Oral Mucosal colour changes Flashcards
what type of epithelium is the oral mucosa
stratified squamous epithelium
what are the layers of the oral epithelium
- stratum corneum
- stratum granulosum
- stratum spinosum (maturation from here and above)
- basal (cell division from here and bellow)
- lamina propria
what are the types of keratinised oral mucosa (4)
- non-keratinised
- keratinised
- orthokeratinised (normal to find in GINGIVA and palate where trauma expected) - no nuclei
- parakeratinised (alterations to usual mucosal type i.e. lichen planus) - flattened nuclei
what is the name for the presentation of hyperpasia of the stratum spinosum and what type of lesion can cause this?
Acanthosis.
Lichen planus.
what are 5 mucosal reacitons
- atrophy (opposite of acanthosis - reduction of viable layers) - more see through, via age
- erosion (partial thickness loss) - erythematous appareance via disease
- ulceration (loss of epithelial layer leaving lamina propria covered with fibrin layer) - yellow
- oedema (intracellular or intercellular (spongiosis)) - cells not as tightly packed
- blister (vesicle less than 5 mm and bulla more than 5mm)
what are 4 benign mucosal conditions of the tongue
- geographic tongue
- black/brown hairy tongue
- fissured tongue
- glossitis
what is geographic tongue
- 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)
what is brown / black hairy tongie
- causes
- bacterial colonisation
- soft or liquid diet
- hyperplasia of papilae become stained - managment
- suck on peach or nectarine seed
- tongue scraper
what is fissured tongue
- dont know cause
- no symptoms unless food stuck in fissure
- managment - soft brush to dislodge food
what is glossitis
- 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
6 exapmles of swelligns in the oral mucosa
- papillary hyperplasia (cause - ill fitting denture, managment - none just better fitting denture)
- fibrous polyp (thin under denture polyp)
- fibro epithelial polyp
- mucocelle
- tori
- pyogenic granuloma
what is a fibro epithelial polyp
- normal mucosa
- cuased by trauma
- only remove if risk of being truamatised
what is a mucocelle
- appear clear or LIGHT blue
- remove if not draining and fixed in large size
what is a tori
- 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
what is a pyogenic granuloma
- 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
what epithelial changes cause the whiteing of tissues in the oral mucosa
- thickening of mucosa
- thcikening of spinosum conreum (keratin layer) - can coincide with thinning mucosa under this however
causes of white patches in oral cavity (6)
- Friction
- smoking
- hereditary
- lichen planus
- candidal leukoplakia
- carcinoma
what are 6 examples of white lesions in the oral mucosa (non infective)
- leukoplakia
- fordyce’s spots (ectopic sebaceous glands from skin - secrete oil for skin)
- frictional keratosis (linea alba)
- smokers keratosis (general whiteing of palate)
- hereditary keratosis (white sponge naevus) - fluid filled epithelium meaning cannot see udnerlying vessels as well
- others - chemical aspirin burn
what is leukoplakia
- white patch which cannot be scrapped off and there is no known cause
- no histopathological connotation, only clincial
- diagnosis of exclusion
what are the infective causes of white lesions in the oral cavity
- candidiasis (candida albicans)
- psudomembranous (acute, thrush)
- hyperplastic candidiasis (white, angular chelitis)
- NOT erythematous candidiasis (red)
- herpes simplex virus
epithelial change that causes erythematous appearance
- blood flow increase (inflammation or dysplasia)
- reduced thcikness of epithelium (atrophy, erosion etc.)
what is erythroplakia
- again diagnosed by exclusion and is a clinical term only for when no known cause
- more chance of malignancy than leukoplakia
examples of red/dark blue lesions
- 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) - large, medium and small vessel disease (connective tissue vasculitis rare diseases)
- desquamative gingivitis (lichen planus, pemphigoid/gus causes)
- OFG
causes of exogenous staining
tea, coffee, chlorhexidine, bacterial overgrowth
causes of intrinsic colour changes in pigmented lesions (black, brown etc)
- reactive melanosis (from smoking)
- melanotic macule (freckle, increased melanin production from melanocyte)
- melanotic naevus (melanocyte becomes abnormal or too many melanocytes so increased pigment)
- melanoma (cancer of a melanocyte causing pigmentation)
- effect of systemic disease (addisons)
- 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)
causes of normal, healthy pigmented areas of the mouth
- melanotic macule
- racial pigmentation
what is a systemic cause of brown / black lesions
Addison’s disease (raised ACTH levels)
- linked to hormones inducing melanin production in melanocytes so increased production
when to worry about melanoma
- variable pigmentation
- irregular outline
- raised surface
- symptomatic (bleeding or itchy)
what is a tell tail sign that increases the chance of a lesion being malignant
- perilesional redness
what causes severe redening of the gingiva but is not gingivitis?
desquamative gingivitis (caused by lichen planus, penphugoid/gus)
