Oral Mucosal Colour Changes Flashcards
What are the causes of white oral lesions?
Hereditary- oral white sponge Naevus (genetic changes to cytokeratins)
Frictional- thickening of keratin layer, obstructs view to blood vessels giving more white appearance
Lichen planus- acanthosis (reduces visibility of vessels)
Candidal leukoplakia- inflammation within epithelium and connective tissue, thickness and fluid builds up reducing visibility of vessel
Carcinoma- thickening of cells
What conditions is lichen planus associated with
Lupus erythematosus
Graft versus host disease
What causes lesions to appear white?
Thickening of the mucosa or keratin
-> Less visibility of blood/vessels
Less blood in the tissues
-> vasoconstrictor effect- slowing of blood passage through connective tissue
What is leukoplakia?
A white patch which cannot be scraped off or attributed to any other cause
-> descriptor/diagnosis of exclusion
What is the risk of leukoplakia becoming malignant?
1-5%
-> risk is based on aetiology of white patch
What are fordyce’s spots?
Ectopic sebaceous glands
-> Benign and normal
What habit is associated with frictional keratosis?
Parafunctional clenching- pulling buccal mucosa in which rubs against cusps of teeth causing keratotic thickening and lack of view of blood flow (white appearance)
What causes smokers keratosis, what are its features?
Trauma caused by thermal gases
Thickening of tissues
mucosa remains normal but sometimes as a result of trauma, melanocytes over produce melanin (pigmentation changed- melanosis)
Malignant conversion potential is low (but general risk is higher due to smoking)
What are the features of White Sponge Naevus?
Starts in childhood in posterior of mouth then spreads forward
Familial
Not caused by trauma
What causes the appearance of WSN?
Fluid accumulates between epithelial cells in the superficial layers- increases opacity of tissue and disrupts visualisation of blood vessels
What would be the general features of a non-worrying oral lesion?
White lesions
Well defined (no inflammation surrounding)
Covering normal mucosa
What is idiopathic keratosis?
Occurs without obvious cause (genetic programming switches to produce more keratin)
-> still biopsy to confirm
How does desquamative gingivitis present?
Lichen planus areas- white, with areas of thinning- red vascular appearance
Why is biopsy of the gingival margin an issue?
Difficult- chance of ischaemia and tissue death (done by specialist)
What occurs as a result of a chemical burn in the oral cavity?
Coagulation of protein and damage to epithelial surface
What medications are associated with causing chemical burns?
Can happen with aspirin or alendronic acid (can be seen if patient has reduced cognitive function and does not swallow tablets)
Which habit is associated with traumatic keratosis?
Tongue thrusting
What happens as a result of hairy leukoplakia, what causes this?
Elongation on papillae on side of tongue and thickening of surface
-> Due to incorporation of Epstein bar virus into genetic code of the cell causing them to reproduce at faster rate and produce more keratin rich appearance
What are the types of lesions associated with candida?
Pseudomembranous Acute (thrush)
Denture Associated - Chronic due to prolonged contact (erythematous)
What does pseudomebraneous mean?
Not part of or adhering to mucosa (can be rubbed off)
How do lesions caused by HSV present in the mouth?
As intra-epithelial vesicles (disrupt view of BVs)
-> Loses white appearance on bursting
When should a white lesion be referred by a dentist?
If RED and WHITE- concentrate on the RED part
If the lesion is becoming more raised and thickened
If the lesion is ‘without cause’- esp in lateral tongue, anterior floor of mouth, soft palate area
-> most are benign and kept under review by dentist only
What are the caused of the red appearance of some lesions?
Blood flow increases
-> Inflammation
-> Dysplasia causing increased vascularity (can become malignant)
Reduced thickness of the epithelium
What are the features of geographic tongue?
White margins with areas of erythema
-> Changes in a few weeks or may resolve
What causes red lesions to present under dentures?
If candida present due to poor denture hygiene
-> Can appear in certain areas only in older dentures if bone has resorbed in certain sections meaning only certain parts of mucosa are in contact
What is erythroplakia?
A red patch which cannot be attributed to any other cause
-> Atrophic or non-keratotic end of the spectrum
-> More of a concern for malignancy than leukoplakia
What are the causes of red/blue lesions?
Fluid in the connective tissue:
Dark – slow moving blood in large vessels
-> varicosities, veins or cavernous haemangioma
Light Blue – clear fluid
-> presence of saliva (mucocele)/lymph (Lymphangioma) within
How do normal haemangiomas look?
More red due to presence of more capillaries
How can vascular lesions be distinguished from malignancy?
Vascular- tend to fluctuate in size
Malignancy- only increases
What cause lymphangioma?
Proliferation of fluid filled spaces
-> common in tongue
-> most are cavernous and appear like cavernous haemagiomas
What does vasculitis cause?
Alteration of blood flow to tissues
What are the different types of vasculitic disease?
Large vessel Disease:
Giant cell (temporal) arteritis
Medium Vessel Disease:
Polyarteritis nodosa
Kawasaki disease
Small vessel Disease:
Granulomatosis with Polyangiitis
What are the causes of pigmented lesions?
Exogenous-
-> Stain from tea, coffee, chlorhexidine
-> Bacterial overgrowth
Intrinsic Pigmentation
-> Reactive Melanosis/melanotic macule- freckles
-> Melanocytic naevus
-> Melanoma
-> Effect of systemic disease, paraneoplastic phenomenon
Intrinsic foreign body
-> metals – amalgam, arsenic
What is melanoma?
Malignant change within melanocyte
-> can be pigment free
-> may be on face, hands or neck rather than the mouth
What are the causes of localised black/brown lesions?
Amalgam tattoos
Melanotic Macule
Melanotic naevus
Malignant Melanoma
Peutz-Jehger’s syndrome
Pigmentary incontinence
Kaposi’s sarcoma
What are the causes of localised black/brown lesions?
Racial/familial
Smoking
Drugs- Contraceptive pill/tetracycline/newer biologics
Addison’s disease
-> Raised ACTH conditions
What does ACTH do to cause generalised black/brown lesions?
More stimulation of melanocytes, more melanin and pigmentation of skin and mucosa
What should be done if patient suspected to have raised ACTH as result of Addison’s?
Check BP and electrolytes
When should oral pigmentation be referred?
If increasing in size, colour or quantity
If related to new systemic disorder
What are the signs of Melanoma?
Variable pigmentation
Irregular outline
Raised surface
Symptomatic- Itch/bleed
What are the causes of mucosal inflammation
trauma- physical or chemical
infection- viral, bacterial or fungal
immunological
What are biopsies used for?
Identifying/excluding malignancy
Identifying dysplasia
Identify other disease- lichen planus
-> All unexplained white, red, pigmented patches
What cases should be referred to oral med?
Patients with abnormal and/or unexplained changes to the oral mucosa
-> Practitioner threshold will vary with experience
If there is concern about dysplasia risk:
Appearance of lesion
Risk site
Risk behavior
Family history
What should not be referred to OM?
Asymptomatic VARIATIONS of NORMAL mucosa
Benign conditions the practitioner has diagnosed that:
Are asymptomatic
Do not have potentially malignant risk
For which there is no treatment
What should you do if you are unsure whether to refer to OM?
Monitor area until next check up
Send photos to OM and discuss with specialist
