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BDS4 Oral Medicine > Oral mucosal colour changes > Flashcards

Oral mucosal colour changes Flashcards

1
Q

What are some reasons Oral white lesions can form?

A
  • Hereditary
  • Smoking/frictional
  • Lichen Planus
    • Lupus eryhtematosus
    • GVHD
  • Candidal leukoplakia
  • Carcinoma
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2
Q

How can candidal leukoplakia cause white lesions?

A
  • Candida can cause inflammation in the epithelium and surrounding tissues
  • Inflammation will allow fluid and thickness in the epithelium , reducing blood flow to epithelium , causing whiteness
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3
Q

How does smoking/frictional cause oral white lesions?

A
  • Cause irritation to mucosal surface
  • Thicken keratin layer (acanthosis)
  • Keratin layer obstructs blood flow to keratin layer causing whiteness
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4
Q

How does a carcinoma cause oral white lesion?

A
  • Associated with thickening of cells as they are proliferating at uncontrollable manor
  • Acanthosis - whiteness
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5
Q

Why are white lesions white?

A
  • In normal mucosa lamina dura exists beneath spinosum and stratum cornea layer
  • Cells become less dense as you move up to surface allows blood vessels to be seen
  • In keratinsed tissues, the cells are denser as thickening of the mucosa or keratin occurs , tissue is less opaque therefore can’t see the blood vessels as clearly, showing whiteness instead
  • Or shows white lesions as there is less blood in the tissues due to vasoconstrictors (blanching)
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6
Q

What is meant by the term Leukoplakia?

A
  • A white patch which cannot be scraped off or attributed to any other cause
  • No histopatholgical connotation
  • Does not mean malignant (around 1% in UK)
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7
Q

What is shown in these pictures? Describe the condition

A
  • Fordyce’s spots
  • Ectopic sebaceous glands
  • Mucosa forms from the skin therefore normal for sebaceous glands to be produced in mucosa
  • Seen mostly on buccal mucosa and also can be seen on lips
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8
Q

What does this picture show?

A
  • Frictional keratosis
  • Rubbing is causing the reactive thickening of the mucosa
  • Keratotic thickening occurs meaning less opacity to blood vessels in lamina dura , there fore white appearance
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9
Q

What does this picture show?

A
  • Smoker’s keratosis
  • Trauma from thermal gases
  • Reactive change of keratin
  • Thickening of keratin , less able to see BV so white appearance
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10
Q

What does this picture show?

A
  • The histology of Smoker’s/traumatic
  • Shows thick layer of keratin formed on the palate
  • Mucosa is normal
  • Melanocytes have overproduced melanin commonly seen with trauma so see an increase in melanin pigment
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11
Q

Does smokers keratosis increase chance of malignant risk?

A
  • Smokers more likely to have leukoplakia
  • Low malignant potential of the lesion
  • BUT higher oral cancer risk due to smoking
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12
Q

What does this picture show?

A
  • White sponge naevus
  • Hereditary keratosis
  • Often starts in childhood and if one person in fam has it , likely others will to
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13
Q

What does this image show?

A
  • White sponge naevus wtih areas of spongiosis
  • Spongiosis causing fluid filled areas within the epithelium
  • Making it less opaque so can’t see the BV as clearly and lesion appears white
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14
Q

Describe this white lesion

A
  • White lesion on the maxillary tuberosity
  • It has clear cut edge
  • Appears thickened
  • No erythema surrounding so inflammation has not occurred
  • If lesion is malignant then will show inflammation surrounding the edge
  • This lesion has no trauma related aspects therefore deemed Idiopathic keratosis
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15
Q

What is this picture showing?

A
  • Chemical (aspirin) burn
  • Acidic substance held in contact with mucosa
  • Caused coagulation of proteins and thickening of the mucosa
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16
Q

What is this picture showing?

A
  • Pseudomembranous acute candidosis (acute)
  • Can be scraped of as not adherent to mucosa due to pseudomembranous
  • Will leave inflammatory area underneath the lesion
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17
Q

What is this picture showing?

