Oral Mucosa Diseases Flashcards
when should a mucosal lesion be referred to oral medicine for an opinion
- Anything the dentist thinks might be cancer or dysplasia
○ NICE and SIGN head and neck cancer guidelines - Any SYMPTOMATIC lesion that has not responded to standard treatment
○ Hospital referral criteria
○ SDCEP guidance - Any BENIGN lesion the patient can’t be persuaded is not cancer…
In these circumstances it is acceptable for the dentist to make a referral to the oral medicine clinic
what is the pathway for actual mucosal malginancies
○ 2 week cancer referral pathway for actual malignancies
§ Anything the dentist suspects is cancer should not go to the oral medicine department
§ All potential oral cancer lesions should be seen within 2 weeks of referral by the specialist cancer team
should a photo of the lesion be sent along with the referral
○ Send photographs of the lesion along with the referral
○ Or if possible the dentist should have a discussion with the consultant with a photograph before even making the referral
should the GDP still refer a lesion to oral med specialists if they know what it is (eg lichen planus) but the lesion is not responding to treatment / the patient has had no relief
○ In this case the dentist might be very aware that the lesion is for example lichen planus but having followed SDCEP guidance for the management of this lesion and the patient is not experiencing adequate relief it is perfectly reasonably for a referral to the hospital service
what sort of epithelium is oral mucosa
= Stratified squamous epithelium
lamina propria
what types of linings are present in oral mucosa epithelium
Masticatory (With keratinisation)
Gustatory
how does oral mucosa appear on a microscopic level in terms of keratin
○ Non-keratinised
○ Keratinised
what are the 2 types of keratinised oral mucosa
§ Orthokeratosis
□ Normally found in areas such as the gingiva and the palate where trauma is expected
§ or parakeratosis
□ Usually found where the keratin change is as a result of alterations to the standard mucosal type
So for example this might be seen in conditions such as lichen planus
is the cheek keratinised or non-keratinised
non-keratinised
is the palate keratinised or non-keratinised
keratinised
where does cell division occur
Cell division in basal and suprabasal cells ONLY
where are the blood vessels in the layers of epithlium
in the lamina propria
what are the names of the cells in the basement membrane
epithelial progenitor cells which are effectively stem cells
how does cell division occur in the basement membrane
the epithelial progenitor cells which are effectively stem cells
Then these cells offshoot mature and progress up through the epithelium in a fairly ordered manner but gradually losing the purple staining suggesting that it is losing the cell organelles as you move towards the surface
Eventually all that is left is the cell wall which becomes the flattened keratin of the surface
where should division only be seen
So division should only be seen in the lower level of the epithelium
Any mitosis or cell division happening further up will be part of a change which could be dysplastic
