Oral Mucosal Disease Flashcards
When may an oral mucosal lesion be referred for an opinion in OM?
Anything potentially cancerous/dysplastic
-> 2 week referral pathway
Any symptomatic lesion which has not responded to treatment
Any benign lesion a patient cannot be convinced is not cancer
Which type of epithelium is the oral mucosa?
Stratified squamous epithelium
Masticatory- keratinised
Gustatory cells
Lining- Non- Keratinised
In which region is Ortho-keratinised tissue present
?
Gingiva and hard palate
-> trauma expected in these areas
What is parakeratinised tissue?
Present when there are alterations to standard mucosal type
-> Lichen planus
What is the lamina propria?
Thin layer of connective tissue containing BV
What are the epithelial layers?
Stratum Basal- basement membrane containing epithelial progenitor cells
Stratum Spinsoum (Maturation)
Stratum granulosum (M)
Stratum corneum (Cornified)
What happens to cells as you move to epithelial surface from BM?
As you move toward surface organelles are lost from cells until just the cell wall remains, these become flattened and keratinised on the surface
What does mitosis closer to epithelial surface suggest?
Dysplasia
-> serial sections may be required to see changes in 3D
What reactive changes occur in the oral epithelium to protect it from trauma and immunological damage?
Keratosis in nonkeratinised site (parakeratosis)
Acanthosis- hyperplasia of stratum spinosum
Elongated rete ridges- hyperplasia of basal cells
What are the types of mucosal reactions?
Atrophy- loss of viable layers
Erosion- partial loss in thickness
Ulceration- epithelium lost completely and fibrin exudate sits on connective tissue
Blisters- collections of fluid in vesicles or bulla
Oedema- intra/intercellular
What can occur in mucosa as a result of age?
Slight thinning-would only be seen on biopsy, not in practice
-> investigate further if noticeable clinically
What can occur to the tongue as a result of iron/vit B deficiency?
Becomes smooth (atrophic)
-> more likely to get infection
When does geographic tongue appear as a result of?
Alteration to maturation and replacement of normal epithelial surface
-> Whole areas of epithelial surface are replaced at once (stop and starting of epithelial production) resulting in thinning of epithelial layer (red appearance- BV are closer to surface)
Why do some people with geographic tongue experience sensitivity?
Nerves are closer to the surface due to loss of tissue
-> can be worse with acidic and spicy foods
What are the features of Geographic tongue?
Can be on dorsum of tongue or lateral borders (can occur on buccal mucosa and palate)- semi-circular white areas surrounded by red
No treatment required- asymptomatic mostly
Can happen at any age- worse in children (difficult to manage sensitivity but is not worrisome)
Intermittent- symptomatic for a week, then settles for months (then process repeats)
If geographic tongue becomes symptomatic, what are the likely underlying causes?
Haematinic deficiency (B12, Folate, Ferritin)
Parafunctional trauma
Dysaesthesia
What causes black hairy tongue?
Can be due to bacteria
Mostly caused by elongated tongue papillae which have been stained with pigments from food etc
-> benign condition, mostly an appearance issue
How is black hairy tongue treated?
Use of tongue scraper or peach stone?
What are the features of Fissure Tongue?
intermittent
Often asymptomatic
Usually aesthetic issue- “grips hold of food better”
Fissures can become deep and trap food and debris- leading to local inflammation
Candida or lichen planus within fissures can cause pain
What can be done to prevent inflammation in fissured tongue?
Fissures can be cleaned using soft brush
What is glossitis?
Inflammation of the tongue:
Usually appears as smoothing and reddening (atrophy)
Can be caused by disease process or nutritional deficiency
Can occur along with angular cheilitis- esp in iron deficient anaemia
What investigations may be done for glossitis?
Hamatinic check
Fungal culturing
Biopsy- Lichen Planus
When should a swelling be referred to OM for removal?
Symptomatic (pain is a feature of salivary gland malignancy!)
Abnormal overlying and surrounding mucosa
Increasing in size
‘rubbery’ consistency
Trauma from teeth
Unsightly
What swellings should not be referred to OM for removal?
Tori
Small polyps
Mucoceles – unless they become fixed as they are difficult to see
-> This is due to risk of iatrogenic damage on removal
What is the cause of Papillary hyperplasia of the palate? How is it fixed?
By denture
-> Modify denture to fix issue
What causes a leaf fibroma (fibrous polyp)? How is it treated?
Squashing of polyp underneath denture as it grows
-> Should be removed and allowed to heal (or it will grow) and then construct a new denture
How do fibro-epithelial polyps appear?
Very similar to surrounding mucosa
-> not usually concerning in oral cavity
What is the issue with a burst mucocele?
It is impossible to find where lesion was
What are tori and their features?
Bony swellings (benign)
Seen in parafunctional habits- may report TMD
Covered by NK mucosa
What is the issue with tori and bisphosponates?
People on bisphosphonates are more likely to get vascular necrosis of the mucosa over tori due to blood supply being derived from bone and periosteum rather than directly from arterial supply
What are the features of a pyogenic granuloma?
does not have epithelial surface (or has patches)
granulation tissue- mixed inflammatory infiltrate on fibro-vascular tissue
Fibrinous yellow or red appearance
Occurs on any mucosal site
Not a granuloma or pyogenic
What are the other names for pyogenic granuloma?
Gingiva (most frequent site)- vascular epulis
Gingiva during pregnancy- Pregnancy epulis
