Oral mucosa: normal, hereditary conditions, ageing and response to trauma Flashcards
What are the different layers of the normal mucosa?
Stratisfied squamous epithelium
Lamina propria
Sub-mucosa = fat/adipose tissue
Skeletal muscle
What type of mucosa is the gingivae?
Masticatory
What is the mucogingival junction?
Line between masticatory and lining mucosa
Does parakeratin have nuclei?
Yes
Does ortho keratin have nuclei?
No
What is the role of basal cells?
Differentiate to form the cells above (cells in prickle cell layer)
What are the qualities of masticatory mucosa?
Firmly fixed to underlying bone
Mucoperiosteum
Resists stressed and strains (when eating)
What are examples of lining mucosa?
Soft palate
Buccal mucosa
What is the difference between buccal mucosa and hard palate?
Buccal mucosa has no keratin, thicker epithelium
No granular layer as not forming keratin
Significant submucosa
What is an example of special mucosa?
Dorsum of tongue
What are the 4 types of papillae?
Filiform - most numerous
Fungiform - larger
Foliate - posterior lateral of tongue - can get caught by molars and molars and become hyperplastic
circumvalate
What are the functions of specialised mucosa?
Taste buds: foliate, fungiform, circum
Abrasion - filiform
Who is leukoedema most commonly found in?
Afro-carribean
How can you differentiate leukoedema clinically?
If stretch the cheek it will disappear
Differentials for leukoedema?
White sponge naevus - thicker and present from birth
Chronic cheek biting (frictional keratosis)
Lichen planus - sore and lacey white lines
What is the halo formed of in geographic tongue?
Keratin
Differentials for geographic tongue?
Lichen planus
Frictional keratosis
What is geographic tongue?
islands of erythema with white borders
Asymptomatic or mild soreness
Aggravating factors
What are fordyce spots?
White or yellows speckling
Asymptomatic
Ectopic sebaceous glands
As get older, become more prominent
What is the aetiology of white sponge naevus
Autosomal dominant
Family history but may skip generations
Point mutation in keratin 4 or 13 genes
What is the clincal presentation of white sponge naevus
Bilateral Cheeka and floor of mouth Thick white folds, wrinkled 'ebbing tide' Grooves and variation in thickness presents in childhood
What is the histological presentation white sponge naevus?
Acanthosis - increased thickness of the prickle cell layer
Parakeratin (with nuclei)
Un-inflamed
Differential diagnosis for white sponge naevus
Lichen planus - causes burning with acidic food
Lichenoid drug reactions - new drug
Chronic cheek biting - only buccal mucosa
Leukoedema
Age changes in oral mucosa
Mucosa may appear atrophic and smoother
Decrease in elasticity
Prominence of Fordyce spots - buccal mucosa
Varicosities ventral surface tongue
Mucosa thinned - veins more prominent with age
What are examples of mechanical, chemical and physical examples of trauma to oral mucosa
mechanical - from dentures, teeth, ortho appliances, surgical wounds
Chemical - burns: aspirin, allergic response to dental materials
Physical - extremes of hot and cold; irradiation
What are the responses to oral mucosa trauma?
Epithelial changes
Connective tissue changes
What are the causes of traumatic ulceration?
Trauma from dentures
Teeth
Chemical burns
Irradiation for malignancy
What is atrophy?
A reduction in thickness of epithelium due to loss of cells
What is hyperplasia?
Overgrowth of connective tissue
What are specific examples of trauma affecting the oral mucosa?
Frictional keratosis
Stomatitis nicotine
Papillary hyperplasia of palate
Chemical burns
What is frictional keratosis caused by?
continual trauma
How would you diagnose frictional keratosis?
must be able to demonstrate lesion caused by trauma.
When remove the cause the lesion should regress
If not then consider other white lesions in differential
What is a differential for frictional keratosis and why is it important?
Leukoplakia - white patch of unknown cause, increased risk of malignant change
How would you manage the white patch if dont know the cause?
Biopsy - incisional to establish diagnosis
Where is stomatitis nicotine found?
palate in pipe and cigar smokers
Epithelium responds to chemical and heat from cigars
Salivary glands become inflamed
What is papillary hyperplasia of the palate?
Symptomless erythematous overgrowth of mucosa
Corresponds to outline of the denture
What is the management for papillary hyperplasia of the palate?
Excision of papillary projections for advanced cases
Not pre-malignant
What are the factors influencing healing?
Primary or secondary intention - wounds closely opposed heal faster
Foreign Body - acts as a focus for infection and delays healing
Vascular supply
Nutritional deficiencies - vit C
Irradiation - reduces blood supply, osteomyelitis/osteoradionecrosis
Malignancy - failure of something to heal
Infection - reduces healing capacity
Poor immune response - leukaemia, diabetes, immunosuppression - steroids
Primary intention
Incisional biopsy
Big biopsy or small biopsy will heal just as quickly
Put together with suture
Secondary intention
Gingivectomy
Tooth extraction socket
Blood clot heals the socket
Example of a foreign body affecting healing
bone left in after tooth taken out
Need to irrigate socket or will frustrate healing
Get lots of neutrophils =pus
and bigger cells = osteoclasts
Need to remove the bone causing the problem
