Oral Mucosal Disease

Question 1

What layers expect see normal buccal mucosa?

Answer 1

Non-keratinised stratified squamous epithelium
Lamina propria = superficial connective tissue
Sub-mucosa = adipose
Muscle = buccinator?

Question 2

What is epithelium like normal buccal mucosa?

Answer 2

See non-keratinised surface
See prickle layer
Basal cell layer on top basement membrane

Question 3

What expect to see in histological sample hard palate?

Answer 3

Keratinised stratified squamous epithelium
Reduced lamina propria/ submucosa
Minor salivary gland tissue

Question 4

What would make you worried about white patch?

Answer 4

If non-homeogenous - mixed red/white lesion

Question 5

How does hyperkeratosis differ from normal epithelium?

Answer 5

Keratinised tissue

Question 6

Why do hyperkeratosis lesions appear raised?

Answer 6

Hyperplasia of epithelium

Question 7

How manage frictional keratosis?

Answer 7

Reassure

Review - remove cause of trauma e.g sharp cusps

Question 8

What histological changes do you see in lichen planus?

Answer 8

Atrophy epithelium
Loss basal cells = ‘sawtooth’ rate pegs
Keratinisation
Inflammation - accumulation T lymphocytes

Question 9

How diff lichen planus and lichenoid reactions?

Answer 9

Look same histologically

Need diff clinically

Question 10

What are the blue cells seen in sample of lichen planus

Answer 10

Lymphocytes - T (but can’t differentiate H&E)

Question 11

How does histology lichen planus relate clinical features?

Answer 11

Rate repair exceeds damage = epithelial thickening
Keratin production = white Lacey apperance
Inflammation in area atrophy = erythema

Question 12

What is associated risk of lichen planus?

Answer 12

1-3% risk of malignant change

Question 13

Management of lichen planus?

Answer 13

Symptomatic relief
OHI 
Topical analgesia
Can consider: topical corticosteroids, immunosupressants
Systemic immunosuppressants if severe

Question 14

What is ulcer?

Answer 14

Full thickness loss of epithelium exposing underlying connective tissue
Granulation tissue and fibre-purulent slough

Question 15

Types of recurrent apthous stomatitis?

Answer 15

Minor, major and herpetiform

Question 16

What are predisposing factors of apthous ulcers?

Answer 16

Stress, nutritional deficiency, familial tendency, allergies e/g cinnamon

Question 17

Differential diagnosis when see erosive lesion on lower lip?

Answer 17

Bullous disorder - pemphigus/ pemphigoid

Erosive lichen planus

Question 18

What see histology of pemphigus?

Answer 18

Intra-epithelial split

Thank cells in split

Question 19

What causes change in epithelium in pemphigus?

Answer 19

Autoantibodies against binding proteins desmosomes which hold epithelium together

Question 20

What investigation can be carried out to confirm pemphigus?

Answer 20

Immunofluroesence of fresh biopsy

Question 21

What see immunoflurosence on pemphigus?

Answer 21

Fish net pattern

Question 22

When would see sub-epithelial separation?

Answer 22

Pemphigoid

Question 23

What happens if sub-epithelium separation is breached?

Answer 23

Ulcer as exposed underlying connective tissue and full thickness loss of epithelium

Question 24

What is pempigoid

Answer 24

Type II hypersensitivity - autooantibodies to hemidesmosomes

Question 25

What see on immunofluorsence of pemphigoid?

Answer 25

Linear pattern along basement membrane

Question 26

What other lesions may pt have if they have pemphigoid?

Answer 26

Ocular lesions
Desquamative gingivitis
Oseophagel/ upper GI lesions