Oral Mucosal colour changes Flashcards

1
Q

what type of epithelium is the oral mucosa

A

stratified squamous epithelium

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2
Q

what are the layers of the oral epithelium

A
  1. stratum corneum
  2. stratum granulosum
  3. stratum spinosum (maturation from here and above)
  4. basal (cell division from here and bellow)
  5. lamina propria
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3
Q

what are the types of keratinised oral mucosa (4)

A
  1. non-keratinised
  2. keratinised
  3. orthokeratinised (normal to find in GINGIVA and palate where trauma expected) - no nuclei
  4. parakeratinised (alterations to usual mucosal type i.e. lichen planus) - flattened nuclei
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4
Q

what is the name for the presentation of hyperpasia of the stratum spinosum and what type of lesion can cause this?

A

Acanthosis.
Lichen planus.

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5
Q

what are 5 mucosal reacitons

A
  1. atrophy (opposite of acanthosis - reduction of viable layers) - more see through, via age
  2. erosion (partial thickness loss) - erythematous appareance via disease
  3. ulceration (loss of epithelial layer leaving lamina propria covered with fibrin layer) - yellow
  4. oedema (intracellular or intercellular (spongiosis)) - cells not as tightly packed
  5. blister (vesicle less than 5 mm and bulla more than 5mm)
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6
Q

what are 4 benign mucosal conditions of the tongue

A
  1. geographic tongue
  2. black/brown hairy tongue
  3. fissured tongue
  4. glossitis
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7
Q

what is geographic tongue

A
  • alteration in maturation and replacement of normal epithelial surface, replication stopped in some areas but still shed cells so epithelium gets thinner in these regions = erythematous and normal in others
  • symptoms - sensitive to acidic and spicy foods
  • managment - eat softer foods, intermittent - i.e. lasts a week then away for a month
  • rull out - haematinic deficiency (B12, folate, ferritin), parafunctional trauma, dysaesthesia (if get symptoms when not active)
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8
Q

what is brown / black hairy tongie

A
  1. causes
    - bacterial colonisation
    - soft or liquid diet
    - hyperplasia of papilae become stained
  2. managment
    - suck on peach or nectarine seed
    - tongue scraper
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9
Q

what is fissured tongue

A
  • dont know cause
  • no symptoms unless food stuck in fissure
  • managment - soft brush to dislodge food
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10
Q

what is glossitis

A
  • red and glossy tongue due to changes in mucosa
  • many causes thus need to refer for biopsy and haemotinics
  • some causes = lichen planus, deficiencies and epithelial changes
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11
Q

6 exapmles of swelligns in the oral mucosa

A
  1. papillary hyperplasia (cause - ill fitting denture, managment - none just better fitting denture)
  2. fibrous polyp (thin under denture polyp)
  3. fibro epithelial polyp
  4. mucocelle
  5. tori
  6. pyogenic granuloma
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12
Q

what is a fibro epithelial polyp

A
  • normal mucosa
  • cuased by trauma
  • only remove if risk of being truamatised
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13
Q

what is a mucocelle

A
  • appear clear or LIGHT blue
  • remove if not draining and fixed in large size
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14
Q

what is a tori

A
  • benign bony growth seen in parrafunctional grinders
  • issues - if on bisphosphonates then more likely to get necrosis here as thin non-keratinised mucosa over them has poor blood supply
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15
Q

what is a pyogenic granuloma

A
  • cause - trauma
  • what - swollen connective tissue with fibrous coverage, vascular also so can have erythematous and yellow appearance
  • also - called vascular epulis on gingiva or if pregnant then pregancy epulis
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16
Q

what epithelial changes cause the whiteing of tissues in the oral mucosa

A
  1. thickening of mucosa
  2. thcikening of spinosum conreum (keratin layer) - can coincide with thinning mucosa under this however
17
Q

causes of white patches in oral cavity (6)

A
  1. Friction
  2. smoking
  3. hereditary
  4. lichen planus
  5. candidal leukoplakia
  6. carcinoma
18
Q

what are 6 examples of white lesions in the oral mucosa (non infective)

A
  1. leukoplakia
  2. fordyce’s spots (ectopic sebaceous glands from skin - secrete oil for skin)
  3. frictional keratosis (linea alba)
  4. smokers keratosis (general whiteing of palate)
  5. hereditary keratosis (white sponge naevus) - fluid filled epithelium meaning cannot see udnerlying vessels as well
  6. others - chemical aspirin burn
19
Q

what is leukoplakia

A
  • white patch which cannot be scrapped off and there is no known cause
  • no histopathological connotation, only clincial
  • diagnosis of exclusion
20
Q

what are the infective causes of white lesions in the oral cavity

A
  1. candidiasis (candida albicans)
  • psudomembranous (acute, thrush)
  • hyperplastic candidiasis (white, angular chelitis)
  • NOT erythematous candidiasis (red)
  1. herpes simplex virus
21
Q

epithelial change that causes erythematous appearance

A
  1. blood flow increase (inflammation or dysplasia)
  2. reduced thcikness of epithelium (atrophy, erosion etc.)
22
Q

what is erythroplakia

A
  • again diagnosed by exclusion and is a clinical term only for when no known cause
  • more chance of malignancy than leukoplakia
23
Q

examples of red/dark blue lesions

A
  1. vascualr hamartomas
    - haemangioma
    - cavernous haemangiona
    - dif - slow moving deoxygenated blood in cavernous = dark blue colour
    - lymphangioma (dark/light blue, around tongue, msot cavernous, histology needed to tell apart from above)
  2. large, medium and small vessel disease (connective tissue vasculitis rare diseases)
  3. desquamative gingivitis (lichen planus, pemphigoid/gus causes)
  4. OFG
24
Q

causes of exogenous staining

A

tea, coffee, chlorhexidine, bacterial overgrowth

25
Q

causes of intrinsic colour changes in pigmented lesions (black, brown etc)

A
  1. reactive melanosis (from smoking)
  2. melanotic macule (freckle, increased melanin production from melanocyte)
  3. melanotic naevus (melanocyte becomes abnormal or too many melanocytes so increased pigment)
  4. melanoma (cancer of a melanocyte causing pigmentation)
  5. effect of systemic disease (addisons)
  6. amalgam (giant cells phagocytose and try to remove so lesion can move and spread)
  • reactive = normal no. of melanocytes but increased production of melanin
  • anibis = more cells producing a normal amount (presents the same)
26
Q

causes of normal, healthy pigmented areas of the mouth

A
  1. melanotic macule
  2. racial pigmentation
27
Q

what is a systemic cause of brown / black lesions

A

Addison’s disease (raised ACTH levels)
- linked to hormones inducing melanin production in melanocytes so increased production

28
Q

when to worry about melanoma

A
  1. variable pigmentation
  2. irregular outline
  3. raised surface
  4. symptomatic (bleeding or itchy)
29
Q

what is a tell tail sign that increases the chance of a lesion being malignant

A
  • perilesional redness
30
Q

what causes severe redening of the gingiva but is not gingivitis?

A

desquamative gingivitis (caused by lichen planus, penphugoid/gus)