Oral mucosa Flashcards
What are the layers of the buccal (lining) mucosa?
No keratin Stratified squamous epithelium Prickel cell layer and basal cell layer - Lamina dura - Sub-mucosa - fat - Skeletal muscle e.g. buccinator from cheek
Gingiva and hard palate mucosa type?
Masticatory mucosa
- pale pink mucosa
Uvula, floor of mouth, buccal mucosa and soft palate mucosa type?
Lining mucosa
Tongue mucosa type?
Gustatory or specialised mucosa
What are the two mucosas above the teeth?
junction of masticatory (pale mucosa) and lining mucosa (darker gingivae) = mucogingival junction
What are the layers of masticatory mucosa - hard palate?
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
Masticatory mucosa features?
Firmly fixed to underlying bone = mucoperiosteum
Resists stresses and strains
Lining mucosa features and locations?
Loose submucosa for movement
Lingual, FOM, buccal mucosa
Specialised mucosa - where is it?
Dorsal tongue
What are the types of papillae
Papilla types:
- Filiform = tongue feels rough
- Fungiform
- Foliate = posterior lateral tongue
- Circumvalate = posterior border of tongue
Layers of specialised mucosa epi?
SS epi with spikes of keratin = filiform papillae
Lamina propria
Muscle
What is the function of specialised mucosa?
Taste buds - foliate, fungiform, circumvalate
Abrasion - filiform (used in mastication)
What are the types of variations in the appearance of normal mucosa that do not need any tx?
Leukoedema
Georgraphic tongue
Fordyce spots
Leukodema appearance?
More common in afro-americans
Milky white areas, typically in buccal mucosa, often bilateral
If you stretch the cheek it will disappear
What does leukodema show histologically?
Oedema
Differential diagnosis for leukodema?
White sponge naevus = white patches are thicker
Chronic cheek biting (frictional keratosis)
Lichen planus
Geographic tongue (erythema migrans)
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
Geographic tongue differential diagnosis?
Lichen planus
Frictional keratosis - doesnt usually affect dorsal tongue
Fordyce spots features?
White or yellow speckling Asymptomatic Ectopic sebaceous glands Common and easily diagnosed Get more prominent when older
White sponge naevus features?
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
Why be more vary with red and white patches in the floor of the mouth?
Common site for dysplasia and oral squamous cell carcinoma
What does white sponge naevus look like histologically?
Parakeratin
Acanthosis - increased thickness prickle cell layer
Uninflamed
Differential diagnosis for white sponge naevus?
Lichen planus - usually symptomatic, burning sensation
Lichenoid drug rxns - has pt started new drug? Usually have redness
Chronic cheek biting - buccal mucosa
Luekodema
Age changes in oral mucosa?
Thinner and smoother, atrophic
Decrease in elasticity
Prominence of fordyce spots
Varicosities ventral surface tongue = prominent veins in tongue
Mechanical trauma to oral mucosa?
From dentures, teeth, ortho appliances, surgical wounds
Chemical trauma to oral mucosa?
Burns e.g. allergic response to dental materials, aspirin
Physical trauma to oral mucosa?
Hot and cold, irradiation
Histological response of oral mucosa to changes - epithelial changes?
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
Causes of traumatic ulceration?
Dentures Teeth Chem burns Irradiation for malignancy Vit deficiencies Chrone's disease
Histological response of oral mucosa to changes - CT changes?
Hyperplasia - overgrowth of CT - full of collagen e.g. polyps
Examples of trauma affecting the oral mucosa?
Frictional keratosis
Stomatitis nicotina
Papillary hyperplasia of palate
Chemical burns
Frictional keratosis features?
White patches caused by continual trauma
Usually along the occlusal line or opposite sharp cusps, orthodontic wires or dentures
Hyperkaratosis, acanthosis, uninflamed
Diagnosis of frictional keratosis?
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
Stomatitis nicotina features? Tx?
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
Papillary hyperplasia of the palate? Tx?
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
What factors influence healing?
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
Primary and secondary intention?
Primary
- Incisional biopsy
- Big biopsy will heal just as quickly as small biopsy
Secondary
- e.g. Gingivectomy
- e.g. Tooth extraction socket healing
