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

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

1
Q

What are the different layers of the normal mucosa?

A

Stratisfied squamous epithelium
Lamina propria
Sub-mucosa = fat/adipose tissue
Skeletal muscle

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2
Q

What type of mucosa is the gingivae?

A

Masticatory

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3
Q

What is the mucogingival junction?

A

Line between masticatory and lining mucosa

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4
Q

Does parakeratin have nuclei?

A

Yes

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5
Q

Does ortho keratin have nuclei?

A

No

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6
Q

What is the role of basal cells?

A

Differentiate to form the cells above (cells in prickle cell layer)

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7
Q

What are the qualities of masticatory mucosa?

A

Firmly fixed to underlying bone
Mucoperiosteum
Resists stressed and strains (when eating)

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8
Q

What are examples of lining mucosa?

A

Soft palate

Buccal mucosa

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9
Q

What is the difference between buccal mucosa and hard palate?

A

Buccal mucosa has no keratin, thicker epithelium
No granular layer as not forming keratin
Significant submucosa

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10
Q

What is an example of special mucosa?

A

Dorsum of tongue

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11
Q

What are the 4 types of papillae?

A

Filiform - most numerous
Fungiform - larger
Foliate - posterior lateral of tongue - can get caught by molars and molars and become hyperplastic
circumvalate

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12
Q

What are the functions of specialised mucosa?

A

Taste buds: foliate, fungiform, circum

Abrasion - filiform

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13
Q

Who is leukoedema most commonly found in?

A

Afro-carribean

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14
Q

How can you differentiate leukoedema clinically?

A

If stretch the cheek it will disappear

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15
Q

Differentials for leukoedema?

A

White sponge naevus - thicker and present from birth
Chronic cheek biting (frictional keratosis)
Lichen planus - sore and lacey white lines

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16
Q

What is the halo formed of in geographic tongue?

A

Keratin

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17
Q

Differentials for geographic tongue?

A

Lichen planus

Frictional keratosis

18
Q

What is geographic tongue?

A

islands of erythema with white borders
Asymptomatic or mild soreness
Aggravating factors

19
Q

What are fordyce spots?

A

White or yellows speckling
Asymptomatic
Ectopic sebaceous glands
As get older, become more prominent

20
Q

What is the aetiology of white sponge naevus

A

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

21
Q

What is the clincal presentation of white sponge naevus

A 
Bilateral
Cheeka and floor of mouth
Thick white folds, wrinkled 'ebbing tide' 
Grooves and variation in thickness
presents in childhood
22
Q

What is the histological presentation white sponge naevus?

A

Acanthosis - increased thickness of the prickle cell layer
Parakeratin (with nuclei)
Un-inflamed

23
Q

Differential diagnosis for white sponge naevus

A

Lichen planus - causes burning with acidic food
Lichenoid drug reactions - new drug
Chronic cheek biting - only buccal mucosa
Leukoedema

24
Q

Age changes in oral mucosa

A

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

25
Q

What are examples of mechanical, chemical and physical examples of trauma to oral mucosa

A

mechanical - from dentures, teeth, ortho appliances, surgical wounds
Chemical - burns: aspirin, allergic response to dental materials
Physical - extremes of hot and cold; irradiation

26
Q

What are the responses to oral mucosa trauma?

A

Epithelial changes

Connective tissue changes

27
Q

What are the causes of traumatic ulceration?

A

Trauma from dentures
Teeth
Chemical burns
Irradiation for malignancy

28
Q

What is atrophy?

A

A reduction in thickness of epithelium due to loss of cells

29
Q

What is hyperplasia?

A

Overgrowth of connective tissue

30
Q

What are specific examples of trauma affecting the oral mucosa?

A

Frictional keratosis
Stomatitis nicotine
Papillary hyperplasia of palate
Chemical burns

31
Q

What is frictional keratosis caused by?

A

continual trauma

32
Q

How would you diagnose frictional keratosis?

A

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

33
Q

What is a differential for frictional keratosis and why is it important?

A

Leukoplakia - white patch of unknown cause, increased risk of malignant change

34
Q

How would you manage the white patch if dont know the cause?

A

Biopsy - incisional to establish diagnosis

35
Q

Where is stomatitis nicotine found?

A

palate in pipe and cigar smokers
Epithelium responds to chemical and heat from cigars
Salivary glands become inflamed

36
Q

What is papillary hyperplasia of the palate?

A

Symptomless erythematous overgrowth of mucosa

Corresponds to outline of the denture

37
Q

What is the management for papillary hyperplasia of the palate?

A

Excision of papillary projections for advanced cases

Not pre-malignant

38
Q

What are the factors influencing healing?

A

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

39
Q

Primary intention

A

Incisional biopsy
Big biopsy or small biopsy will heal just as quickly
Put together with suture

40
Q

Secondary intention

A

Gingivectomy
Tooth extraction socket
Blood clot heals the socket

41
Q

Example of a foreign body affecting healing

A

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

Oral disease (3 decks)

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