Oral mucosa: normal, hereditary conditions, ageing and response to trauma

Question 1

Histological layers of oral mucosa (4)

Answer 1

Epithelium
Lamina propria
Sub-mucosa
Skeletal muscle

Question 2

What are the features the masticatory mucosa? (3)

Answer 2

Firmly fixed to underlying bone
Mucoperiosteum
Resists stresses and strains

Question 3

Two examples of masticatory mucosa (2)

Answer 3

Gingiva

Hard palate

Question 4

Histological layers of hard palate (4)

Answer 4

Orthokeratin
Prickle cell layer
Basal cell layer
Lamina propria

Question 5

Examples of lining mucosa (2)

Answer 5

Soft palate

Buccal mucosa

Question 6

Histological layers of buccal mucosa (3)

Answer 6

Non-keratinised surface
Prickle cell layer
Basal cell layer

Question 7

Features of lining mucosa (3)

Answer 7

Loose mubmucosa
Movement
Lingual, FOM, buccal mucosa

Question 8

Examples of specialised mucosa (5)

Answer 8

Dorsum of tongue (4 types of papillae):

• filiform
• fungiform
• folate
• circumvalate

Question 9

Histological layers of dorsum of tongue (3)

Answer 9

Filiform papillae
Lamina propria
Muscle

Question 10

Features of specialised mucosa (2)

Answer 10

Multiple functions:

• taste buds - folate and fungiform
• abrasion - filiform

Question 11

Variations in the appearance of ‘normal’ mucosa (3)

Answer 11

Leukoedema
Geographic tongue
Fordyce spots

Question 12

What is leukoedema? (5)

Answer 12

• blue, grey or white mucosa (usually buccal)
• harmless and very common
• may be variation of normal appearance no disease but could be due to local irritation
• more common in black people and tobacco users
• clear epithelial cells

Question 13

Differential diagnosis of leukoedema (3)

Answer 13

White sponge naevus
Chronic cheek biting (frictional keratosis)
Lichen planus

Question 14

What is geographic tongue and what are the features? (6)

Answer 14

Erythema migrans
Islands of erythema with white borders
Movement
Asymptomatic or mild soreness
Aggravating factors
Common

Question 15

Differential diagnosis of geographic tongue (3)

Answer 15

If classic appearance, dx can be made clinically
Lichen planus
Frictional keratosis

Question 16

Features of fordyce spots (4)

Answer 16

White or yellow speckling
Asymptomatic
Ectopic sebaceous glands
Common and easily diagnosed

Question 17

How does one acquire white sponge naevus? (4)

Answer 17

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

Question 18

Clinical features of white sponge naevus (5)

Answer 18

Bilateral
Cheeks and floor of mouth
Thick white folds, wrinkled, 'ebbing tide'
Life long
May affect other mucosal sites

Question 19

Histological appearance of white sponge naevus (3)

Answer 19

Parakeratin
Oedematous prickle cells
Acanthosis - increased thickness prickle cell layer
Un-inflamed

Question 20

Differential diagnosis of white sponge naevus (4)

Answer 20

Lichen planus
Lichenoid drug reactions
Chronic cheek biting
Leukoedema

Question 21

Age changes in oral mucosa (4)

Answer 21

Mucosa may appear atrophic and smoother
Decrease in elasticity
Prominence of fordyce spots
Varicosities ventral surface tongue

Question 22

Types of trauma in oral mucosa (3)

Answer 22

Mechanical: from dentures, teeth, ortho appliances, surgical wounds
Chemical: burns e.g. aspiring; allergic response to dental materials
Physical: extremes of hot and cold; irridation

Question 23

Histological response of oral mucosa to trauma (2)

Answer 23

Epithelial changes
-ulceration (loss of epithelium)
CT changes

Question 24

Causes of traumatic ulceration (4)

Answer 24

Trauma from dentures
Teeth
Chemical burns
Irradiation for malignancy
*other causes such as malignancy and immunologically mediated disease

Question 25

Define atrophy (1)

Answer 25

Reduction in thickness of epithelium due to loss of cells

Question 26

Define hyperplasia (1)

Answer 26

Overgrowth of connective tissue

Question 27

Examples of trauma affecting oral mucosa (1)

Answer 27

Fictional keratosis Stomatitis nicotina Papillary hyperplasia of palate Chemical burns

Question 28

What is frictional keratosis (2)

Answer 28

White patch caused by continual trauma | Usually along oclcusal line or opposite sharp cusps, ortho wires or dentures

Question 29

Diagnosis of frictional keratosis (3)

Answer 29

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 *leukoplakia is white patch of unknown cause, increased risk of malignant change

Question 30

Management of frictional keratosis (2)

Answer 30

Biopsy - incisional to establish diagnosis

Question 31

What is stomatitis nicotina (3)

Answer 31

Palate in pipe and cigar smokers Not a pre-malignant lesion. Positive correlation between intensity of smoking and severity

Question 32

Treatment for stomatitis nicotina (3)

Answer 32

Stop or reduce smoking Lesions may disappear Regular review

Question 33

What is papillary hyperplasia of the palate (3)

Answer 33

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

Question 34

Management of papillary hyperplasia of the palate (3)

Answer 34

New dentures Excision of papillary projections for advanced cases NOT pre-malignant

Question 35

Factors influencing healing (8)

Answer 35

Primary or secondary intention: wounds closely opposed heal faster than those separated. Foreign Body: acts as a focus of infection and delays healing 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

Question 36

Primary intention examples (2)

Answer 36

-incisional biopsy -big biopsy will heal just as quickly as small biopsy

Question 37

Secondary intention examples (2)

Answer 37

- gingivectomy | - tooth extraction socket