A
  • Denture associated erythemous candidosis (Chronic)
  • Denture covered tissues are erythematous due to poor denture hygiene
18
Q

What are these pictures showing?

A
  • Herpes simplex virus
  • Gives intraepithelial vesicles that disrupt the view of the connective tissue blood vessels
  • Once the vesicle bursts you lose the whiteness
19
Q

When do you refer a white lesion?

A
  • Most are benign
  • If red and white parts concentrate on red part
  • If lesion is becoming more raised and thickened
  • If lesion is whitou cause i.e. lateral tongue / anterior floor of mouth / soft palate area
20
Q

Why are red lesions red?

A
  • Blood flow increases due to inflammation or dysplasia
  • Or due to reduced thickness of epithelium which is making connective tissue redness more visible
21
Q

What does this picture show?

A
  • ## Desquamative gingivitis due to thinning of epithelium
22
Q

What is Eruthroplakia?

A
  • Area of redness which can’t be attributed to any other cause
  • Higher concern than leukoplakia and require biopsy
23
Q

What are blue lesions?

A
  • Due to fluid in the connective tissue
  • Can be dark which show slow moving blood like varicosities - are going to be veins or cavernous haemangioma
  • Can be light blue and contain clear fluid - most likely saliva (mucocele) or lymph (lymphangioma)
24
Q

What does this picture show?

A
  • Vascular haemangioma
  • Can be capillary or cavernous
25
Q

What is this picture?

A
  • Cavernous haemangioma
26
Q

What is the difference between these two pics?

A

First one shows capillarious haemangioma - red lesion

Second one shows cavernous haemangioma - slow moving blood , rapid deoxygenation giving blue appearance (can see the larger areas)

27
Q

What is a Lymphangioma?

A
  • Takes lymph fluid from the tissues back into circulation
28
Q

What are some exogenous causes mucosal pigementation?

A
  • Tea , Coffee , Chlorhexidine
  • Bacterial overgrowth
29
Q

What are some intrinsic causes of mucosal pigmentation?

A
  • Reactive melanosis/melanotic macule
  • Melanocytic naevus
  • Melanoma
  • Effect of systemic disease, paraneoplastic phenomenon
30
Q

What are some intrinsic foreign body cause of mucosal pigmentation?

A
  • Amalgam, arsenic
31
Q

What is a melanocytic naevus?

A
  • Melanocyte is becoming abnormal and produces too much melanin (proliferation increases)
  • Produces benign skin lesion
32
Q

What is a melanotic macule?

A
  • Normal amount of melanocytes with increased amount of melanin
  • Benign mucosal pigmentation
33
Q

What is a melanoma?

A
  • Cancer producing pigment
34
Q

What are the causes of brown or black lesions?

A
  • Racial/familial
  • Smoking
  • Drugs like contraceptive pill or tetracyclines as this stimulates production of melanin by melanocytes
  • Addisons disease caused by raised ACTH conditions so stim of melanocytes increases
35
Q

What does this image show?

A
  • Melanotic macule
36
Q

What do these pictures show?

A
  • Amalgam tattoo
  • Metal is a foreign body and is being phagocytosed by giant cells to be removed in mucosa
  • Dont take radiograph it is not justified, take biopsy
37
Q

What disease do these pictures show

A
  • Addisons / Cushing disease
  • ACTH hormone is increased
  • Increased ACTH increases melonocyte production of melanin
  • Lead to pigmented mucosa
38
Q

What are the characteristics of melanoma?

A
  • Variable pigmentation within single lesion
  • Irregular outline
  • Raised surface
  • Symptomatic - May itch or bleed
  • Refer
39
Q

Why are biopsys important?

A
  • Identify or exclude malignancy
  • Identify dysplasia
  • identify other disease like LP
40
Q

What is the general rule in regard to biopsy?

A
  • Any white, red or pigmented patch that can’t be explained must be biopsied
41
Q
A

BDS4 Oral Medicine (18 decks)

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