eyes, genitals
21
Q

Why be more vary with red and white patches in the floor of the mouth?

A

Common site for dysplasia and oral squamous cell carcinoma

22
Q

What does white sponge naevus look like histologically?

A

Parakeratin
Acanthosis - increased thickness prickle cell layer
Uninflamed

23
Q

Differential diagnosis for white sponge naevus?

A

Lichen planus - usually symptomatic, burning sensation
Lichenoid drug rxns - has pt started new drug? Usually have redness
Chronic cheek biting - buccal mucosa
Luekodema

24
Q

Age changes in oral mucosa?

A

Thinner and smoother, atrophic
Decrease in elasticity
Prominence of fordyce spots
Varicosities ventral surface tongue = prominent veins in tongue

25
Q

Mechanical trauma to oral mucosa?

A

From dentures, teeth, ortho appliances, surgical wounds

26
Q

Chemical trauma to oral mucosa?

A

Burns e.g. allergic response to dental materials, aspirin

27
Q

Physical trauma to oral mucosa?

A

Hot and cold, irradiation

28
Q

Histological response of oral mucosa to changes - epithelial changes?

A

Epi changes

  • Ulceration = loss of epithelium, fibrin on top, then granulation tissue (endothelium cells forming new BVs and fibroblasts forming collagen to help healing)
  • Keratosis (if was non keratinised at first), hyperkeratosis (if keratin thickens), hyperplasia (epi can become thicker)
  • Atrophy = epi becomes thinner due to loss of cells
29
Q

Causes of traumatic ulceration?

A 
Dentures
Teeth
Chem burns
Irradiation for malignancy 
Vit deficiencies
Chrone's disease
30
Q

Histological response of oral mucosa to changes - CT changes?

A

Hyperplasia - overgrowth of CT - full of collagen e.g. polyps

31
Q

Examples of trauma affecting the oral mucosa?

A

Frictional keratosis
Stomatitis nicotina
Papillary hyperplasia of palate
Chemical burns

32
Q

Frictional keratosis features?

A

White patches caused by continual trauma
Usually along the occlusal line or opposite sharp cusps, orthodontic wires or dentures
Hyperkaratosis, acanthosis, uninflamed

33
Q

Diagnosis of frictional keratosis?

A

Demonstrate lesion caused by trauma
Remove cause and lesion should regress
If not then must consider other white lesions in differential diagnosis
Important that it is not a laukoplakia - increased risk of malignant change
Management - incisional to establish diagnosis

34
Q

Stomatitis nicotina features? Tx?

A

Palate in pipe and cigar smokers - red dots = irritated salivary glands
Not a pre-malignant lesion
Positive correlation between intensity of smoking and severity

Tx

  • Stop/reduce smoking
  • Lesions may disappear
  • Regular review
35
Q

Papillary hyperplasia of the palate? Tx?

A

Caused by ill fitting dentures - bumpy hard palate
Symptomless, erythematous overgrowth of mucosa
Corresponds to outline of denture

Tx:
New denture
Excision of papillary projections for advanced cases
NOT pre-malignant

36
Q

What factors influence healing?

A

Primary or secondary intention - wounds closely opposed heal faster than those separated
Foreign body - acts as a focus of infection and delays healing (e.g. bone/fractured root after extraction)
Vascular supply - reduced blood supply reduces healing capacity
Nutritional deficiencies - vitamin C
Irradiation - reduces blood supply
Malignancy - failure to heal e.g. non-healing tooth socket
Infection - reduces healing capacity
Poor immune response - leukaemia, diabetes, immunosuppression

37
Q

Primary and secondary intention?

A

Primary

  • Incisional biopsy
  • Big biopsy will heal just as quickly as small biopsy

Secondary

  • e.g. Gingivectomy
  • e.g. Tooth extraction socket healing

Oral Disease (42 decks)

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