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BDS4 Oral Medicine > Oral Mucosal Changes > Flashcards

Oral Mucosal Changes Flashcards

1
Q

What are 5 causes of white lesions?

A

Hereditary
Smoking/Frictional
Lichen Plans
Candidal Leukoplakia
Carcinoma

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2
Q

What is oral white sponge nevus?

A

This is a lesion that has genetic changes in cytokeratins in mouth resulting in white lesion

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3
Q

What is a smoking/frictional white lesion?

A

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)

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4
Q

What can cause lichen plans?

A

Lupus
GVHD - there is acanthuses - thickening of ep layers which reduces visibility of BVs so reduced pinkness

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5
Q

What is candid leukoplakia?

A

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

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6
Q

Why can a carcinoma produce a white lesion?

A

Thickness of cells as the proliferate increases - blood vessels less visible

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7
Q

Why does oral mucosa have pink/red colour?

A

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

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8
Q

Why are white lesions white? 2

A

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

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9
Q

Why do tissues blanch when using LA?

A

LA causes vasoconstriction so there is less blood flow through th CT and the area as a result becomes whiter

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10
Q

What is leukoplakia?

A

White patch/lesion that cant be explained - there is no histopathological explanation and no malignancy

IT IS A CLINICAL DESCRIPTION

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11
Q

Can leukoplakia be rubbed off?

A

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

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12
Q

How many leukoplakia become malignant?

A

1-5% - not all leukoplakia become malignant - it is a white patch with no other cause

1% is acceptable value

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13
Q

How can we describe leukoplakia as a dx?

A

Dx of exclusion

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14
Q

Can leukoplakia be sued to describe white lesion due to hyperkeratosis?

A

NO - as leukoplakia is dx of exclusion - theres no known cause for it

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15
Q

What are fordyces spots?

A

These are ectopic sebaceous glands that are seen mostly on buccal mucosa and lips - there are benign oral structures with no malignant potential

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16
Q

What is frictional keratosis?

A

This is white lesion due to traumatic source such as parafuntional clencher

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17
Q

What can parafucntional habits such as clenching lead to?

A

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

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18
Q

What is a smokers keratosis?

A

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)

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19
Q

How are melanin and trauma related?

A

IN trauma melanocytes can repeatedly produce melanin resulting in melanin pigment on the mucosa known as melanosis

20
Q

IS smokers keratosis a high risk lesion?

A

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

21
Q

What is hereditary keratosis?

A

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

22
Q

What is a hereditary keratosis known as?

A

White sponge navus

23
Q

Why is the mucosa white in hereditary keratosis?

A

This is because fluid accumulates between epithelial cells making it harder to visualise underlying BVs so lesion appears white

24
Q

If a white lesion was likely malignant what would we see?

A

Inflammatory process surrounding lesion - erythematous halo

25
Q

What is a sign a white lesion is less worrying?

A

Clearly defined margins, regular, normal mucosal covering

26
Q

What is idiopathic keratosis?

A

This is a white lesion with no obvious cause for keratosis but under microscope there is keratin increase

27
Q

What are some provisional dx for white lesions on the gingival margin?

A

Idiopathic - unknown cause
Trauma
Nail biting habit or toothbrush onto lesion

28
Q

What can a chemical burn of mucosa present as?

A

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

29
Q

What do acids do to mucosa?

A

They cause coagulation of proteins which damage the epithelial surface

30
Q

What type of white lesions can we see on tongue?

A

Traumatic keratosis - from incisal edge of teeth rubbing
simple idiopathic keratosis - keratin but no obvious cause for lesion

hairy leukoplakia

31
Q

What is hairy leukoplakia?

A

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

32
Q

What is an infective reason for white lesion?

A

Infectiev candidiasis

33
Q

what are the four types of oral candidiasis?

A

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)

34
Q

What is thrush also known as?

A

Acute pseudomembranous candidiasis

35
Q

What are 3 features of acute pseudomembranous candidiasis?

A

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

36
Q

Presidposing factors for acute pseudomembranous candidiasis?

A

HIV
diabetes
inhaler user

37
Q

What is acute erythematous candidiasis?

A

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)

38
Q

What is chronic hyperplastic candidosis?

A

White patch that can’t be rubbed off -, can occur in angle of mouth

39
Q

WHat is chronic denture stomatitis known as?

A

Chronic atrophic candidiasis - common in pts who wear dentures have poor OH and can see outline of denture (red raw)

40
Q

What is angular chelitis?

A

This is fissuring at oral commissures often due to intra oral candida infection - can be due to decreased OVD in denture pts

41
Q

Why can herpes simplex virus produce white lesions?

A

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

42
Q

What is the overall rule for white lesions?

A

Most are benign - 1% become malignant - if theres no obvious need for referral dont refer

43
Q

When might we consider referral for white lesion?

A

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

44
Q

What is the importance of an inflammatory margin in white lesions?

A

If there is an inflammaoty margin be more inclined to refer as there is process occurring leading to inflammation surrounding lesion

45
Q

What areas might we refer if we see white lesion?

A

Borders of tongue with no parafunctonal habits
FOM - no obvious trama
Soft palate area

BDS4 Oral Medicine (12 decks)

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