oral mucosal colour changes

Question 1

reasons for oral white lesions

Answer 1

hereditary
smoking/frictional
lichen planus
candida leukoplakia
carcinoma

Question 2

hereditary white lesion

Answer 2

oral white sponge navus
produces characteristic mucosa which is related to genetic changes to cytokeratin’s in the mouth

Question 3

how does smoking cause white lesions

Answer 3

irritation to mucosal surface causing thickening of keratin layer on surface which obtructs view to blood vessels on the tissues so makes mucosal appearance less pink and more white

Question 4

cause of lichen planus

Answer 4

lupus erythematous
GVHD

Question 5

how does lichen planus cause white lesion

Answer 5

associated with acanthosis which is thickening of epithelial layers reducing visibility to epithelial blood flow reducing pinkness and increased whiteness of mucosa

Question 6

how does candida leukoplakia cause white lesions

Answer 6

candida cause a lot of inflammation within epithelium and surrounding tissue and this inflammation causes fluid to accumulate in epithelium reducing blood flow visibility

Question 7

how does carcinoma appear white

Answer 7

thickening of cells as these are proliferating in an uncontrolled manner making blood flow appearance through tissues less

Question 8

why are white lesions white

Answer 8

thickening of mucosa or keratin layer
less blood in tissues

Question 9

what is leukplakia

Answer 9

a white patch which cannot be scraped off or attributed to any other cause
white lesions that is not otherwise explained

Question 10

does leukoplakia have a histopathological connotation

Answer 10

no, it is a clinical description

Question 11

what are Fordyces spots

Answer 11

ectopic sebaceous glands
usually in the buccal mucosa or on the lips
benign and normal structures

Question 12

what causes frictional keratosis

Answer 12

traumatic source usually
e.g. clenching habit and the clenching pulls buccal mucosa in with the buccinator muscle contraction so cusp edges rub against the mucosa which causes reactive thickening of mucosa = keratotic thickening

Question 13

what is smoker’s keratosis

Answer 13

trauma from thermal gases
reactive change again

Question 14

what colour is smokers keratotis

Answer 14

white
keratosis is thickening of the mucosa so harder to see blood flow through CT

Question 15

how much more likely are smokers to get leukoplakia

Answer 15

6x more

Question 16

how does trauma to the mucosa cause melanin pigment to be seen histologically

Answer 16

melanocytes overproduce melanin from the trauma

Question 17

what is the malignant potential of smokers keratosis lesion

Answer 17

low risk of the lesion
but higher risk of oral cancer overall because pt is a smoker

Question 18

what is hereditary keratosis

Answer 18

not a traumatic keratosis
start posterior in mouth and spread anteriorly in buccal mucosa up and down into sulcus
genetic factors

Question 19

what does hereditary keratosis look like

Answer 19

white sponge appearance caused by fluid accumulating between the epithelial cells in superficial layer and fluid is making it difficult to see through so can’t see blood vessels, so area more white appearing

Question 20

if pt has a malignancy associated with a lesion what would it look like

Answer 20

would have inflammatory process surrounding it
if there is normal mucosa around a lesion that is less worrying

Question 21

why does idiopathic keratosis happen

Answer 21

not for any reason
genetic programming in the cell switches to produce more keratin than usual in this area

Question 22

why is taking biopsy of gingival margin hard

Answer 22

could be a pocket which then means if you biopsy there it would make the gingiva non-viable and then could turn necrotic and die off and you would lose the gingival margin

Question 23

how does chemical burn happen

Answer 23

acidic substance (tablet) held in contact with mucosa causing coagulation of the proteins and damage to the epithelial surface

Question 24

how does hairy leukoplakia happen on tongue

Answer 24

elongation of papilla on side of tongue and thickening of surface due to incorporation of EBV into the genetic code of cells causing them to reproduce at a faster rate

Question 25

what is another name for pseudomembranous candidiasis

Answer 25

thrush

Question 26

what is oral thrush

Answer 26

white lesions all over the soft palate and uvula
can be scraped off
once scraped off will leave an inflammatory change and red bleeding area underneath the lesion

Question 27

what is a pseudomembrane

Answer 27

not firmly adhered to the mucosa and not part of the mucosa so can be scraped off