Oral Mucosal Changes Flashcards
What are 5 causes of white lesions?
Hereditary
Smoking/Frictional
Lichen Plans
Candidal Leukoplakia
Carcinoma
What is oral white sponge nevus?
This is a lesion that has genetic changes in cytokeratins in mouth resulting in white lesion
What is a smoking/frictional white lesion?
This is where smoking chemicals/friction irritates the mucosal surface causing a thickening of keratin on surface of mucosa which obstructs BVs and CTs which is what provides mucosa with pink colour (less pink more white due to thickening of keratin)
What can cause lichen plans?
Lupus
GVHD - there is acanthuses - thickening of ep layers which reduces visibility of BVs so reduced pinkness
What is candid leukoplakia?
White lesions associated with candida organism and will case inflammation in epithelium and surrounding CT - the inflammation of ep allows thickness and fluid to accumulate which reduces visibility of blood flow and CT and therefore white lsion
Why can a carcinoma produce a white lesion?
Thickness of cells as the proliferate increases - blood vessels less visible
Why does oral mucosa have pink/red colour?
This is due to the underlying blood vessels in the connective tissue which can be seen through the opaque layers of the epithelium
the pink/red colour is seen less when there is thickening of the epitheliumm so we can’t see BVs as clear resulting in paler whiter mucosa
Why are white lesions white? 2
This is due to thickening of the mucosa or increase in keratin production resulting in less visibility of BVS and blood flow
or if there is less blood in the tissues such as vasoconstriction caused by LA which slows blood flow down through CT and area becomes white or pale
Why do tissues blanch when using LA?
LA causes vasoconstriction so there is less blood flow through th CT and the area as a result becomes whiter
What is leukoplakia?
White patch/lesion that cant be explained - there is no histopathological explanation and no malignancy
IT IS A CLINICAL DESCRIPTION
Can leukoplakia be rubbed off?
No its a white patch lesion with an unknown cause and no histological reason or malignancy
it can’t be rubbed off or attributed to any cause
How many leukoplakia become malignant?
1-5% - not all leukoplakia become malignant - it is a white patch with no other cause
1% is acceptable value
How can we describe leukoplakia as a dx?
Dx of exclusion
Can leukoplakia be sued to describe white lesion due to hyperkeratosis?
NO - as leukoplakia is dx of exclusion - theres no known cause for it
What are fordyces spots?
These are ectopic sebaceous glands that are seen mostly on buccal mucosa and lips - there are benign oral structures with no malignant potential
What is frictional keratosis?
This is white lesion due to traumatic source such as parafuntional clencher
What can parafucntional habits such as clenching lead to?
frictional keratosis - this is where pt clench teeth, pulls cheeks in and cusp edges rub against buccal mucosa causing a thickening of mucosa - keratin thinking resulting in less visibility of BVs in CT so white appearance
What is a smokers keratosis?
This is when there is trauma from the thermal gases in smoking which causes a reactive change known as keratosis (thickening of keratin) making BVs in CT harder to see
Thick layer of keratin forms on palate
Mucosa can appear normal besides some melanin pigment from irritation to prs mucosa (melanocytes over produce melanin)
How are melanin and trauma related?
IN trauma melanocytes can repeatedly produce melanin resulting in melanin pigment on the mucosa known as melanosis
IS smokers keratosis a high risk lesion?
White lesion in general is low risk but pt is high risk due to smoking
The area of white change is low risk for cancer but oral mucosa in general is high risk
What is hereditary keratosis?
This is a non traumatic keratosis where there is a white lesion in area that isn’t subject to trauma (for example in the sulcus with intact dentition)
It often begins posterior and spreads anterior to buccal mucosa up and down the sulcus and is seen in familie
What is a hereditary keratosis known as?
White sponge navus
Why is the mucosa white in hereditary keratosis?
This is because fluid accumulates between epithelial cells making it harder to visualise underlying BVs so lesion appears white
If a white lesion was likely malignant what would we see?
Inflammatory process surrounding lesion - erythematous halo
What is a sign a white lesion is less worrying?
Clearly defined margins, regular, normal mucosal covering
What is idiopathic keratosis?
This is a white lesion with no obvious cause for keratosis but under microscope there is keratin increase
What are some provisional dx for white lesions on the gingival margin?
Idiopathic - unknown cause
Trauma
Nail biting habit or toothbrush onto lesion
What can a chemical burn of mucosa present as?
Can present as white erosive lesion - often due to acidic substance held in contact with mucosa
aspirin - held in mucosa
alendrotnic acid - if pt doesn’t swallow properly or holds in mouth leading to chemical change
What do acids do to mucosa?
They cause coagulation of proteins which damage the epithelial surface
What type of white lesions can we see on tongue?
Traumatic keratosis - from incisal edge of teeth rubbing
simple idiopathic keratosis - keratin but no obvious cause for lesion
hairy leukoplakia
What is hairy leukoplakia?
Elongation of tongue paella on lateral border and thinking of surface due to EBV that causes cells to reproduce at a faster rate and produce more keratin
What is an infective reason for white lesion?
Infectiev candidiasis
what are the four types of oral candidiasis?
Acute pseudomembranous candidiasis (THRUSH)
Acute erythematous candidiasis
Chronic hyperplastic candidiosis
Chronic denture stomatitis
ITS A COMMON OPPORTNISTIC INFECTION IN THE ORAL CAVITY CAUSED BY OVERGROWTH OF CANDIDA SPECIES (C.Albicans)
What is thrush also known as?
Acute pseudomembranous candidiasis
What are 3 features of acute pseudomembranous candidiasis?
Produces white lesions all over the soft palate and uvula
Can be scraped/wiped off as its pseudomembranous (doesn’t firmly adhere to mucosa)
Can be removed with swab leaving inflammatory change - red, inflamed, bleeding area
Presidposing factors for acute pseudomembranous candidiasis?
HIV
diabetes
inhaler user
What is acute erythematous candidiasis?
This is when there is red appearance, pt often has burning feeling on mouth or tongue (can be seen in pts with steroid inhaler use and no rinse)
What is chronic hyperplastic candidosis?
White patch that can’t be rubbed off -, can occur in angle of mouth
WHat is chronic denture stomatitis known as?
Chronic atrophic candidiasis - common in pts who wear dentures have poor OH and can see outline of denture (red raw)
What is angular chelitis?
This is fissuring at oral commissures often due to intra oral candida infection - can be due to decreased OVD in denture pts
Why can herpes simplex virus produce white lesions?
In primary herpes virus lesions begin as white intra-oral epithelial vesicles which eventually burst resulting in breach of ep and CT exposure - no longer white appear as ulcerations
What is the overall rule for white lesions?
Most are benign - 1% become malignant - if theres no obvious need for referral dont refer
When might we consider referral for white lesion?
IF lesion is both white and red - focus on red area
if lesion is raised and thickening
if theres an inflammatory margin
if theres no known cause of lesion - lateral border of tongue with no parafucntional habit, anterior floor of mouth and no trauma or soft palate
What is the importance of an inflammatory margin in white lesions?
If there is an inflammaoty margin be more inclined to refer as there is process occurring leading to inflammation surrounding lesion
What areas might we refer if we see white lesion?
Borders of tongue with no parafunctonal habits
FOM - no obvious trama
Soft palate area
