Oral Mucosal Disease Flashcards
In what circumstances do you refer a mucosal lesion to Oral Med for an opinion?
- Anything the dentist thinks might be cancer or dysplasia
- Any symptomatic lesion that has not responded to standard txt
- Any Benign lesion that pt can’t be persuaded is not cancer
If you think a mucosal lesion might be cancer or dysplasia what guidelines can you consult for what to do next?
- NICE and SIGN Head and Neck cancer guidance
What epithelium is this diagram and is it keratinised or non-keratinised?
- Buccal mucosa
- Non-keratinised
What epithelium is this and is it keratinised or non keratinised?
- Palate
- Thick Keratinised layer sitting on surface
Label this diagram and explain
- Lamina propria with blood vessles
- Basal layer with epithelial progenitor cells (essentially stem cells)
- As you go up through spinosum the cells are undergoing maturation , become less purple staining suggesting they are losing their cell organelles
- Eventually becomes stratum corneum where cells have lost all organelles except cell wall and becomes the flattened keratin of the surface
- Mitosis should only occur in basal membrane layer, any other mitosis occurring could be dysplastic
How is the oral mucosa histologically set up?
- Stratified squamous epithelium
- Lamina propria
- 3 gross types depending on function so can be lining, masticatory, gustatory
- Keratinised or non keratinised
- Keratinised can be orthokeratosis or parakeratosis
What are some reactive changes that can occur in the oral epithelium?
- Keratosis on nonkeratinsed site called parakeratosis
- Acanthosis (hyperplasia of stratum spinosum)
- Elongated rete ridges (hyperplasia of basal cells)
What is an atrophy mucosal reaction?
- Reduction in viable layers
What is erosion mucosal reaction?
- Partial thickness loss
What is ulceration mucosal reaction?
- Fibrin on surface
What is oedema mucosal reaction?
- Intracellular or intercellular (spongiosis)
What is blister mucosal reaction?
- Vesicle or bulla depending on size of lesion
What is commonly seen with age in regard to mucosa?
- Progressive mucosal atrophy
What does this picture show and what can cause this?
- Smooth tongue
- Mucosal atrophy on dorsal of tongue
- Nutritional deficiency of iron or B group vitamins
- Predisposed to infection
What does this image show?
- Geographic tongue
- Alteration to maturation and replacement of normal epithelial tissues at different rates
- Makes some areas appear redder due to closer proximity to lamina dura (blood vessels)
- Will resolve as epithelium is then replaced
- pt may complain to sensitivity from spicy or very flavoured foods
- Requires no txt and can be started at any age (feels worse in children)
- BENIGN with no symptoms
What does this image show? Describe the condition
- Brown/black hairy tongue
- Can be due to bacterial colonisation but most commonly due to elongation of surface papilla - then becoming stained with food or drink or chlorhexidine
- Benign
What is the management of black/brown hairy tongue?
- Can be done with tongue scraper
- Can also be done with nectarine or peach stone (suck the stone for an hour a day) improve appearance
What does this image show? Describe the condition
- Fissured tongue
- Unsure as to why it is fissured
- Fissures aren’t usually painful but if deep food can become trapped and cause local inflammation - use a soft brush to clean daily
- If fissures are painful consider another disease like LP or Candida which is causing the symptoms
What does this picture show? Describe the condition
- Glossitis
- Inflammation of the tongue
- Investigate with haematinics and small biopsy to diagnose whether due to deficiencies or other disease like LP
When should a swelling be refered to OM?
- Symptomatic (pain is a feature of salivary gland malignancy)
- Abnormal overlying and surrounding mucosa
- Increasing in size
- Rubbery consistency
- Trauma from teeth
- Unsightly
What are some things you usually would not refer in regard to swellings?
- Tori (small bony swelling usually in lingual; aspect of mandible or palate )
- Small polyps
- Mucoceles
Describe this picture
- Multiple Small swellings in vault of palate
- Same coloured tissue as surrounding
- Multiple fibrous enlargement caused by ill fitting denture wearing
- Papillary hyperplasia of palate and usually get better fitting denture
Describe this picture
- Leaf fibroma
- Polyp instead of becoming round lesion has been squashed by denture wear
- Now have thin and elongated lesion
- Remove and give time to not wearing a denture to allow site to heal
Describe this picture
- Simple fibre epithelial polyp
- Mucosal covering is same as surrounding mucosa
- No signs of inflammation
- Could be left alone but due to size of this it may cause difficulty in closing teeth together causing more trauma
- remove
Describe this picture
- Parafunctional habit of child sticking tongue between teeth has caused polyp to grow on apex of tongue
- Use appliance to stop tongue or close the gap with ortho with stop the polyp
Describe this picture
- Small mucocele in palate
Describe this picture
- Large fixed mucocele that has filled with saliva
- Possible to remove the extravasated mucous and associated gland
Describe what you see in these pictures
- Tori which are bony swellings
- Benign
- Common with pts with parafunctional clenching habits - present with TMD pain
For pts taking bisphonates what do you need to consider in regard to Tori?
- Tori considered risk factor for necrosis due to limited blood supply from periosteum in pts taking bisphophonates
- Removal of Tori is not recommended though
What does this picture show?
- Pyogenic granuloma
- Inflamed granulation tissues with no epithelial covering
- Has fibrinous yellow appearance or red lesion
- Can occur on any mucosal site and is a response to trauma
Not a granuloma and not pyogenic
