Oral Mucosa: normal, ageing, hereditary conditions & response to trauma Flashcards
What are the normal layers of lining mucosa?
Epithelium
Lamina Propria
Sub-mucosa
Skeletal muscle
give 2 examples of masticatory mucosa in the mouth
Hard palate
Gingivae
give 2 examples of lining mucosa in the mouth
soft palate
uvula
buccal mucosa
etc
what type of epithelium is the tongue?
specialised epithelium
what is the name for mucosa fixed to bone
Mucoperiosteum
what is the difference in epithelium between the masticatory and lining mucosa?
lining mucosa is non-keratinised
masticatory mucosa has orthokeratin on top of prickle cell layer
what are the 4 types of papillae on dorsum of tongue?
-filiform
-fungiform
-foliate
-circumvalate
what are the functions of the specialised mucosa of the tongue?
Multiple functions:
-taste buds-foliate,fungiform
-abrasion-filiform (outbursts of keratin)
what is leukoedema?
Leukoedema is an asymptomatic, whitish or. whitish-gray edematous lesion of the oral mucosa.
variation of normal mucosa
what could also be included in the differential diagnosis of leukoedema and how can you tell if it is or not?
Differential Diagnosis: (none of these will disappear on stretching)
* White sponge naevus
* Chronic cheek biting (frictional keratosis)
* Lichen planus
leukoedema will disappear on stretching
what is geographic tongue?
- Islands of erythema with white borders
It is also called erythema migrans as the red patches migrate around the tongue
it is a variation of normal mucosa
what are the symptoms associated with geographic tongue?
- Asymptomatic or mild soreness
- Aggravating factors
what would be included in differential diagnosis of geographic tongue?
Differential diagnosis:
* If classic appearance, dx can be made clinically
* Lichen planus
* Frictional keratosis
what is a fordyce spot?
- Ectopic sebaceous glands – no function in the oral cavity
- can have White or yellow speckling
- Asymptomatic
it is a variation of normal mucosa
- Common & easily diagnosed – just record in the notes no tx
what are the genetic association of white spongey naevus?
Hereditary condition:
* Autosomal dominant
* Family history but may skip generations
* Point mutation in keratin 4/or 13 genes
life long
what are the clinical signs of white spongey naevus?
- Bilateral
- seen on cheeks and floor of mouth
- Thick white folds, wrinkled, ‘ebbing tide’
- Life long
- May affect other mucosal sites
- Wont rub away and won’t disappear with stretching – probably been there since birth
explain the histological features of white spongey naevus?
- has acanthosis - increased thickness of prickle cell layer
- it is uninflamed
- has parakeratin on surface
what could be included in differential diagnosis of white spongey naevus?
Differential Diagnosis:
* Lichen planus – unlikely as tends to be painful
* Lichenoid drug reactions
* Chronic cheek biting
* Leukoedema
Name 4 age related changes that happen to oral mucosa
Age Changes in Oral Mucosa:
* Mucosa may appear atrophic (thinner) & smoother
* Decrease in elasticity
* Prominence of Fordyce Spots
* Varicosities ventral surface tongue
name epithelial and connective tissue changed to trauma
EPITHELIAL - ulceration
- keratosis
- hyperkeratosis
- hyperplasia
- atrophy - not common
CONNECTIVE TISSUE - hyperplasia eg polyps
give 4 examples of reasons for trauma related ulcers
- Trauma from dentures
- Teeth
- Chemical burns
- Irradiation for malignancy
- These are common ones there are many more – common exam Q – eg chrons disease (covered in other lectures)
what is frictional keratosis?
- White patch caused by continual trauma.
- Usually along the occlusal line or opposite sharp cusps, orthodontic wires or dentures.
give the features of frictional keratosis histologically?
hyperkeratosis
acanthosis of epithelium
unimflammed connective tissue
how is frictional keratosis diagnosed?
Diagnosis:
* Must be able to demonstrate lesion caused by trauma.
* Remove cause and lesion should regress
* If not then must consider other white lesions in differential diagnosis
